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Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

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« Putting OMA and the MOHLTC Negotiations in Context | Main | Oil, Ageism, and Pharmacare »
Thursday
Jan152015

OMA Rejects Government Offer

OMA

PRESIDENT’S UPDATE

Vol. 20, No. 1

January 15, 2015



OMA Board Unanimously Rejects Government Final Offer, Ministry to Impose Further Cuts to Medical Services



Today, the OMA Board of Directors unanimously rejected a final offer from the Ontario government that would cut an additional 4% in medical services, and place an arbitrary ceiling on the physician services budget, which would cap the number of services physicians are able to provide to our patients.



The government’s final offer, submitted late Wednesday evening, included:

· $580 million in cuts over two years, including

- $259 million through 9 specific cuts in physician payments, the majority of which impact family practice;

- $50 million in system savings;

- Increasing the current 0.5% payment discount to 1% on all physician payments;

- Further additional increases to the payment discount by specialty of practice.

· A 1.4% one-time payment in year 3.



The Ministry warned the OMA that if we did not accept this punitive offer, it would pursue unilateral action against physicians immediately. We have received details of this arbitrary action and are assessing its potential impacts.



The OMA and the physicians of Ontario have worked hard to build and maintain a positive relationship with government. We have negotiated in good faith to improve the health care system for our patients. In 2012, Ontario’s doctors did our part and contributed more than $850 million in fee concessions and health system savings. To impose a further $580 million in cuts to medical services and payments is unwarranted and destabilizing.



The government’s position will lock in system underfunding for future years and subject physicians to open-ended liability for growth in the utilization of medical services that is beyond our control. It will limit training opportunities in primary care, mental health, and many other specialties. Also, the government’s pattern of heavy-handedness toward doctors, and unwillingness to negotiate reasonable agreements with the profession, will make Ontario an undesirable place to practice.



The OMA will be active in the media and other venues to ensure that the public and our patients understand the truth and the real impacts of the government’s final offer and its arbitrary measures.



We anticipate the government will claim to have offered the profession a modest raise based on the language in its proposal — this is disingenuous and misleading. In fact, government plans to set an arbitrary baseline for the physician services budget that is more than $80 million below current levels, and fund growth of no more than 1.25% per year, despite the current growth of 2.7%. This difference will be funded through cuts to physician payments. Also, the government intends to claw back from physicians through reconciliation any expenditure that exceeds its arbitrary budget.



While we have rejected the government’s final offer, and it has been withdrawn by the Ministry, the OMA Board considers it vital that we share the government’s proposal with all members. We know that members will have many questions, and we will work to ensure that you get the information and answers that you need in a timely and effective manner.



The OMA will undertake an extensive member education campaign to provide all details of the rejected government offer, as well as the Ministry’s unilateral cuts. We are organizing a series of face-to-face meetings and teleconferences across the province.

OMA Council will meet in the near future to review these developments and plan how we intend to move forward championing our patients and supporting our members in the face of the government’s cutbacks.



The OMA has been negotiating with government for more than a year. These talks have been difficult. Since the outset, the government focused exclusively on cutbacks and balancing its budget. We concluded the first round of negotiations in August and were unable to reach an Agreement. We then moved to facilitation, and subsequently conciliation with former Chief Justice of Ontario Warren Winkler. Here too, we were unable to reach a deal. Justice Winkler submitted his report to the parties on December 11. In his report, he suggested the OMA should reconsider the government’s offer, and we did.



The OMA called a meeting of physician leaders, which was held December 20. More than 150 physicians from across the province attended. The Board outlined the negotiations timeline, the government position, and the results of our facilitation and conciliation process. We detailed the challenges at the negotiations table and the significant gap between both sides. We circulated the offer on the table from government at that time and we shared Justice Winkler’s then-confidential report, which will be available on the OMA website. We set out the positives and negatives of the government position, and reviewed the Winkler recommendations and the critical elements not referenced in the final conciliator’s report. Physician leaders provided valuable perspective to inform the final stage of the negotiations process.



The OMA and Ministry reconvened for a brief final round of negotiating that concluded January 9, with the government tabling its final offer on January 14. Today, the OMA Board met to review that offer. After careful consideration of the potential impacts of the proposal, threatened unilateral action, and the valuable input from more than 150 physician leaders who attended the December 20 meeting, the Board voted unanimously to reject it.



This offer will not improve quality of care, nor will it improve public access to medical services. In fact, we know the opposite will result. In the face of this arbitrary action, the OMA and Ontario’s doctors, on behalf of our patients and our partners in the health care system, intend to candidly and aggressively inform the public and all stakeholders about the truth of the government’s offer and the real implications for health care.



I urge all members to stay focused on our patients and avoid divisive actions or any actions that will compromise patient care. We need to monitor the impacts of the government’s measures on the system and our ability to practice. We need to work together as a profession and with our partners in the system to assess our relationship with government, and establish our collective strategy going forward.



I want to thank all members for your tremendous patience during the past year. The Board recognizes that these developments will be frustrating for physicians and have significant implications for your practice and your patients. We have made every effort to convince government that heavy-handedness is not the solution, however, it is clear the government is entirely focused on fiscal targets and not patient care.



The OMA will be communicating regularly with you in the coming days. Documents will be posted on the OMA website and the site will be updated on a continuing basis (www.oma.org).



Once again, I encourage all members to maintain focus on patient care and professional unity as we assess the current circumstance, and let’s work together to address this challenge collectively on behalf of our patients and our colleagues.



Dr. Ved Tandan

OMA President

Reader Comments (97)

As we know, this was going to happen. Next will be the imposition of a 5 year contract. Those unhappy can leave. Lots in waiting to fill any losses. A 5 years all will have figured out their new positions in health care, and stop trying to fight. Just front line "workers" as directed by central.

The 5-10 year plan for physicians, nationally, is not one of income growth.

With a reducing income, yet rising expenses, all small practices get driven into budget-able groups, with conditions of assured coverage.

The majority government has public support (for the most part), and almost 4 years to deal with strains. The biggest argument is going to be "in this environment physicians should be pleased how well they are being compensated, compared to how most citizens are being squeezed by the times".
January 15, 2015 | Unregistered CommentermovingforwardOntario
As gov't takes over we should expect costs to soar. The gov't experts had and have little concept of what MDs provided on their own time and dime. Gov't is about to find out.
Central doesn't care. It wants control, and can raise taxes. This is not about care, this is about central believing it "knows" best. We can improve your health, but we must be able to ensure you do as we tell you.
January 15, 2015 | Unregistered CommentermovingforwardOntario
As long as the government keeps meeting mush from the OMA and the profession the MOH will continue ratchet down fees. I think this time around we'll see what the profession is made of but I'm not holding my breath. There is a lot of learned helplessness in this profession.
January 15, 2015 | Unregistered CommenterCanary in a Coal Mine
CICM, I agree.

Leadership MUSH.
January 15, 2015 | Unregistered CommenterMerrilee Fullerton
R

It is a complex world. Sometimes it is just safer to take the assured carrot, than than the complicity involved to get the not getting the stick.

One can have two philosophies. It is going to get worse, or we can make it better. because ll will "improve". Centrals current position clearly mixed, and we all are confused. Either things are getting better, or they are getting worse. Getting worse is scary.

Behind the scenes, central does know, the next decade in Ontario is not optimistic.No one can publicly say the words.
January 15, 2015 | Unregistered CommentermovingforwardOntario
question:
- is this supposed deal going to be retroactive to April 2014??? In other words, do we have to pay back money already earned??


If the major fee reductions hit the FPs (alphabet groups), you will see a lot of the older FPs, who have done extremely well over the last 5-8yrs, decide to retire.
January 15, 2015 | Unregistered Commentergot2Bkidding
http://www.thespec.com/opinion-story/5257651-health-care-is-a-bloody-mess/


Health care is a bloody mess
Free advice on how to rescue our broken, obsolete, unsustainable system

Hamilton Spectator
By Stephen Skyvington

"Innovation distinguishes between a leader and a follower."

•Steve Jobs


Dear Premier Wynne:

First off, I should tell you I'm not in the habit of writing letters to politicians. Especially not Liberal politicians.

But I couldn't help but feel sorry for you, premier, what with talks between the province's doctors and your government about to fall apart once again, on top of all the other troubles you're dealing with. Troubles a cruel person would say you've brought upon yourself, but I'll try not to be cruel today. Just this once.

What I would like to do, instead, is offer up a little free advice. And while we all know what that's worth, I really think you should listen to me. I've spent the past 20 years in the trenches — if not exactly fighting side by side with doctors, then at least as a passionate observer. Think of me as a war correspondent or perhaps a canary in the coal mine.

So, what have I witnessed during that time? One bad decision after another, made by one politician after another, over and over again. Things are a bloody mess in health care — no pun intended — and they're about to get worse. But there is hope. Something I suspect you understand all too well, premier, having surprised pretty much all of us by winning a majority last year, just when it seemed you and your party were headed for the scrap heap.

Here, then, are 10 things you could do tomorrow to turn a negative into a positive. Hell, if you play your cards right, you might even be able to balance the budget by 2017-18, like you promised you would during the election campaign.

1. Call a news conference and come clean. It's high time someone fessed up and let the rest of us in on government's dirty little secret. Our health care system is broken, it's unsustainable and obsolete, and unless we act fast, we'll end up with the very thing all of us agree we don't want — namely, a U.S.-style health care system.

2. Explain to the people that just as there is no such thing as a "free lunch," health care also isn't "free." While you're at it, premier, it would be most refreshing if you could remind everyone just how much our free health care system costs all of us. Remember, it's our system too. We deserve to know the truth.

3. Stop "bashing" doctors. Ever since David Peterson took over from Frank Miller as premier back in 1985, it's become fashionable for politicians of every political stripe to bash doctors. While this has proven to be a great way to win votes and public support in the never-ending battle to keep health care costs under control, the fact remains that without doctors our system would collapse. Time to make them your allies, not your enemies.

4. Announce that you're going to "modernize" the fee schedule. Here's another dirty little secret, from the days I worked at the Ontario Medical Association. When we talk about modernizing the fee schedule, we're talking about delisting things. Sorry to be so blunt, but our health care system simply can't go on being all things to all people. Time to sharpen the scalpel and start cutting.

5. Bring back annual co-payments. I'm not sure if you're aware of this, but Tommy Douglas, the patron saint of medicare, thought it was perfectly fine having co-payments when he first introduced his health care scheme as premier of Saskatchewan way back in 1962. A measly $100 co-payment for every man, woman and child in Ontario per year would generate over $1 billion of badly needed revenue for our ailing health-care system.

6. Introduce tax-free "medical savings accounts." The concept is simple. Let the people decide what they'd like to spend their health care dollars on. Instead of going ahead with your unworkable, job-killing, made-in-Ontario pension scheme, why not bring in legislation that allows Ontarians to set aside up to $3,000 a year to cover medical expenses not covered by OHIP? It's not exactly brain surgery.

7. Do something about all those "bed blockers" by investing heavily in nursing homes. Want to fix the problem of overcrowding in our hospital emergency departments? Start building more nursing homes so all those seniors who can't take care of themselves and are stuck taking up valuable space, occupying hospital beds meant for real patients, will finally have some place to go.

8. Embrace "medical tourism" right here in Ontario. Funny thing. We seem to have no problem selling our expertise and technological advances to the rest of the world, so why do we get all queasy when we talk about doing the same thing when it comes to health care? If your government is serious about balancing the budget by 2017-18, then here's an excellent way to find the funds to get the province out of the red and into the black. The situation we find ourselves in calls for a little "out-of-the-box" thinking. Be bold, premier. Be very bold.

9. Introduce a parallel private health care system. Rumour has it your health ministry has commissioned thousands of dollars worth of studies by consultants during the past decade, trying to figure out a way to bring in a parallel private health care system, without you having to take the blame for doing so. Forget about playing the blame game. Let's dust those reports off and get down to business.

10. Fund it or free it. It's pretty simple. If you can't afford to fund our health care system properly — and let's face it we both know you can't — then it's time to do something about it. As Janis Joplin once sang: "Freedom's just another word for nothing left to lose." I'd say that's where we pretty much find ourselves today, my friend — with nothing to lose and everything to gain.

Don't be afraid, premier.

The future is now. We can't afford to wait any longer.


Stephen Skyvington is the director of the Meighen Institute’s Centre for Healthcare Reform and Innovation, and former manager of government relations for the Ontario Medical Association. Follow him on Twitter @SSkyvington.
January 15, 2015 | Unregistered CommenterStephen Skyvington
It looks as if WIC's are to be impacted in a negative fashion....what is the Ministry's goal where stand alone WIC's are concerned....in the original offer WIC's linked to FHG's for example would be able to Bill as per FHG FP's. but stand alone WIC's would get their own / lesser fee schedule.

Many young graduates work in stand alone WIC's as they bide their time to join the alphabet soups, what will their future to be?...the goal is, of course, to guide them to under serviced regions....where, in fact, will they go?
January 15, 2015 | Unregistered CommenterAndris
WICs evolved as a necessary access point for after people returned home from work. It keeps the working population productive.

WICs were demonized by the OMA because they were seen as taking a significant part of the health care funding pie.

They could be and in some cases are, an excellent way to create a form of urgent care that keeps patients out of the ERs.

Wiping out WICs will drive more ER use. Watch and see.
and good news from Dr Day. He has a good case.
Andris, I'm going to remove your post because it makes me feel queasy. I would appreciate your understanding.
I understand...nevertheless we will all be feeling queasy all too soon.

BOHICA.
January 15, 2015 | Unregistered CommenterAndris
In terms of WICs it appears they are targeting the rostered patients after hours WIC premium fees because those of us working on pure FFS do not receive any premiums for working after hours.

Looks like our clinic is about to get a whole lot busier if the after hour WICs for rostered patients are targeted for fee reductions.

If I was a rostered doc and they cut the premium fees I'd just stop working after hours and let the patients go to the ER. Make it the government's problem. No payola no service.

We're about to see how much calcium is in the spine of these PEM docs.
January 16, 2015 | Unregistered CommenterCanary in a Coal Mine
Regarding the after hours coverage of rostered patients of the FHNOTs....they signed voluminous pages in their contracts covering such matters....binding on them, not binding on the government....one anticipates that the government will try to force them to honour whatever they signed off on.

As I understood from the December meeting the free standing WIC's would get a different ( lesser) fee schedule from those WIC's that were offshoots of a FFS Family practice which could bill the regular FP fee schedule.

Who knows what the government will do now that they've withdrawn their offer and declared war on the profession....the laws of paradox and of unintended consequences are about to hit the health care system.
January 16, 2015 | Unregistered CommenterAndris
It is not a war on physicians. They accepted all the money, and supported moving to a free at point of care system, fully funded by taxes. It was easy, and offered good income without the struggle of money collecting.It can not be spoken but the available tax pool can't keep up, many of the Utopians are beginning to realize that also.Now the only thing left is for central to more tightly manage those who draw on public resources. Physicians are the first group because of their revenue draw. Central is inundated with calls, emails, etc. supporting clawing down the doctors, from others, with lower revenues are getting squeezed. 2014 represents each physicians maximum income peak( if they were still building their career). Now the reshuffle begins.

All of this is going on when oil was felt to be a $100 cost in the system, and had tax redistributions based on that $100. This $50 dollar is a real re-shufflers of tax revenues to central that haven't been figured out yet.
January 16, 2015 | Unregistered CommentermovingforwardOntario
Round 2

http://www.cbc.ca/news/canada/toronto/ontario-doctors-reject-province-s-contract-offer-1.2911779

"The ministry will apply a 2.65 per cent "discount" to all fee for service physician payments next month and will apply the reduction to non-fee-for-service payment contracts after the respective requirements for providing notice are met, it said."

Almost across the board income reduction, effective February 1. With a behind the scenes overall cap on the available pool (You can't "volume" your way out)
January 16, 2015 | Unregistered CommentermovingforwardOntario
I remind the reader of justice Winkler's report, with specific underscoring of the following,

" It is apparent that these positions are irreconcilable in the longer term. Absent some rationalization, the system may not be sustainable. Thus, the consensus emerged that without systemic changes to the health care system, the Parties seemed to be on a collision course so that a PSA, at some point in the future, may not be achievable.

The Parties had a window of opportunity in these negotiations to create a process whereby the present structure could be studied with a view to reform. A study of this nature requires time for research and reflection and input from a number of stakeholders. These sort of systemic issues cannot be effectively addressed in a set of PSA negotiations."

http://www.health.gov.on.ca/en/news/bulletin/2015/docs/hb_20150115.pdf
January 16, 2015 | Unregistered CommenterEklimek
When one faces such infire it certainly feels as if war has been declared....of course the public is supportive with even the Health Minister, nominally a FP who likely has never had to meet a pay roll and cover overhead costs, refers to the gross income as a " salary"....a " salary" of $354,000 sounds great , most then add another 15% to cover the various benefits...cutting that by 2.56% sounds "reasonable".
January 16, 2015 | Unregistered CommenterAndris
It is inherent from many of the comments on this blog that government has an unsustainable system and has proven unwilling or unable to make fundamental systemic corrections. I think Justice Winkler refers to this in his report. The lack of acceptance by the OMA for cost increases of physician services reflects this.
January 16, 2015 | Unregistered CommenterEklimek
Round 3:

OMA PR campaign. Meanwhile, central has attained its needed savings, both economically, and to move the system the direction its physician advisers want.

Round 4:
Legislative majority imposes contract on "its" employees.

There is no round 5.
January 16, 2015 | Unregistered CommentermovingforwardOntario
mfo

This is not a boxing match. The problem(s) nevertheless continue and doctors have declined personal indemnification. Physicians have opted to be a catalyst for a solution. The alternative was no solution.
January 16, 2015 | Unregistered Commentereklimek
DrK

All parties, including now both independent mediators and concilators, kmow the system is broken. Central however can not announce that because of the massive loss of power that would occur

This is not about health care, this is about who gets the power. Central has made its decison, has the support of the majority of the public, for now, and has dumped the issue of the "brokenness". It is politically easier to blame the greedy doctors, than to say, the infrastructure we now have serves neither the patients or providers, it serves central.
January 16, 2015 | Unregistered CommentermovingforwardOntario
DrK

All parties, including now both independent mediators and concilators, kmow the system is broken. Central however can not announce that because of the massive loss of power that would occur

This is not about health care, this is about who gets the power. Central has made its decison, has the support of the majority of the public, for now, and has dumped the issue of the "brokenness". It is politically easier to blame the greedy doctors, than to say, the infrastructure we now have serves neither the patients or providers, it serves central.
January 16, 2015 | Unregistered CommentermovingforwardOntario
mfo

Thank you, we got that message. I think Justice Winkler got it too.
January 16, 2015 | Unregistered Commentereklimek
"All parties, including now both independent mediators and concilators, kmow the system is broken. Central however can not announce that because of the massive loss of power that would occur"- mfO

Long live Dr Day!
Yes where can one make a donation to Dr. Day's court costs without going through the Canadian Constitution Foundation?
January 16, 2015 | Unregistered CommenterCanary in a Coal Mine
Best I can do is the Charter Health site which indicates the funds will go to the Charter case through CCF

I would encourage you to donate.
http://www.charterhealth.ca/contact/
You could also try contacting the Cambie Surgical Centre
The OMA leadership has been complacent. They had to have known this was coming. They were told but they believed they could "comanage" their way through it.

Being blinded by one's self-importance is never a good thing.
Social media, press, calls, all carefully monitored by central, show two things, a real none response by the public, and overwhelming positive support.

This thing is done and over.
January 16, 2015 | Unregistered CommentermovingforwardOntario
So planning for the future, just read up on US HMOs and you will know the structure and outline for physicians. However, this will be worse, in that HMOs can, and do raise rates, and can cherry pick patients. Fied pot of money, unlimited access, and quotas for units needed to be handled.Four unrestricted years of authority to put it in place, after which it is so done, it can't be reversed.
January 16, 2015 | Unregistered CommentermovingforwardOntario
Mfo there are almost no pure US HMOs left so it can be very well reversed here in Ontario. Both the providers and patients in the US rebelled and the pure HMO model as we have here in Ontario today disappeared south of the border quite some time ago. Out of the dozen or so US docs I know none are working on capitation today. The model has gone the way of the do do bird and will do so in Ontario with time as well.

The law of unintended consequences has been sprung here in Ontario with the government's unilateral fee reduction decree which will only ensure their utopian wet dream of complete control will not last for very long. A win by Dr. Day could very much upset the apple cart.
January 16, 2015 | Unregistered CommenterCanary in a Coal Mine
Thanks Realist for the CharterHealth link for donations. I wanted the donation specifically earmarked for the court case not some of the CCF's other projects.
January 16, 2015 | Unregistered CommenterCanary in a Coal Mine
I remain puzzled by how this imposition by government will impact WICs.

As I understood it the government wanted to have a separate fee schedule for free standing WICs as opposed to those populated by FPs with medical practices.

The FHNOTs will likely work the minimum coverage as defined in their agreements sending the rest to ERs rather than be negated if the patients went to WICs.
January 16, 2015 | Unregistered CommenterAndris
I think it is clear the OMA has failed the rank and file membership and it is time for Sapsford the CEO to go.

Why they ever hired this ex-assistant MOH deputy minister is beyond me. Probably was feeding the OMA's negotiation strategy back to the MOH to say thanks for that nice pension package he received.
January 16, 2015 | Unregistered CommenterCanary in a Coal Mine
Andris if there is truly a separate lower fee schedule for the free standing WICs then that will be the end of the system overnight. The ERs will be swamped and unable to handle the extra WIC volumes as those clinics become uneconomic to run.

I think we'll have to wait until the fine print of the decree is released.
January 16, 2015 | Unregistered CommenterCanary in a Coal Mine
"Contract talks between the province and the Ontario Medical Association fell apart because the organization representing doctors refused not to overspend beyond a fixed budget, a government source close to the negotiations said.

“The OMA did not want to be held accountable to a budget,” he said. "

http://www.thestar.com/life/health_wellness/2015/01/16/contract-talks-failed-because-mds-did-not-want-to-be-held-accountable-government.html#
January 16, 2015 | Unregistered CommenterCanary in a Coal Mine
The government wanted to keep the pot fixed at a level that did not reflect the anticipated increase in population via immigration etc., ...that ignored the age tsunami with its increased demand for services...it wanted the profession to pay for the increased demand for their services.

How can the profession be truly expected to be held accountable for the anticipated increased demand?

The government expects it....so that's that.
January 16, 2015 | Unregistered CommenterAndris
CICM

You're correct HMOs are a proven failed model. So by evidence proven studies, we know this is a failure. Yet, we're doubling down.
January 16, 2015 | Unregistered CommentermovingforwardOntario
The RCMP has just won the right to have collective bargaining....perhaps physicians will be able to have a similar right one day.

Physicians have the downside of being public employees without the benefits...with the government being able to legally run roughshod over the essentially helpless profession....and doing so....this cannot continue for ever.
January 16, 2015 | Unregistered CommenterAndris
Of course, the other model, to involve the public, the cap and trade model, along with the fixed budget. You, as a patient have your encounters as your 2014 used limit. If you exceed your cap, you pay. If you are under you can sell your units. New drawers can only have access to units, freed up by death, or based on the ool expansion they provide through tax contribution.

Problem solved in a monopoly fixed budget system.

The current government will be bringing that system in as a resource control model. Let's use it in health.

It's broken. This is an embarrassment in game playing with peoples health.
January 16, 2015 | Unregistered CommentermovingforwardOntario
"Most Canadians would probably be a little shocked to hear that their country is no longer the international darling of universal health care. But it’s true. Out of 11 countries, ours is ranked 10th by the Commonwealth Fund, a private American foundation that compares the United States’s health system with those of other nations. The U.S. habitually takes the 11th spot, but we’re right there behind them.

Compared with Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K. and the U.S., Canada has the worst “timeliness of care” and the second-worst overall efficiency. "

http://www.theglobeandmail.com/globe-debate/editorials/when-a-stagnant-health-system-meets-an-aging-population-disaster-awaits/article22487481/
January 16, 2015 | Unregistered CommenterCanary in a Coal Mine
The new health care system:

What central determines can be provided, what the providers are trained could be provided, what the patients could get to improve their health but can't get.

Isn't going to last. Too much frustration building.
January 17, 2015 | Unregistered CommentermovingforwardOntario
Realist there is an excellent article in today's G&M by Wente ' is automation making us helpless'....she touches on medicine and touches on my fears regarding the erosion of skills....once upon a time, in the bad old days, I could palpate an abdomen, carry out a WBC and do an urinanalysis make a pretty accurate diagnosis and organize the OR even prior to the arrival of the surgeon on call....nowadays there is a prolonged protocol that is followed with a variety of expensive investigations....8 hours+ can pass before the patient is on the table, when it was an hour or two in the bad old days.
January 17, 2015 | Unregistered CommenterAndris
"What central determines can be provided, what the providers are trained could be provided, what the patients could get to improve their health but can't get."

If the MoHLTC proceeds it will necessarily be inundated with applications for out of country approval so that clinical responsibility for care is not abandoned.

http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4459a.pdf
January 17, 2015 | Unregistered CommenterEklimek
Andris,

We had a discussion about this over the holidays. I do not use GPS but still rely on paper maps in order to get an overview in my head of the lay of the land and when in the bush I still rely and use the good old compass rather than a GPS. One of these days during a military crisis the hackers will shut down the satellite system and we'll need to know these skills.

I do have a TomTom and have been geocaching but they are not the same as mastery of orienteering skills. Last time I checked the Toronto Orienteering club had been inactive for some time.

As for patients they often complain about their physicians staring at a screen rather than talking to them. As you know we still have paper charts which I think helps resist the urge to multi-task while interviewing.

Nicholas Carr also wrote the book The Shallows: What the Internet is Doing to Our Brain. Personally I am of the opinion that not only are we losing the mastery of many skills but regaining those skills will be very difficult because we have also lost the focus required to develop the skills in the first place.

More and more I see society's individuals with the inability to focus for long periods of time and that is one of the observations made in Carr's book,...that the use of smartphones, Twitter, Google, etc. is rewiring our brain for short term reward and that delayed gratification, a skill needed to develop mastery of a subject, is being lost.


"Computerization has narrowed the autonomy of doctors and deskilled them. It has also changed the doctor-patient relationship. Today, the computer, not the doctor, may decide what treatment you get. And your doctor may spend more time interacting with her screen than with you. The patient has been reduced to a pile of data points."

http://www.theglobeandmail.com/globe-debate/is-automation-making-us-helpless/article22489327/
January 17, 2015 | Unregistered CommenterCanary in a Coal Mine
Why has Hoskins not been front and centre reassuring the public that he will deal with these unacceptable private health care data breaches to the full extent of the law.

In the private sector employees sign a legal document yearly which outlines the types of IT transgressions which will result in their firing on the spot,....snooping into clients' files, forwarding porn, use of offensive language in emails, visiting inappropriate web sites. There is no warning given once caught because you've been forewarned in the 12 previous months of what the consequences will be.

This one though with an abortion activist accessing files of patients who have had abortions likely for the purpose of harassing these individuals should result in jail time in order to set a precedent. Why were the police not called in?


"Anti-abortion activist fired after a hospital privacy breach in which hundreds of patient records and abortion files were inappropriately accessed."

http://www.thestar.com/life/health_wellness/2015/01/17/anti-abortion-activist-snooped-into-patient-records.html
January 17, 2015 | Unregistered CommenterCanary in a Coal Mine

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