@OntariosDoctors – Page 2 – justanoldcountrydoctor

Expanded Scope of Practice Will Ultimately Hurt Patients

On October 1, the CBC published an article on how a program to expand the scope of practice of pharmacists in New Brunswick completely fell apart and was cancelled. There’s a litany of reasons why the project died. But the ones that stood out for me were (italicized quotes are lifted from the CBC article):

the project promoted a “a convenient new option” as opposed to to focusing on quality health care first
the project’s hypothesis – “..every patient getting care at a pharmacy would take pressure off the public system — remained unproven..”
there is a lot of focus on the fact that pharmacists need to be able to order bloodwork
There is significant mention of the role of Perry Martin, a paid lobbyist for Shoppers Drug Mart pushing for this change. There’s also this line – “the pilot pharmacists were being deluged with patients prescribed point-of-care tests by Maple, the private company operating the eVisit virtual care service.” Curiously, even though Maple referred patients to Shoppers Drug Mart pharmacies, there’s no mention of the fact that Shoppers Drug Mart invested $75 million into Maple. One would think that if company “A” invests in company “B”, and then company “B” sends business to company “A”, and company “A”makes money from the government for that business (though public health insurance), that should get a mention.
The provinces physicians feared duplication of tests and fragmenting of care
There was significant push back to the statement that letting pharmacists treating minor illnesses led to a 9.2% drop in Emergency room visits in Nova Scotia – “Health officials checked, however, and concluded the drop was because of a combination of several initiatives.“
Unsurprisingly, the government noted “an Ontario report that surveyed pharmacists who complained of corporate pressure to hit quotas and revenue targets“
Most importantly to my eyes: “Nicole Poirier, the director of primary care, pointed out the report contained “no conclusive findings” that it reduced pressure on the public system, and did not show better health outcomes for patients.“

I bring this up because in Ontario, we continue to fail to heed these warning signs. On Sep 17, the Ontario government announced plans to consider expanding the scope of practice of many allied health care professionals (AHCP).

It’s not just this report from New Brunswick that should raise concerns. There has been a growing body of evidence over the years about how the idea of offloading “minor” illnesses to non-physicians doesn’t achieve the benefits intended.

For example a three year study of expanding Nurse Practitioner (NP) autonomy in US Veteran’s Health Administration hospitals found that:

There was a 7% increase in immediate costs to patient care, and an overall 15% in costs for caring for patients when one included downstream costs. This was attributed to NPs taking longer to evaluate patients and ordering more tests.
Sub optimal triage of patients was also noted leading to things like under‐admission when needed (leading to worse outcomes and later, costlier interventions) or over‐referral/overuse
Patients under NP care had worse decision‐making about hospital admissions and increased return ED visits (which cost more)

It’s not just studies that are opposed to scope expansion that have expressed concerns. In Australia, a generally favourable report to having AHCPs work to their full scope of practice, still mentioned the significant need for training, regulation, and funding to support safe expansion. The training part is important because contrary to what’s being put out, many AHCPs are not trained to recognize a potentially serious issue from a minor one. (You don’t know what you don’t know). The same report also mentioned significant concerns about more fragmented care, waste and higher long term health system costs.

Another generally supportive of scope expansion of NPs study purports to show that NP delivered primary care for patients with multiple chronic conditions show similar outcomes to care delivered by family doctors. BUT, a deep dive into the study showed that the models studied often included physician-NP teams, or limited scope expansions. They did not always include fully independent NPs. Training, team collaboration, and oversight often remained intact.

With respect to AHCPs expanding their scope of practice in general, a number of concerns need to reviewed.

First is antibiotic stewardship. This is a big problem as overprescription of antibiotics is increasingly resulting in more and more virulent and drug resistant strains of bacteria. As I’ve pointed out before – CANADIAN provinces which allow pharmacists to provide antibiotic prescriptions- have a higher per capita rate of antibiotic prescriptions than others. That’s just reality.

Secondly the reality is that AHCPs will over order diagnostic testing, particularly if they “are not sure” about the diagnosis. We saw that with the Veterans Hospital study above. We will see that if, as suggested, AHCPs will be able to order more and more tests.

Thirdly, there is going to be an increase fragmentation of care. Whether one looks at Japan, Norway, Great Britain, or really any other country, it’s been repeatedly shown than having a consistent family doctor will result in better health care outcomes and reduced costs to the health care systems. Central to this is the family physicians ability to provide a medical home where all of the patients information can be consolidated at one spot, and their ability to help patients understand and navigate health care.

In Ontario our system is so disjointed and disorganized that it is not possible for all of the testing/prescribing done by allied health care providers to get to the family physicians easily. This very quickly will lead to fragmentation of care and will eventually come back to hurt patients. To their credit, both OMA Past President Dr. Domink Nowak and current President, Dr. Zainab Abdurrahman have repeatedly pointed this out.

Finally one thing that has not been discussed is the liability concerns. I don’t see any of the people talking about expanding scope of practice acknowledging that there will be increases in the cost of liability insurance. We’ve already seen in the US that NPs have had increased lawsuits against them. I’m positive that this will happen to other allied health care professionals if these changes go through.

It’s fair to note that much literature also finds benefits (e.g. improved access, equivalent outcomes in many primary care settings, especially for chronic disease management), and some cost savings under certain models. The risk is that decision-makers may generalize from settings where allied expansion worked well under supportive conditions to settings where such supports are weaker. Which appears to be where we are heading in Ontario.

All of which means we should expect a newspaper report in about 2029 showing that expansion of scope of AHCPs has not shown the expected results. Say, isn’t that about the time of the next Provincial Election?

Never Ending Arbitration Seems to Be Our Fate

On September 18, 2026, Arbitrator William Kaplan handed down an award for Ontario physicians in their ongoing and seemingly never ending negotiations process. I imagine rather a lot will be written about this. There are already lots of comments on social media, and many rushes to analysis, sacrificing accuracy for expediency. This is sadly true for any hot button news topic these days. I’m going to take my time to review the ruling in detail and probably have some more thoughts on it later. I would prefer to be accurate, not quick.

Photo of Arbitrator William Kaplan, owner of Kaplan Arbitration — Arbitrator William Kaplan

One thing I will say is that physicians are going to be locked into a perpetual negotiations/arbitration process for the next few years. In a previous blog I had commented that all outstanding arbitration issues would be resolved with this ruling. I based that on comments made by the OMA, and by the arbitrator himself. Being a victim of Murphy’s Law on many occasions, I did go on to say that:

“Of course now that I write this there probably will be yet another process announced after this which will mean more negotiation and arbitration”

Unfortunately, it appears that last part is indeed the case. All this ruling really does is set a (too low) dollar value ruling for how much of an increase (general and targeted) physicians are entitled to for the fiscal years April 1, 2025-March 31, 2028. It doesn’t deal with rather a whole lot of implementation issues.

For example, what exactly is going to be the dollar value of each fee code as of April 1, 2026?. The Ontario Medical Association (OMA) has long stated that current fee codes/billing are temporary and the new permanent values for codes will be implemented this coming April 1. The award defers that to the ongoing Physician Payment Committee (PPC) process that is supposed to have fee codes ready by then.

Additionally, the Award mentions the targeted funds for things like Hospital On Call (HOCC)/Unbundling Surgical Codes/Alternate Payment Plans and more – > but not the specifics of how those funds are going to be distributed or billed. Even the OMA’s own “agreed issues document” doesn’t really offer an agreement. For HOCC for example, it states:

“The parties shall conclude negotiations on the revised burden-based HOCC system bilaterally….If agreement cannot be reached by January 1, 2026, either party may refer the matter to mediation/arbitration ….”

Ok – what about things like the constant delay in physicians getting paid for work they do, supposedly due to the inefficient and ancient OHIP computers. The Award doesn’t set out a specifically penalty. It simply directs the OMA/MOH to make it a priority to fix this issue and if they can’t :

“This Board will remain seized in the event that the parties cannot reach agreement, with either, party having the right to return to this Board after January 1, 2026”

Yup, more negotiations and arbitration if the OMA asks for penalties for delayed payments. I hope there’s a good legal reason the OMA didn’t ask for specific penalties in their Arbitration briefs, otherwise it was dumb of them not to. The MOH asked for penalties in the new FHO+ model for family doctors, and that was awarded.

There’s also the fact that this award has funds that should have been already paid to us on April 1 of this year. The award does provide some guidance in terms of saying the increases should be paid retroactively on a lump sum basis, but once again – if the parties can’t agree to the relativity splits for that money – it goes back to……..more Arbitration.

Essentially the award says physicians as a whole are to get 7.3 percent in general increases and 2.2% in targeted increases. The MOH and OMA are to figure out how to split that (mostly through the PPC) – and then go back to the Arbitrator if they can’t agree.

Now the PPC itself is, you guessed it, a bilateral committee of the OMA and the Ontario Government. In fairness to them, they have been working quite hard all this time from what I can tell. They may be further along than we think. But I’m guessing that the government members will have a different overall agenda than the OMA. All it takes is for the government to put their foot down on one issue and the whole thing goes back to Arbitration.

The lawyers are gonna get really really rich……

I will once again state that this Arbitration process is still preferable to having unilateral actions imposed upon physicians by governments. Those of us who lived through the Eric Hoskins/Bob Bell years realize just how much worse things would be with the government acting unilaterally.

BUT – never also forget that this protracted process is also because the current government doesn’t really have the capacity to understand the complexity of the health care system (and the complexity of how physicians get paid). Rather than have a bold vision for transforming health care, and making it clear how they will invest funds to promote that vision, they have opted to simply drag out the contractual process. If the MOH had come to the table in a constructive spirit, all the implementation could be rapidly done. The MOH’s absolute insistence on doing everything in the most drawn out way, regardless of the worsening health care crisis, is where they are really failing the people of Ontario.

Politically, of course, it makes some sense. Instead of negotiating a fair contract right from the start and then getting up and defending that from the usual critics, the government instead has chosen to simply let the Arbitrator make all their decisions . Then the government case say “we did what the Arbitrator told us” and shrug their shoulders if things go bad.

I’m acutely aware that to a certain extent the process benefits the OMA as an organization as well. Look at the new FHO+ model for paying family physicians. Because a couple of elements of the program couldn’t be negotiated – that issue went to Arbitration. Because it’s gone there, family doctors don’t get a chance to actually vote on the model like they would if there was a negotiated tentative agreement. So the OMA can kind of impose a model of payment they feel is acceptable on family physicians, rather than promote it in a free and fair vote.

The unfortunate thing is that I actually do think the FHO+ is a small step forward (not as big as the OMA is making it out to be) and likely would have passed if given to members to vote on. I would have voted for it myself despite my criticism of some aspects of it.

So what does this all mean for physicians? It means that for the next three years (at least) we should all get used to living in an era of constant ongoing negotiations and constant Arbitration, with continual delays in payments because of an intransigent government.

Sigh…

How the Arbitration Process Works and How it Applies to Family Medicine

Dr. Mark Dermer (pictured inset) , a recently retired family physician guest blogs for me today. He posted his thoughts about the arbitration process and how it can potentially affect family medicine on a private facebook group. I thought his post was excellent and I’m honoured that he has agreed to allow me to republish his thoughts here, so more people can see it.

A common misconception about how the arbitration decision will be determined is that the arbitrator will choose either the entire OMA submission or the entire MOH submission as the PSA award for 2025-28. While some arbitrations work like that – salary arbitration does – that’s not the case in the OMA-MOH 2017 Binding Arbitration Framework (BAF). As stated in paragraph 18 of that document (in this group’s files section):

“Absent an agreement of the parties, the method of binding interest arbitration to be used shall not be final offer selection. In particular, unless the parties agree otherwise, the arbitration board may, on any issue or issues, select either party’s proposal, choose a middle ground, or issue any award that it determines is appropriate in the circumstances.”

In other words, the arbitration board will issue a decision that is built point-by-point, with quantitative decisions set anywhere on the continuum between the two parties submitted positions. And the choice for each point/issue will be made in the context of the entire Physician Services Agreement (PSA).

For family physicians, there are four points of dispute that await the final PSA arbitration decision:

1) Annual increases to the Physician Services Budget (PSB) in years 2, 3 and 4 (2025-26, 2026-27 and 2027-28) of the present 2024-28 PSA. Note that these overall increases will then be subject to relativity adjustments that are managed within the OMA.

– OMA submission: 3.75% in each of the three years for a total of 11.25%

– MOH submission: 2.25% year 2, 2% in years 3 and 4 for a total of 6.25%

The arbitration board will award a percentage amount for each of the three years that lies on the range between the two parties submitted figures guided by the information supporting their numbers (the OMA’s justifications for its figures in its submission look to my eyes to be considerably stronger).

2) Continuity of Care Accountability Measure with Financial Consequences – the methodology of the measure has been agreed by the parties. But the question of whether there will be financial consequences and if so, the trigger threshold and financial magnitude, have not.

– OMA submission: no financial consequence but if so, trigger threshold should occur only if continuity falls below 70% and penalty should be a 10% reduction in base rate

– MOH submission: Trigger threshold is falling below 80% continuity and penalty should be 20% reduction in base rate

The arbitration board must first decide whether there should be a financial consequence and if so, when it should be implemented. For example, it could say that physicians need several quarterly reports to allow them to adapt their practices before the financial penalties start. With respect to the threshold, the arbitration board will likely choose a figure in the 70-80% range, though it is free to choose outside that range and here to, it could make a setting that changes over the three remaining years of the agreement. Same goes with the size of the base rate penalty, which we can assume will be in the 10-20% range if a penalty forms part of the new PSA.

** Note – Continuity of Care and any penalty is assessed at the level of each individual physician’s practice, NOT at the level of the FHO.

3) Increase to FHG premium

– OMA submission: Increase from the current 10% to 20%

– MOH submission: No change

The arbitration board may choose to keep the FHG premium the same, or increase it by any amount it wishes. Including raising it by more than 20%.

4) $5 per patient visit overhead fee for community practices (up to 40 visits per day; excludes hospital, contract and FHO/FHO+ services)

– OMA submission: Newly proposed by OMA

– MOH: No response

The arbitration board will have to decide whether to introduce this fee at all and then at what dollar rate to set the fee. Note that this fee applies to community specialist practices as well as to non-FHO family medicine practices.

The bottom line:

There is a wide range of possible financial outcomes of the arbitration board award. That’s why trying to forecast how it will affect you, or plan adaptations, will likely not be a very good use of your time at the moment.

I also think that the past week has demonstrated, yet again, the OMA’s poor member communication skills: it was irresponsible of them to publish scenarios and calculators that neither acknowledge nor take into account the possible continuity of care financial penalties. My recommendation is to generally ignore their messages until the arbitration board issues its decision.

The FHO+ Model Alone Won’t Save Family Medicine in Ontario

Disclaimer: I’ve looked through the OMA page on the FHO+ model and interpreted the data as best I can, BUT, this information should NOT be used by others for their own financial planning – they should review the data for themselves. Additionally, because this is a complex model – if the OMA’s Negotiations Task Force feels there are mistakes – I would be happy to correct those.

Last week, the OMA announced that they and the Ontario government had developed an enhanced model for paying family physicians. In Ontario, the most popular model for paying family physicians is something called the Family Health Organization (FHO). More physicians would choose it, but in typical unthinking and regressive fashion, the bureaucrats at the MOH convinced the government to limit entry into that model in the 2010s – because you know, why would you want people going into family medicine to have their preferred payment model? What were they going to do? Stop working as family doctors? Sigh…..

The OMA website states the new FHO+ is the “Future of Family Medicine” and talks glowingly about how this will “bring back the joy of family medicine, and build a foundation to support recruitment and retention”.

It’s always tough to break things down with a new model, and there are a lot of variables and enhancements to review. I encourage all family physicians to watch my friend Dr. Adam Stewart’s set of truly excellent videos on this new model.

For my part, I consider myself to have a medium sized practice. I therefore looked at Dr. “B” on the OMA’s web page to come up with my thoughts. (Note to OMA – come up with some better names for the doctors!)

How much of an increase in income am I going to get?

According to the OMA site, I should expect an increase of 13% of my gross income. But it’s not clarified what the baseline for that increase is? Is it this year’s income? Last year’s? So I emailed the OMA and was given this answer:

“The base rate the parties agreed to use in our costing was FY2023/24, keeping in mind the last permanent increases were on April 1, 2023, the recent years 2.8%, 9.95% and the monthly relativity for FY2024/25 are all temporary and will end on April 1, 2026.”

Alright, some more math (my apologies). Let’s use fiscal year 22/23 to start. Let’s assume I grossed $X in that year. For FY 23/24 – that was the last year of the previous PSA and we got a 2.8% increase in fees. So I grossed $1.028X that year. FY24/25 was year I of the current PSA and we were awarded 9.95% by the Arbitrator (compounded to the 2.8%). Because there was no agreement on how to divide it up, it was distributed equally among all docs. So I grossed $1.13X.

Still with me? This year, FY 25/26, by mutual agreement, there was a relativity based increase from the original FY 22/23. FHO docs like me got 11.7% so this year, for now, I will be grossing $1.117X. This is down from last year but may change based on whatever happens in Arbitration.

Based on the OMAs reply, if FY 23/24 is the base year they used in their calculations (when I made $1.028X) then and increase of 13% on that will translate to $1.161X. In essence, if FHO+ goes through, it will mean a 4.4% increase for me next year, compared to this year (1.161-1.117) and a mere 3% more than last fiscal year. Better than nothing? Sure. Is it the major dollar influx needed to save family medicine? I think you know the answer to that.

Graph showing a hypothetical growth in gross income for a category “B” family physician who billed $350,000 in FY 22/23

2. How will rural medicine fare?

One of the things that strikes me about this model is that effectively, rural medicine will not do as well. Now, in fairness, there are attachment bonuses for taking on new patients, and those bonuses are higher in rural areas. So there is that. But my understanding is that rural doctors are working overtime anyway and not really able to take more patients right now.

But what should be noted is that in the OMA calculations, the assumption has been made that doctors are getting at least some access bonus currently. So let’s look at Dr. Rustic and Dr. Metro, a rural and urban doc.

Let’s assume they also fall into category “B” as per the OMAs example. It is well known that urban doctors, despite how hard they work, have challenges getting the access bonus. Dr. Metro currently gets an access bonus of $0 because there are five walk in clinics with 15 minutes of her office. This is despite her group working after hours care. Dr. Rustic on the other hand, gets $25K in access bonus, mostly because his group is the only game in town.

With FHO+ the access bonus gone and repurposed to pay for other items (and that is a very good thing as my friend Dr. Mark Linder pointed out) in effect, Dr. Metro’s raise will be $25k MORE than Dr. Rustic’s. I don’t begrudge Dr. Metro the income, she deserves it. But in order to recruit in rural areas, we’re going to have to find a way to bump Dr. Rustic’s income more.

3. What exactly will the Accountability Metric be?

This is of course, the great unknown. These metrics are often presented as “reasonable” and then governments always find a way to make them unreasonable. We won’t know the answer to that until after Arbitration.

Final Thoughts

At the end of the day, I think family doctors as a whole need to realize that FFS family medicine has gone the way of the Dodo bird (I know this will upset some FFS purists). The government also seems to recognize this and as part of the agreement is increasing the number of FHO+ positions.

Despite some of the concerns above, I do think that FHOs should migrate to the new model. It is slightly more money, and I do wonder if by tweaking your practice more – the amount can go up. For example, I have about 200 patients whom I have not rostered because of outside use issues – I would now roster them – and this would increase my income even more. So I suspect there is potential to make more than a 4.4% increase if you manage your roster well. Looking at increased shadow billing rates also offers some potential for more growth.

However, saving family medicine requires a multi-pronged approach that requires a single, unified health information system, family practice teams with physicians clearly placed as the leaders of the teams (with funding for leadership roles) and much more than a 4.4% increase in income. So take the money for now, but don’t in anyway shape or form believe that this in and of itself will fix family medicine.

MOH Pleasantly Surprises (!) and OMA Disappoints in Arbitration Briefs

As I write this, yet another round of Arbitration has begun between the Ministry of Health (MOH) and the Ontario Medical Association (OMA). This time, the goal is to provide a contract for years 2-4 for the Physicians Services Agreement (PSA). As was pointed out to me on social media (thanks Jane and Lisa), year 2 of this current PSA cycle began on April 1, 2025. Yet again, physicians are going to be due retroactive pay for whatever the Arbitrator decides.

Lawyers from both sides have prepared rather thick legal documents called “briefs”. (Proof number 4,638 that lawyers have a rather weird sense of humour). These briefs are public.

I’d be lying if I said that I had thoroughly understood the briefs from both sides. The excruciating agony in trying to parse the language in these things would make having a kidney stone preferable. But these are my humble thoughts from trying to do so….

The MOH team appears to have learned their lesson from last time.

To be abundantly clear right off the bat, the MOH offer for physicians is too low. They are clearly undervaluing doctors in their stance and if the Arbitrator was to accept their position, it would spell further disaster for health care in Ontario.

But….

As I mentioned in my last blog, offering low is what you expect from the other side. It’s part of posturing for the Arbitrator and I’m genuinely not ruffled by it. What would have been unacceptable is they had refused to recognize the severity of the health care crisis like they did last time. Or if they had once again repeated the truly stupid statement that they weren’t concerned about the shortage of comprehensive care family doctors.

Additionally, the MOH has actually agreed to enhance family medicine models through the “FHO+” program, and has agreed to spend a large chunk of the funds on family physicians, an area of the health care system that is dire need. In essence, they admit that there is a problem with a shortage of comprehensive care family doctors. (NB – I will have my thoughts on the FHO+ model sometime early next week).

To re-iterate, there are still a number of problematic issues with their arbitration proposals, including the too low wage increase, the hopelessly complex method of “accountability” in the FHO+ model, a laughable statement that attachment bonuses for Complex patients will begin on July 1, 2025 when the Arbitrator won’t even rule on this until September or October of this year.

But their position is at least not stupid, and certainly not enough to make me go off like last time.

2. The OMA Disappoints With Their Brief

Once again, to be fair, there is a lot to like in the OMA Brief. There is a good analysis of the economic picture in Ontario, a great analysis of the the delays in care, the crisis in family medicine, hard hitting information about the challenges of recruiting and retaining physicians, superb advocating to relieve the admin burden and a clear explanation of why many Alternate Payment Plans are outdated.

Alas, there is once again a “but” here…..

All of the above is what one should expect from a representative organization. One should however, also expect that organization to advocate strongly to make sure their members get their increases in a reasonable time. And it’s here that the OMA falls (badly) flat.

One of (if not THE biggest) issues for physicians these past couple of years has been the constant delays in getting the increases the Arbitrator awarded them in a timely manner. Just recently the MOH unilaterally announced a delay in paying the retroactive funds owed physicians. This is amongst a series of delays all attributed to an ancient and decrepit computer system at the government. (They’ve been making this statement for well over a decade, and very tellingly, have NEVER bothered to upgrade their system).

While the last 4 pages of the OMA Arbitration Brief does a nice job of outlining the issue for the Arbitrator, including the consequences of the MOH incompetence (physicians will simply stop doing certain procedures), the remedy the OMA seeks is milquetoast at best. From the Arbitration brief (edited):

“As a result, the OMA requests, as is normal and customary, that this Board of Arbitration remain seized with respect to any issues arising from the implementation of this Award……….“

“….with the OMA reserving its right to seek appropriate remedies (e.g. interest) in the event that the Ministry fails to meet agreed upon or directed implementation dates, particularly where the Ministry is unable to provide justification for any delay, or otherwise where the delay is unreasonable and unwarranted.”

That’s it?? All this means is that WHEN (not if – we all know the MOH can’t get their act together) the next payment delays show up, all that will happen is the OMA will complain to the Arbitrator, then there will be more hearings, and those hearings will go on for months/years and then finally, the Arbitrator MAY announce penalties to the MOH. The only good that will come out of this is that a bunch of lawyers will get rich going to repeated hearings.

What’s worse is the OMA readily admits they know the Arbitrator “favours accountability measures” in their video on the new FHO+ model (around the 3:36 mark). So doctors have to be accountable to follow an agreement, but the MOH can wiggle out and delay? The OMA can’t advocate for accountability to go both ways?

EVEN worse is that in reading the MOH briefs, they actually clearly lay out what accountability measures they want from physicians. Page 92 specifically outlines what accountability they expect from family physicians in the new FHO+ model, and how the penalties will be implemented if physicians don’t meet those accountabilities. No “seizing of the Arbitration Board” or any such thing. Now I disagree wholeheartedly with the MOH stance on this – but at least they clearly outlined what remedies they are seeking without the need for further drawn out processes. The OMA couldn’t have done the same thing??

Overall, this Arbitration hearing appears less contentious than last time, and the gap in asks is smaller overall. Hopefully this means a quicker resolution. But while there is a lot of good stuff in the OMA brief, it’s hard not feel let down by the subservient, almost nonchalant attitude the OMA is taking on payment delays. Sure looks like a golden opportunity to address this was missed.

What to Look For in Next Weeks Arbitration Hearings

As I write this, it appears that once again, the Ontario Ministry of Health (MOH) and the Ontario Medical Association (OMA) have been unable to agree on a contract for physicians. We are again heading for Arbitration on June 30, with hearings all next week. A slim chance exists that a last minute deal will be struck – but I highly doubt it.

Up until now of course, the negotiations have been held under a strict cone of silence. There is no public knowledge of what has really been said between the two sides. But Arbitration in Ontario is public. The MoH and the OMA will have to publicly disclose what they are asking the Arbitrator to award.

Some Things to Remember:

These arbitration hearings are a continuation of last years hearings. Last year the Arbitrator only set an award for the total dollar amount to be given to physicians for the FIRST YEAR of a four year contract. This year’s hearings were originally slated for March of this year, but the Arbitrator delayed them until June. He wrote:

“The issues discussed have been far-ranging and include various implementation matters, the allocation of the Year 1 targeted funding, and complex and significant physician compensation issues for Years 2, 3 and 4.”

and:

“…the Board of Arbitration is now directing that the arbitration proceedings over any remaining Year 1 targeted allocation issues, and over physician compensation and all other issues for Years 2, 3 and 4, now take place over four days during the week of June 30. ”

These hearings will be a lot more complex than last years, and will have a lot of moving parts. Not only will the Arbitrator decide on how much of an increase will be allotted to physicians in years 2-4, but he will decide on how the targeted funds are distributed. Remember that 30% of the year one Award (approx $480 Million) was to be “targeted” for areas of health system need. Because of the malignant obstinacy of the MOH’s negotiations Team, the OMA and MOH have not arrived at an agreement on how to distribute these funds. So now the Arbitrator will rule on that.

Not only that, but there is the issue of how much of an increase each specialty should get. There was general agreement between the MOH and OMA the last couple of times that 25% of any increase would be given to across the board raises for all members, and the remaining 75% would go to relativity based increases. But the two sides have never really agreed on how the 75% would be split between various specialties. Reading the statement from the Arbitrator makes it sound like he will decide that too this time. (Of course now that I write this there probably will be yet another process announced after this which will mean more negotiation and arbitration).

Last year by my very rough count, the OMA and MOH submitted over 1,400 pages of documents (ironically called “briefs”) just to determine what percentage increase should be given to physicians. I can’t imagine how big the “briefs” will be this time. I won’t be able to go through them without gouging my eyes out but I do know what we should be looking for.

Has the Ministry of Health’s Team Smartened Up?

Look, both sides are going to “posture” for the Arbitrator. As part of that, the MOH will significantly undervalue physicians and offer a pittance. We should expect that and NOT get all worked up about it.

Unless…..

Last time, the MOH team went far beyond posturing. They showed nothing but contempt for physicians and an utter and complete lack of understanding of how health care works in Ontario. The MOH teams statement that there was “no concern” about a shortage of comprehensive care family physicians while the media was full of pictures of people lined up for hours for the mere hope of getting a family doctor, set a new bar for stupid government statements. The fact that they lied to the Arbitrator saying there was no crisis in family medicine until being forced to release documents proving otherwise made me wonder if a Court Jester was their spokesperson.

A Court Jester who, given the accuracy they present, could probably be a great MOH Spokesperson

It will also be telling when reviewing the MOH briefs exactly where they feel health care is most lacking in Ontario. Do they propose more investments in family medicine? How much for each specialty? In the last couple of negotiations the MOH has tried to alter the Family Health Organization (FHO) contracts on how family doctors are paid. What changes do they propose this time?

Finally – it will be VERY telling how the MOH wants to spend the $480 million in targeted funds. Will they try to skirt paying physicians for it? For example, will they propose to pay certain physicians to hire an allied health care practitioner, saying “well it will reduce your workload”, all the while demanding copies of proof you are paying that person in triplicate? Or some such thing.

I appreciate the above may sound far fetched, but the MOH Team has proved itself to be so incompetent and borderline vengeful that a scenario like that wouldn’t surprise me in the least.

What About the OMA Briefs?

In comparison, the OMA’s job is relatively easy. They simply have to advocate for increases that will make each of their many sections 100% satisfied and not complain……

OMA Negotiations Chair Dr. Nikolina Mizdrak

In all seriousness, OMA briefs will also tell the profession a lot. I imagine each of the sections of the OMA will pour through the documents and send information to their members. But in short order we should all see how much of an increase the OMA has concluded each specialty warrants, and how the OMA plans to handle the perpetually thorny issue of relativity.

Additionally, the OMA has repeatedly point out that we have a shortage of comprehensive care family doctors. They’ve used the word crisis more than once to describe this. So as a family doctor, I am eager to see what changes they propose to the FHO model as well.

Most importantly, will the OMA be aggressive in defending its members? These last couple of months had seen absolutely unacceptable unilateral decisions by OHIP, delaying payments to physicians and making mistakes on their remittance . The OHIP bureaucrats blame their old outdated computers. Of course, when they plan to recoup the 9.95% they overpaid for the preventive care bonuses this past month – the OHIP computers magically managed to figure out how to get the money back immediately.

Will the OMA finally demand in their Arbitration briefs some sort of penalty for OHIP screwing up? Remember, the fee changes as a result of this contract are to come into effect on April 1, 2026. Given the Arbitrator likely won’t hand down a ruling until the fall, there is no way OHIP will get their act together in time without……..encouragement. Penalties/Interest for delayed payments should absolutely be demanded by the OMA.

All in all, next week, physicians will learn just how both the OMA and MOH feel about them. Buckle up folks……

Survey on Delayed OHIP Payments

NB: The following is a guest blog, written by the (anonymous) author of the survey I referenced in, “Will the OMA Learn Lessons from OHIPs Latest Attack on Doctors?“. While it’s true these surveys tend to attract negative responses by their nature, the rather large number of respondents (especially compared to some of the OMAs own Thought Lounge surveys), suggests the OMA really needs to pay attention to the extreme dissatisfaction this issue has caused. My thoughts follow at the end.

The purpose of this survey was to highlight to the OMA the need to take this issue more seriously and to outline the impact the delayed payments had on members. The OMA’s response to this has been tepid. At the time the survey responses were collected, the payment timeline for November and December, 2024 retroactive pay was set as November, 2025. This was changed to August, but this does not alter the fact that the MOH has repeatedly delayed payments for physicians over the years.

Even with a signed, public agreement, the MOH has not managed to uphold its obligations, yet the OMA seems resigned, on behalf of its members, to accept whatever delays happen, based on whatever excuse the MOH provides. The members are not the cause of the MOH’s problems, yet they pay, over and over, for these deficiencies.

The survey results are summarized below. As a practicing physician, my time is at a premium, so I utilized AI to summarize the main findings of the survey.

Technology willing, the full survey results are here. Survey Monkey dashboard is here.

AI-Generated Summary of the Full Survey Document:

The survey responses reveal widespread dissatisfaction among Ontario physicians regarding delayed payments, systemic issues in healthcare administration, and inadequate advocacy by the Ontario Medical Association (OMA). Key themes include the impact of late payments, financial hardship and impact to personal finances.

Many respondents reported being unable to meet financial obligations, pay taxes, or fund discretionary purchases due to delayed payments. Some had to take on debt or cancel planned expenses like maternity leave benefits, vacations, or home down payments.

Clinic Operations:

Clinic owners faced cash flow disruptions, inability to pay staff, and delayed renovations. Others mentioned the administrative burden of tracking payments and rejected claims.

Mental and Emotional Toll:

Physicians expressed feelings of moral injury, frustration, and discouragement, with some considering early retirement or leaving the province entirely. The delay has eroded trust in the Ministry of Health and the OMA.

Lack of Accountability:

Respondents described the Ministry as untrustworthy, disrespectful, and adversarial, with unilateral decisions that breach agreements. Many called for interest payments on delayed funds and legal action to hold the Ministry accountable.

Systemic Issues:

Complaints included outdated payment systems, rejected claims, and lack of transparency in billing processes.

Weak Advocacy:

Many respondents felt the OMA failed to advocate strongly for physicians, with delayed and insuﬃcient responses to the payment issue. Some called for legal action, media campaigns, and stronger negotiation tactics.

Loss of Trust:

Physicians expressed frustration with the OMA’s perceived lack of power and transparency, with some questioning the value of membership dues.

Declining Appeal to Practicing in Ontario:

Many respondents are considering leaving Ontario or medicine altogether due to poor compensation, lack of respect, and systemic challenges. Some noted that other provinces offer better pay structures and support.

Family Medicine Crisis:

Respondents highlighted the lack of investment in family medicine and primary care, with concerns about burnout, scope creep, and inadequate funding.

Rejected Claims:

Physicians reported valid claims being rejected by OHIP , causing financial losses and administrative burdens.

Delayed Payments:

Delays in flow-through funding, parental leave benefits, and relativity-based fee adjustments were frequently mentioned.

Outside Use Penalties:

Respondents criticized penalties for outside use, especially when patients sought care elsewhere due to hospitalizations or urgent needs.

Recommendations for Advocacy:

Demand Accountability:

Push the Ministry to honour agreements, pay interest on delayed funds, and improve payment systems.

Increase Transparency:

Advocate for clearer communication about payment timelines, rejected claims, and billing processes.

Strengthen Negotiation:

Take a more aggressive stance in negotiations, including legal action and public campaigns to highlight the Ministry’s failures.

Support Physicians:

Address broader issues like rejected claims, outside use penalties, and inadequate funding for family medicine and specialists.

Conclusion:

There have been severe financial, emotional, and operational impacts of the delayed OHIP payment. There is an urgent need for the OMA to advocate more forcefully with the Ministry of Health to address late payments and systemic issues affecting Ontario physicians. Physicians are calling for immediate action, including interest payments, stronger advocacy, and accountability from the Ministry of Health and the OMA. The dissatisfaction expressed by respondents highlights the risk of losing physicians to other provinces or professions if these issues are not resolved.

An Old Country Doctors Thoughts:

While the above was written by my colleague, my personal thoughts on the survey is that I’m not really surprised by the results. I try to “keep my ear to the ground” so to speak, and there is a broad level of dissatisfaction with how the MOH repeatedly gets away with violating its own signed contracts, and the frankly abject level of incompetence at the MOH. The incompetence is unfortunately, not limited to just their payment systems/processes, but also how they run health care in general.

I’m also not surprised by the negative comments towards the OMA. Admittedly (as mentioned before) these surveys tend to cater to negative responses. However, there is a real sense of defeat on the ground about how physicians are being treated by the current government (protracted arbitration, stupid statements about the family physician shortage, and more). My sense is most physicians are resigned to defeat and are disengaging from health care – which is bad for the whole health system.

It does not help frankly, that a few short days after being told physicians would not get paid on time, OMA CEO Kim Moran was quoted in an Ontario Government News release on Primary Care saying:

“Ontario’s doctors are encouraged by this announcement and look forward to working with government to ensure that every Ontarian has access to a family doctor. We will do everything we can to accelerate this goal by collaborating with Deputy Premier and Minister of Health Sylvia Jones, and the lead of the Primary Care Action Team, Dr. Jane Philpott. It’s a long road ahead but this is a positive step forward to protecting Ontario’s valued health care system.”
Kimberly Moran
CEO, Ontario Medical Association (OMA)”

A very well respected physician from another province told me after seeing this: “It’s a bit pathetic. Screw us over and we’ll still be nice to you”. Personally I think Ms. Moran should look up “Stockholm Syndrome“.

I’ve repeatedly said you cannot have a high functioning health care system without happy, healthy and engaged physicians. These survey results suggest that that isn’t the case in Ontario.

Will the OMA Learn Lessons from OHIP’s Latest Attack on Doctors?

Last Friday (May 2), in what was a classic Friday afternoon bureaucratic dump, the OHIP bureaucrats at the Ministry of Health announced that they wouldn’t be paying the full amount of back pay owed Ontario’s doctors, as per the arbitration award. This was a unilateral decision on their part. It was contrary to what was in a signed agreement, and the OMA Board was notified at the last minute. (OMA CEO Kim Moran’s email is attached to the bottom of this blog). The bureaucrats promptly ran away an hid for the weekend hoping this issue would go away (kind of like how Sam Bennett cowardly hid from the press after putting an elbow to Leafs goalie Anthony Stolarz head).

This is, in my opinion, the latest attack on physicians as a whole from Ministry of Health (MOH) bureaucrats, who clearly are more interested in trench warfare than working co-operatively with Ontario’s doctors to improve health care for the citizens of Ontario. Don’t believe me? Consider the following:

The bureaucrats had the option of realizing that provinces like Manitoba/BC/Saskatchewan and even Alberta(!) recognized the need to work with their doctors and come up with a funding formula for them. Instead they chose to drag Ontario’s physicians through a protracted (going on three years now) and highly antagonistic arbitration/negotiations process.

Not only that, in response to now multiple stories of people lining up to find a family doctor in the press, their response was that there was “no concern” about the shortage of comprehensive family care physicians. (Seriously, how out of touch must they be to think that that type of Orwellian double speak is going to work in Canada).

People lined up hoping to get a family doctor in Walkerton. Photo originally posted in the farmers forum.

Frankly, this inept, combative and dismissive treatment of physicians is just par for the course for this bunch of bureaucrats. It saddens me, but it doesn’t surprise me.

No blame for this decision should fall to the OMA. They did negotiate a signed agreement (as per Ms. Moran’s email) and they clearly were not notified about the unilateral change until far too late. So the unilateral action is not their fault.

But….

What the OMA can, and should be held accountable for is how they proceed from here.

I don’t want to seem overly difficult here. If I truly was an obstinate person, I’d try to get a job at the Ministry of Health – perhaps on their Negotiations Team. The reality is that I actually have a long history of working co-operatively with government to improve health care in my neck of the woods.

I’m serious. In 2001 I helped bring in the first stage of Primary Care Reform called the Family Health Group. In 2004 I was one of the lead physicians who brought in a capitation model of payment for family physicians (it was initially a Family Health Network and it eventually evolved into a Family Health Organization). From 2007 -2013 I was the founding Chair of the Georgian Bay Family Health Team and From 2013-2015 I was the Health Links lead physician in my area.

And in each of these roles I worked closely and co-operatively with government to try to improve the health care needs of the patients in my area.

But – in those days, the bureaucrats wanted to work with doctors. They wanted to co-operate to improve health care and they were genuinely concerned about the lack of family physicians providing comprehensive care. They didn’t want to play power games with physicians or harass them or do dumb things like the current crop just did.

It’s important for the OMA to (finally) realize that there really is no hope that they can work with the current lot. They’ve already dragged us through three miserable years of negotiation/arbitration and fought us (thankfully often times stupidly – as even the Arbitrator pointed out) – for the sake of…….. I don’t know why really. Maybe it’s a power play? Maybe there are just bullies?

Recognizing the obstinance of the MOH bureaucrats is why I was proud (and still am) to have my name on an Op-Ed in the Toronto Star last year advising Family Medicine Residents to NOT start a practice in Ontario at this time. But I have to tell you the blowback from the OMA was saddening to me. I will not mention names – but one senior exec told me that the OMA was working well with the Government. Worse, one senior physician leader texted me the following:

Text from a very senior physician leader at the OMA

Remember – at the time this text was sent to me – we had already been locking horns at the negotiations table for two years and the government had done absolutely nothing to solve the family medicine crisis. Perhaps the physician leader felt the relationship was “best ever” because at least they weren’t sabotaging doctors left right and centre like the abhorrent Eric Hoskins did.

Despite all of that, there was some movement forward with arbitration. While no where near what other provinces got, it at least recognized the need to fund health care better, and provided hope for funding for offices, clinics, and frankly other badly needed resources.

Now the MOH has decided unilaterally to not pay, or pay whenever they feel like it, so we are back to – do NOT start to work in Ontario.

At any rate – as mentioned, while the OMA cannot be judged on decisions by the Ministry, what the organization does next will be telling. Will they finally recognize that the current lot of bureaucrats simply cannot be dealt with by reason? Will they recognize that physicians are essentially being bullied by these ruffians and the best way to deal with a bully is to stand up to them? Will they take legal action (according to Ms. Moran’s email – there was a signed agreement which the MoH is now in violation of)?

I don’t know the answer to any of the above. But I can only hope that the current Board recognizes that there is no hope of working in good faith with this lot of bureaucrats and that strong, frankly militant actions, are needed to support the members.

Addendum: After I published my original blog, an anonymous colleague asked that I publish a link to a survey about this issue. I’ve therefore appended my blog and ask all Ontario physicians to click on the link below and honestly reply to the questions:

https://www.surveymonkey.com/r/W2ZPMCC

Re-Post: Hoskins Won’t Survive The Mess He’s Made Of Ontario Health Care

NB. The following is a re-print of a blog I wrote for the Huffington Post, published originally on July 10, 2017. It’s being republished here mostly for my own record keeping.

Recently, one of my medical school classmates (now a cardiologist) was awarded the Society of Thoracic Surgeons top rating for patient care outcomes. A great honour for her, and well deserved. Unfortunately for the rest of us, she practices in South Dakota, one of the many physicians who left Ontario during the protracted battles with Ontario Governments in the 1990s.

Back then, as I mentioned in my first blog, many health ministers continued to insist that physicians in Ontario were the highest paid in all of North America. Yet we lost physicians in droves. The reality is that while physicians wanted to be paid a fair wage (who doesn’t?), what they really wanted was to have a say in how health care was delivered and be able to advocate for their patients.

So when the then Ontario government of Bob “Super Elite” Rae made unilateral decisions about health care, physicians left for jurisdictions where they were paid less (according to then Health Ministers Frances Lankin and Ruth Grier). But at least they had a say in how health care was delivered.

I mention this because it appears that current Ontario Health Minister “Unilateral Eric”Hoskins and his Deputy Health Minister Bob Bell have been unable to grasp this fundamental concept. Hoskins (and, to a lesser extent, Bell) have based their whole political strategy on portraying the dispute in the media as one of doctors wanting endless sums of money. If only the doctors would take less, the health-care system would improve. They appear unable to grasp the fact that doctors VALUE the ability to advocate for their patients and contribute to health care decision making.

From a purely political point of view, the strategy had some benefits for Hoskins and Bell. They were able to pass both the Patients First Act and the Protecting Patients Act. There was muted public response because they were able to portray physician opposition to these Acts as physicians protecting their incomes. The fact that the Patients First Act does nothing but increase bureaucracy and that the Protecting Patients Act actually violates Charter Rights of all health-care workers, and will likely be the focus of a Charter challenge, meant nothing to Hoskins and Bell. Good PR in the face of mounting, repeated, ongoing evidence of the collapsing health-care system was all they wanted.

Surely the Hoskins/Bell duo thought their troubles were behind them when the OMA ratified the BA framework. Not so.

It must therefore have come as a shock to Hoskins and Bell when, after giving Physicians Binding Arbitration (BA), physicians actually increased their attacks on the Liberal Government mismanagement of the health-care system. Now to be clear, giving BA is not the same as awarding a contract. The Ontario Medical Association still has to negotiate a contract for physicians.

But central to Hoskins and Bell’s way of thinking was that all physicians cared about is money. And the spectre of BA does force both parties to negotiate fairly.

Also in fairness, it’s pretty evident that Hoskins himself didn’t want to give physicians BA. Not only did he deride physicians for asking for it and fight it in cabinet, but when the Ontario government sent a press release indicating they want to return to negotiations with the OMA with the first order of business being to develop a BA framework, it came from the premier’s office, not Hoskins’ office.

Regardless, surely the Hoskins/Bell duo thought their troubles were behind them when the OMA ratified the BA framework. Not so.

Wait Time Series: Cataract surgery patients are finding themselves on longer #waitlists as funding fails to meet demand in Ontario. #ONpoli pic.twitter.com/Nh466RND1k

— Ont. Medical Assoc. (@OntariosDoctors) July 5, 2017

Since then, the OMA has become even more aggressive in its attacks on the Liberals. Have a look at their Twitter feed where they attack wait times for cataract surgery and joint replacement surgery.

Also, a grassroots group of doctors have now begun tweeting multiple barbs at the Liberals. Saying that doctors are required to put the pieces of health care together, they’ve used inventive and creative images to drive home the point that the Liberals don’t know what they are doing in health care.

Finally, OMA President Dr. Shawn Whatley openly wrote in his blog that physicians need to be champions, not doormats, and fight for health care for their patients. Surely poor Hoskins and Bell never expected this when they actually gave the OMA a path to a fair contract via BA. Goes to show you just how much they misjudged physicians’ desire to advocate for their patients and for a fair health-care system for all of us.

Hoskins and Bell are now, as the old joke goes, officially “post turtles.” This joke compares a (usually inept) politician to a turtle balancing on a fence post. You know he didn’t get there by himself, he doesn’t belong there, he doesn’t know what to do while he’s up there, and you just want to help the poor thing get off the post.

Ontario Premier Kathleen Wynne basically has little choice now. Hoskins and Bell are just too easy targets for the mess that they’ve made of health care and the way they’ve badly misread physicians passion for protecting their patients. The differences are irreconcilable.

Hoskins is the easier of the two to deal with. Wynne needs to shuffle her cabinet and move Hoskins on to minister of sanitation or something.

Bell, being an employee, has certain rights and can’t just be fired. However, the anonymous surveys done by Quantum Transformation Technologies indicating how unhappy his own bureaucrats are should be enough evidence for Wynne to order a formal administrative review of the senior management team at the ministry of health. Maybe they can be salvaged with administrative coaching.

But what’s clear is that as the health system fails, Wynne needs front line physicians to help put its pieces back together. Wynne needs to regain their trust. The way to do that is to bring tangible change to the leadership of the ministry of health.

OMA Board Betrays Members By Latest Action and This Changes My Vote

OMA Elections period has opened. A chance for members to have a say in how the organization is run and what strategic direction it should take .

After my last couple of missives on OMA Elections, I was going to leave this alone and see what transpired. However, when I went to vote, I noticed a curious thing. None of the non-physician Board candidates were up for re-election. This sent up a red flag. There are three non-physician Board Directors – and every year, as members we have to vote for either one or two of them (the terms are staggered).

If one looks at the OMA website, this little nugget is hidden away in the depths of the Elections FAQ page, a page that I suspect extremely few members would access, much less be aware of:

“…In the case where the director holds a non-physician position and is interested in serving an additional term, the director would be presented to the membership as a re-appointed director…”

There are some conditions the sitting non-Physician Board Directors have to meet, but the blunt reality is that the OMA has taken away the right and ability of Members to vote for these 3 positions if those Directors want another term. This represents 27% of the Board (11 positions total) – which is frankly a large block of votes and can sway a close vote at the Board.

Worse is the vagueness of what is written for IF there was a vacancy. There are a number of requirements for running for the Board for these candidates – all of which are appropriate – however the very last sentence simply states:

“Shortlisted candidates will go through detailed vetting by Promeus Inc., including reference checks, police record checks and social media checks.”

Nowhere does it clearly state that in the event of a vacancy – there would be an election for the non-physician Board Directors. Perhaps this is still the case – however not mentioning it definitively in writing suggests the possibility that this may change.

I was on the OMA board when the governance changes took effect. I supported the overall thrust of them (still do). One of the issues when discussing non-Physician Board Directors was a concern expressed that the type of candidates that might help the OMA out would not want to run in an election. Apparently, these candidates would be “used” to being recruited and simply expected to be given a job.

I personally thought that was silly. If you’re a strong person, have a sense of self-worth, and are confident in yourself, you should be willing to run in an election. You might lose but that’s life (I’ve lost elections). But the personal integrity to run is essential. If the OMA is to represent members, then the members must have the right to vote for all Board Directors. Up until now, that’s what was happening.

Perhaps some non-Physician Directors are thinking “if I was on another board, they’d simply appoint me, and I wouldn’t have to take a chance on losing and ruining my precious resume.” But those are NOT Boards of representative organizations like the OMA

As far as I’m concerned, worrying about offending the egos of some candidates is not enough reason to take away the rights of members to choose ALL of their Board Directors. How much longer will it be before these 3 non-Physician Board candidates will simply be chosen by a process set up by the OMA without any input from the part of members? In case you think it unlikely, that is actually what was initially proposed by the governance consultants in 2019, until we shot it down.

Worse this change was made without an open discussion with the membership. The OMA should have presented arguments for this change to the members in an open, transparent manner. By hiding it in a FAQ without informing members is a betrayal of the principles of giving members power over the OMA. That was the main thrust of the governance changes in the first place.

What can members do? I mentioned in my previous blog that I personally won’t vote for incumbents. It seems that there’s only one incumbent up for re-election, current Board Chair Dr. Cathy Faulds. I have a lot of respect for Dr. Faulds (really). She’s accomplished much in her career (her resume is incredible) with work in health systems transformation/patient care advocacy and bilateral work with governments.

I was considering voting for her based on the fact that a good Board does need to hear all view points (even those that differ from mine) but I so fundamentally disagree with this move, and the current culture the Board has overseen that I personally can’t vote for her now. Whether other members see it that way is up to them.

A glance at the other candidates for Board show that there are 11 candidates who couldn’t be bothered to do a video statement to advertise themselves. Sorry – but as much as I disagree with the current elections process – if you are going to run for the top position at the OMA, and you can’t even find the time to put a video together to advertise yourself – well that is concerning.

My few loyal readers will know that I strongly supported Dr. Ramsey Hijazi last year – and continue to do so this year. He has consistently stood up for members – most recently by setting up a petition demanding that the government stop tormenting Dr. Elaine Ma for running a Covid Vaccination clinic. He’s also been strong in the press. He will get my first vote (which in the weird way the OMA weighs votes is the most important).

After that, there are a number of candidates that caught my eye – in alphabetical order – Dr. Khaled Azzam, Dr. Douglas Belton, Dr. Joy Hately, Dr. Pamela Liao, Dr. Afsheen Mazhar, Dr. Shawn Mondoux, Dr. Sameena Uddin, Dr. Darija Vusovejic. To be clear, members should review all the candidates themselves and vote, but I am going to vote for them after Dr. Hijazi.

As a family doctor, I also have a vote for my SGFP representative. Lots of great candidates running there. It will again, not surprise any of my followers that I will strongly endorse Dr. Nadia Alam for SGFP Vice-Chair. She’s an excellent leader and a dear friend. She took a well deserved break from medical politics for a bit. But it’s good to see her getting involved again and our profession will better for it. I leave the rest of the voting to your good judgement.

Dr. Nadia Alam, Candidate For SGFP Vice-Chair

Disclaimer: NONE of the candidates listed asked me to endorse them.