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Looking for Solutions in Health Care for 2006 and Beyond

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

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 

 

 

 

 

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Monday
Jan192015

Putting OMA and the MOHLTC Negotiations in Context

Over the years of blogging and writing about health care I've talked a lot about context. That is because without context we cannot fully understand how decision making happens in health policy or the impact of those decisions.

As a disclaimer before I go on:

I will neither lose or gain from the current negotiations. As a retired MD, or physician in transition as I prefer to call it, I will see no monetary gain or loss from the resulting contract. I have no vested interest in supporting the OMA or Ontario's physicians other than to be a potential receiver of care down the road. I have no interest in supporting the Liberal government either as I have seen them dig Ontario tax payers deep into debt while promising many things they could not afford.

You may not like it but let's confront some realities so we can get on with the solutions.

1. Health care IS political. Government has made it that way. It is not MDs who have done this. In Ontario in 2004, the Commitment to the Future of Medicare Act or "Bill 8" was passed. Then MOHLTC Minister George Smitherman talked about strengthening and restoring confidence in our public health care system.The government made it illegal for physicians to provide necessary medical care outside of the publicly insured program. Hefty fines would result and even jail time was considered.

The good times in Ontario were expected to go on for a long time judging from the stance the Liberals took on health care. Either that or the lack of affordability they had created would become someone else's problem once they vacated office most likely within 12 years of taking power.

The Ontario Liberal government had poured money by the bucketful into health care. It dumped money into eHealth, team care, and new models of primary care such as Family Health Teams and Community Health Centres. When a hospital went overbudget to meet demand, money was thrown at it. When patients were being sent to the US because of lack of capacity in Ontario hospitals, Mr Smitherman threw money at that too and the voices of physicians were quieted.

But the good times didn't last and in 2008 the Great Recession hit. The Liberals were stuck. Debt was mounting and all their promises on health care were becoming unaffordable. Almost a decade of flat out spending doubled the debt and drove Ontario to annual budget deficits that were mounting every year. Credit rating agencies were and are biting at the Liberals' heels.

Despite the unaffordability of what the Liberals have created, they continue to insist that it is perfectly sustainable. If only providers would continue to do more with less. If only physicians would agree to absorb all the costs of the hundreds of thousands  of new patients needing care in the system over the coming years.

Supporters of this approach claim that the system is sustainable. More efficiencies, more team care, more electronic health records, Big Data, wearables, more prevention, better lifestyles will create some kind of health care nirvana. I've got news. They don't. They all cost even more.

The politicians won't tell you that. They will not tell you that the system we have created is unaffordable because it would potentially cost them their jobs and their power. They will not tell you that we need to move to a Hybrid health care system because of the risk to their own power and careers.

2. The Ontario Medical Association will also not tell you that the health care system as we know it is unsustainable. They insist that government provide more dollars for more patient care for a number of reasons including the aging population with more complexity and the growing population both of patients and physicians.

The OMA can't tell you that a Hybrid health care system is needed  because they are joined at the hip with the  Ontario government. The OMA depends on the government for its existence. Legislation exists to require the OMA to be the representative body of Ontario physicians. Ontario physicians must pay annual dues to the OMA.

The government has the power to change this which creates a huge conflict of interest for OMA Board members. If they do not support the government and its agenda, the OMA could cease to exist effectively. It becomes the fiduciary duty of the OMA Board members to support the organization not necessarily the best interests of the public or physicians. The OMA cannot  come out in support of a Hybrid health care system that all other better performing health care systems of other countries have. Instead, it must insist that the government provide more funding to the health system even when it is clear that this is an untenable position.

3. The Public is unaware of the challenges facing a single payer system. The government won't discuss the challenges ahead other than to speak of fiscal responsibility. The public needs to know that our ability to fund more and more health care on the backs of a shrinking tax base is unlikely. The new advances in science and technology such as genomics, epigenetics, organ regeneration, cancer as a chronic disease, stem cell treatments, new expensive medications that will prolong life or save the lives patients with rare diseases are here. They cost huge amounts of dollars. They cannot be funded by holding the line of physician income for the next thirty years or longer.

The challenges ahead in health care in Ontario are too great to ever be carried by physicians. The coming costs of care will not be offset by freezing or cutting physician wages. A Hybrid model of health care is needed. The sooner we can all be honest about this we can get on with finding the way forward. In the meantime, the negotiating game continues to the detriment of us all.

We have until 2020-2025 to create the beginnings of a Hybrid health care system like many other countries with systems that provide better access, more care, and even pharmacare. Let's stop the political posturing, look reality straight in the eye and get on with it.

 

Reader Comments (224)

A nice blunt summary, that has been discussed for almost a decade. This is (was) all predictable, because nothing be tried in Ontario has been tried elsewhere, with limited success/failure. Ontario's issue, it is the only pure monopoly.

Health money in Ontario, truly, is not about health. Your individualized maximized treatment, as best it can be delivered. It is about whom in the system gains political points. Soon, as a patient, you'll be an economic draw that needs to "go" for the good of us all.

Money can be saved is isn't that hard. For every dollar of direct patient care stopped, match it with 1 administrative dollar. It actually is easy. Businesses do it, painfully, everyday.
January 19, 2015 | Unregistered CommentermovingforwardOntario
Great piece, Merrilee.

You want some help getting it in front of an editor.

The world should be reading what you just wrote.

It's bang on!
January 19, 2015 | Unregistered CommenterStephen Skyvington
We should examine the paths that other health care systems took when they hit the wall and how they resolved it....Australia and New Zealand come to mind.

It is obvious that our own system is in the process of hitting the wall and one suspects that someone, deep in the bowels of the MOHLTC, is working on the matter...heck, even prior to the collapse of the USSR, the KGB under Andropov knew that the system was in a state of collapse and were planning for the post collapse period...Putin and the KGB/GRU/FSB landed on their feet.
January 19, 2015 | Unregistered CommenterAndris
SS,
Sure. You know where to find me!

And thanks for the plug a few weeks ago. I did notice an uptake in visitors.
Excellent summary and should be a Globe and Mail op-ed piece.
January 19, 2015 | Unregistered CommenterCanary in a Coal Mine
R:

Wealth redistribution is the major agenda. Central is prepared, and will, accept some downgrading of population , and individual, health levels in order to obtain wealth redistribution.

The consultants have assured central, that the better good is to redistribute wealth over individual health needs.

The plan is good. Central wishes to do "good".
January 20, 2015 | Unregistered CommentermovingforwardOntario
For a government professing it wishes to be "transparent". agenda for redistribution known before election (this was going to happen), all negotiations done behind closed doors, are, at the end, it was known the decision would be dealt with by cabinet, not Queen's Park. The beauty of a parliamentary majority government it gets to do exactly what it wants to do. his one has an ideological first goal of distributing wealth, not the best health care to individual that can be provided.

Thus one knows the inequality in health care will grow. The further one is from downtown Toronto (where per capita the resources are higher), the less access to resources.
January 20, 2015 | Unregistered CommentermovingforwardOntario
Mfo was correct this new agreement really does eat the young.

For family medicine:

1. 2.65% across the board fee discount on top of existing 0.5% discount effective Feb 1/14 for FFS and May 1 for PEMs.

Specific FM discounts are thought to represent an additional 3.4 % reduction on top of 2.65% payment discounts

Specific discounts

1. Elimination of all enrollment Q codes
2. Reduction of new entries to FHN or FHO from 40 to 20 per month and only into areas deemed by MOH as "high need". Alternative for new grads will be to join FHG, CCM, or non-PEM FFS. New grads can only join existing group as locum or if someone leaves that group.

MOH states average payment to FHO is $70K more than CCM.

3. Income stabiliziation programs for FHN and FHO will only be offered in areas MOH deems underserviced.

4. Elimination of CME subsidy program.

All CME payments discontinued.

5. Acute Modifier

Government will not pay for two years.

6. A888 code will no longer be paid on weekends or holidays

Instead clinics will bill A007 and A001, etc. This reduction also impacts the FHG 10% premium on A888 and 30% Q012 and Q016 premiums.

7. HOCC One Time Payment

for groups less than 5 physicians will not be paid.

8. HOCC payment freeze


Not much there for us docs on pure FFS except for the across the board reductions, but it is very clear the government considers the FHNOT groups a failed expensive model. They are actively directing new grads in the urban areas back onto all FFS models and even pure FFS.

Looks like the new grads are going to have to take off their Guccis and put on their Nikes as they have to move from seeing 20 patients a day to 40 patients a day. That will be a real shock to their system not to mention the big financial hit with their start up subsidies gone at a time when they are carrying huge student debt.

It appears our FFS physician recruiting problem may start to improve.

As for the loss of the weekend A888 code I guess we go back to billing A001 and A003 as well as A007. Net net probably a wash.

So it appears the government is moving away from the capitation models at the local level but will try to fix costs at the global level with a claw back.
January 20, 2015 | Unregistered CommenterCanary in a Coal Mine
Looks like the market value of FFS practices in saturated urban markets may start to rise again.

New grads need to get revenue stream up quickly to start paying down debt and purchasing a full practice will be attractive again.
January 20, 2015 | Unregistered CommenterCanary in a Coal Mine
CICM,
Thanks for that.
"Looks like the new grads are going to have to take off their Guccis and put on their Nikes as they have to move from seeing 20 patients a day to 40 patients a day."

We said here over and over again that the FHTs were expensive models that were unaffordable.

CHCs will continue as they serve low income areas etc. Still, I find it hard to control my response to the CHC groups who are continually spouting rubbish how all family MDs need to be in a CHCs etc. The idiocy of it all.

I do feel sorry for the young MDs who have been trained to believe that FHTs were the way of the future. Bamboozled comes to mind.

I know of one student who wanted Orthopedic surgery but was now thinking of Family Medicine because no jobs for new Orthos (despite tens of thousands of patients waiting...can you believe it..). I feel bad for him.
My blog journal entry from 7 years ago:

Cost-effectiveness of Family Health Teams
DateThursday, May 8, 2008 at 09:04AM

I've talked about productivity and motivation in another journal entry way back when but the issues surrounding these two important variables are getting more significant and deserve another mention, particularly as information filters out about the lack of cost-effectiveness of Family Health Teams in Ontario.

A recent article in the Ottawa Citizen on May 5 by Lynne Cohen, an Ottawa-based lawyer and journalist, was titled, "We Need More Workaholic Doctors, Not Fewer".

As her story goes, she had a "workaholic cardiologist father" (her term not mine) who died back in 1990. She links "dedication" with the "health care crisis" suggesting that it is lack of dedication and fewer hours worked by physicians that is causing problems for publically funded health care. In her opinion, doctors seeking work/life balance are the crux of the problem.

Although she is way off the mark and perhaps demonstrating the bitterness that may occur in children (even grown up children) with absentee fathers, I don't believe her view is unique.

But really, doctors are people too--with children, other lives beyond medicine and much to contribute to society besides treating the sick and preventing disease, although I'll agree that the last two items are fairly significant.

If we look back to the caps in Ontario, the claw-backs, the Medical Review Committee (MRC), the medical schoool cut-backs, we can see that it was certainly government's intention to have doctors working less. In an environment when productivity is seen as an economic burden to the system, do you really think that doctors would feel encouraged to be workaholics?

And even if they did, it is frequent that the resources their patients need are not available including diagnostics, cancer treatments, mental health support and on and on.

Some people including politicians and various colleges including the Ontario College of Family Physicians where the CEO is nurse Jan Kasperski) would like us to believe that capitated teams with other providers are the panacea to all that ails primary care from insufficient numbers of family physicians, to improved patient outcomes, to improved cost-effectiveness and productivity. But some proof is emerging that this is not the case.

A study assessing how family health teams are doing is being conducted by University of Ottawa professor Dr. William Hogg. Reported in the Ottawa Citizen, April 29 by Randall Denley, "Family Health teams need a checkup", Dr. Hogg is reported to have said that instead of increasing doctor capacity, doctors in FHTs are seeing patients just as they always have. Any increased efficiency is eaten up by the meetings that these multi-disciplinary practices require.

While doctors and patients like the teams, "this approach costs more, substantially more. "

Randall Denley indicates that the government will soon begin a five-year study of the pluses and minuses of family health teams. He writes, " The fact that they cost more without increasing productivity seems like a big negative."

I am concerned that by the time this study is completed, a new Ontario Premier will be in charge, the study will be forgotten and in the meantime fee-for-service...probably the most productive system around...will have died off.

Who cares you ask? If doctors are gravitating to teams (now remember that docs have always worked in teams, virtual or not) and to the higher pay in these new and ?improved teams. What happens after they turn out to be gobbling up oodles of cash? Six hundred million on 150 health teams is a fairly significant amount...just to get them going. What happens after that? What happens to all the orphaned patients as FFS doctors close up shop, unable to find replacements and cast adrift up to a couple thousand patients each?

Independent nurse-led clinics are not likely to be able to do the job with nurse practitioners seeing 7-12 patients a day (several times lower than what a typical family doctor would see in a day) at $86,000 to $100,000 no overhead plus benefits, referrals to specialists will increase swamping the sinking specialist boats too.

And as much as some groups have a "hate" on for walk-in-clinics and urgent care clinics, they do keep orphaned patients out of the ER quite well. Even if all the walk-in clinic docs switched to comprehensive family care, there are not likely to be sufficient numbers of them to absorb all the orphaned patients.

So it is clear to me that fee-for-service must be preserved because of its value in terms of productivity. The idea that salaried physicians working with less efficient nurse practitioners will be able to carry the health care load is misguided. But nobody asked me. I guess we'll just bumble along to the next provincial election with a tanking economy and the next Health Minister will take over along with his "eager to please the voters" Premier. Wonder who it will be and if they will care. Maybe Hugh McLeod will take the provincial lead....he was at the OMA gala as an invited guest/chief MOHLTC negotiator for the government after all, during OMA/MOHLTC negotiations no less.....nahhhhhh, he knows better.
As time allows, some thoughts on ramifications.

Insurance costs will shift, and rise at the expense of the taxpayers.

Until Jan 15, 2015, in Ontario, when less than optimistic care arose, the MD bore the hit of "money" caused by it. The CMPA, and other similar agencies, advised best care money can get. The courts had clearly said, money can not restrict care, placing the MD right in the firing line, if money restricted care. A large proportion of CMPA costs were paid by the provider, out of fees collected.

Central has now seized control and well, as they announced, impose a contract. It has publicly stated this is about saving money. Thus when money is restricting care, formally transfer the money issue to central, and document who, at central, is making the money care and picking up the liability.

So central tries to dodge accountability, but a wise patient hurt, with a good lawyer can track it, and sue. They sue central for cost avoidance, that the courts have viewed as not acceptable. The taxpayers now directly absorb the legal costs, and the settlements that might occur. Imagine the anger of the "wronged" patient now finding out, their tax dollars are being used to prevent them getting justice.

Not only will the be unfair, the costs to the tax paying system rises because this power grab, does pick up accountability costs.

Maybe, legislation will be passed formally indemnifying all cases of money restrictions by central free from prosecution.

All confabulated thoughts and concepts, but this changes things.
On the positive soon, in Ontario, CMPA fees could go down.

This change, and should, but as they do, it has major downstream shifts.

One would love to see the MOHLTC planning paper on this, and the issues NOT examined, but the position paper just deals with cost containment. Those pesky MOHLTC physician consultants may not be as thorough as they should be.
January 20, 2015 | Unregistered CommentermovingforwardOntario
" central tries to dodge accountability, but a wise patient hurt, with a good lawyer can track it, and sue. They sue central for cost avoidance, that the courts have viewed as not acceptable. The taxpayers now directly absorb the legal costs, and the settlements that might occur. Imagine the anger of the "wronged" patient now finding out, their tax dollars are being used to prevent them getting justice"

Already happens mfO.
Gov't spends bucket loads of cash trying to stop patients from getting care ie ALC patients, Wait Time strategies, Measurement systems etc.

When does the cost of keeping patients from getting care outweigh the cost of providing the care. At some point we can't provide more of either.
R

Not fighting you on this, we all now know, and have it based in evidence, that the ideology of income gap closure on a population basis, is more important to central than best possible health acre to an individual.You, as an individual, must compromise for the good of mankind.

"Life, liberty, and the pursuit of happiness" versus "peace, order, and good government". Neither right or wrong, just pick your ideology and support it as budgetary restraint. Works differently warn growth is occurring.
January 20, 2015 | Unregistered CommentermovingforwardOntario
Realist just read your post from 7 years ago which was very prescient like most of us on here,..lol. It is hard to believe that was written so long ago and we are only now seeing the ramifications which shows how slow health care really changes.

We sat down tonight and still figure we can make our clinic work economically for a while yet even with the cuts. The weekend code change is not a big deal.

I was speaking with a FP on a FHT today who said he is sick and tired of boomers coming in and whining about access or lack there of. He's so fed up he said he is ready to take the pay cut and move back to a CCM or pure FFS to be able to rid himself of the inherent COI capitation introduces between doctor and patient and which has made his heartburn much worse.
January 20, 2015 | Unregistered CommenterCanary in a Coal Mine
Don't blame central for the COI that exists between central and providers outside of the FFS relationship, or any of the other methods, where physicians become agents of central, and not the patient. Taking the "king's coin" has issues.
January 21, 2015 | Unregistered CommentermovingforwardOntario
Public policy.

Central should be about public policy. If the public policy is the MD pool is too big, central should provide the points where inefficiencies are, and do the targeted cuts with pinpoint precision, and then promote how effective central is. Instead, the public policy is, we are out of money, and thus must cut, and we are targeting the easy targets one by one, as we reduce costs. We have mismanaged the tax resources and now are correcting the bad management.
January 21, 2015 | Unregistered CommentermovingforwardOntario
mfo

"we are targeting the easy targets ".

It is more accurate to consider the government as reflexive rather than targeting.

The contractual disagreement is fairly easy to characterize. Government failed to monitor the outcome of previous agreements. Now it wishes the burden of cost increases to be shouldered by the providers.

A trivial example: waiting list efforts resulted in windfalls for some and the public display of mulitmillion dollar billing is an embarassment. Presumably none of the high rollers was fraudulent and government castigates these doctors for invoicing as directed.

This results from failing to modernize fee schedules which are the exclusive regulatory domain of government.

In addition, the next step of reconciling the budget demands a fee recovery mechanism to be implemented. An across-the-board 3.15% reduction recognizes no duty on the part of government to distinguish areas where needs are unmet from those areas where service utilization has grown well beyond population growth.

This tactic sinks all ships, friendly or enemy. The collateral damage of firing on your own initiatives will be most obvious and harmful.
January 21, 2015 | Unregistered Commentereklimek
Taking the "king's coin" has issues. Mfo

I said the same thing to myself when I heard his complaint. Some of these effects on a person are insidious and unless pointed out often they don't see them.

It will be very interesting to see if a reverse flow starts from FHNOT back to FFS models when the financial inequities are reduced and that COI stone in the shoe begins to grate further.
January 21, 2015 | Unregistered CommenterCanary in a Coal Mine
DrK

We are in agreement. This move further destablize the situation, and is not going to help. If a reduction is needed, pick the precise targets, and annouce why they must occur. Then move on.
January 21, 2015 | Unregistered CommentermovingforwardOntario
One suspects tyat there will be a barrier for those attempting to migrate back from the FHNOTs....but perhaps not in the over serviced areas.
January 21, 2015 | Unregistered CommenterAndris
The government has no clue what it is doing. It copies the NHS in some ways (wait times for the ER, what a fiasco) and the US in other ways (primary care homes when we already had a robust primary care system functioning here unlike the US).

It seems many of the people working within the MOHLTC have never really worked in Ontario. Eric Hoskins may have lots of awards for his work in Africa and that is all very well. He does not have much experience in the complexity of Ontario health care and yet he is vaulted into the position as Minister of Health because of exactly what??

Same with Dr Bell, former UHN exec and Medical Tourism officienado. Somehow now as Assistant Deputy Minister he is going to make the system work.

It's OPTICS...over and over again. No substance.

Let's see. We had George Smitherman (wasn't he a camera salesman or something before he go into politics)

Then David Caplan, nice guy, no clue.

Then Deb Matthews, the demographer whose neighbor was the OMA President and whose brother in law is Chair of the Board of Shoppers Drug Mart

Now we have Dr Hoskins who I'm sure is a very nice fellow and a doctor to boot...but he seems to have no idea about the history of the health care system in our province or how to fix it.

Over the years I have heard directly from people working within the Ministry who have told me they agree with me that we need a Hybrid and the system is unsustainable but they cannot make it happen. They usually move on to other things.

People, we've got to get this sorted out. Pay cuts are not going to do it. We need structural change.

Big question is:
Have the young and old MDs who have taken the "Kings coin" and bent to accommodate whatever money wss being sent their way still able to stand up from their sitting position and be strong?

Or

Are they so weakened from comfort and complacency that they can no longer do what is necessary to preserve both their dignity and health care access?
In my travels, I came across this infographic from the BMA. Young MDs might want to take note:
https://communities.bma.org.uk/community_focus/f/51/t/866?utm_source=The+British+Medical+Association&utm_medium=email&utm_campaign=5243689_NEW11Z1+MAIN+ENEWSLETTER+190115&utm_content=InfographicButton&dm_i=JVX,34E21,6K5DLQ,B6Z0D,1
Search for
"BMA How could future training reforms affect you?"

and you should get it.

Essentially in the UK it is being suggested that to train as a specialist you will have to be associated with a facility and community that wants you or you won't be trained.
Good to hear this privacy breach will be prosecuted.

"The anti-abortion activist who pried into hundreds of abortion records for over nine months at an Ontario hospital would be referred for prosecution today, the privacy commissioner says.

Acting privacy commissioner Brian Beamish told the Star the anti-abortion activist fired from Peterborough Regional Health Centre in 2011 had snooped into the files of 201 abortion patients, inappropriately accessing the records 414 times."

http://www.thestar.com/life/health_wellness/2015/01/21/anti-abortion-activist-snooped-into-414-abortion-files.html
January 21, 2015 | Unregistered CommenterCanary in a Coal Mine
Ruminations 2:

(Insurance was number 1)

Accountability is absence in the takeover. Since central wishes to "own", it has to assign accountability. When a licensed provider goes through the right steps, does the right things, and central doesn't want it occur, and needs to ration: name the individual and number of the provider consultant advising the rationing so that liability is transferred. Part of the "new" system must be a "central decided" accountability.

Ms. Smith, medically I advice you to do "x" in a timely fashion. My recommendation, or the timely fashion, isn't occurring despite my efforts, and your desire, to comply.Your contact for concern about this is "XXXXX" at central, who has been authorized by you, a taxpayer, to restrict your access to your care.
January 21, 2015 | Unregistered CommentermovingforwardOntario
Mfo Now we agree, just a wee bit further perhaps like this

If health care providers are to be agents of social policy they must be
immune from legal, disciplinary or other proceedings against them
resulting from compliance in good faith with the policy. Further, they
shall not be required to disclose in any proceeding the information
provided to them beyond that upon which compliance resulted. Failing this,
health care providers will make every effort to impose the burden of
compliance onto those immune from such actions.
January 21, 2015 | Unregistered CommenterEklimek
DrK:

Without any authority to speak for central, you are correct. Those who make the "final" decision should, and must, own the accountability. If central wants that, change the legislation to grant them that "privilege". Accept the imposed contract, and shift the d*** accountability!!

Ms. Smith, sorry you must die because things aren't available as I think best, but here's the MOHLTC personnel who has made that decision. Have a good day.
January 21, 2015 | Unregistered CommentermovingforwardOntario
"Ms. Smith, sorry you must die because things aren't available as I think best, but here's the MOHLTC personnel who has made that decision. Have a good day."

Perhaps it could be printed on a card and handed to the patient or better yet, send them to a web site where nurses can officially take care of it. It could be called

HealthCareDisConnect!
Media Release

FOR IMMEDIATE RELEASE


DOCTORSONTARIO DECLARES 'CODE RED' FOR FIRST TIME EVER;

PLANS JOB FAIR TO HELP DOCTORS FIND WORK IN FRIENDLIER JURISDICTIONS



(January 22, 2015, Toronto, Ontario) – Dr. Douglas Mark, Interim President of DoctorsOntario (DO), today issued a Code RED practice advisory for the first time ever, declaring the situation in the province of Ontario as untenable, as a result of fallout from the collapsed talks between the Ontario Medical Association (OMA) and the Government of Ontario. Dr. Mark also announced at the same time that DoctorsOntario would be providing doctors with talking points so they can discuss with their patients the ramifications of the Liberals imposing a deal on doctors instead of negotiating one, as well as organizing a job fair in the spring in order to help doctors find work in friendlier jurisdictions.



"It's with great reluctance that DoctorsOntario has been forced to issue its first ever Code RED declaration," Dr. Mark said. "Unfortunately, as a result of fallout from the collapsed talks between the OMA and the Liberal Government, we're left with no choice but to do so. The situation in Ontario has clearly become untenable, and we cannot in good conscience remain silent anymore.”



Dr. Mark went on to explain that one of the reasons doctors are so upset with the Liberals is that doctors had already agreed to a number of significant cuts in the last Physician Services Agreement in 2011, in addition to helping the Government find family doctors for over one million Ontarians and reduce waiting lists during that time. This is the real reason the Liberals spent $200 million more on healthcare than was budgeted for over the past three years, Dr. Mark said, not because doctors were milking the system or defrauding OHIP.



"Premier Kathleen Wynne and Treasury Board President Deb Matthews now own this agreement," Dr. Mark said. "When our healthcare system collapses over the course of the next three years, they'll be the ones responsible. In the meantime, DoctorsOntario will turn its attention to organizing a job fair in the spring in order to help doctors, especially the nearly twenty percent of new specialists who are unemployed, find work in friendlier jurisdictions—places where doctors are cherished and respected and not made to be scapegoats for the failures of others."



Dr. Mark also pointed out that the Liberals have, over the past decade, blown several billion dollars on various boondoggles such as eHealth, ORNGE air ambulance, and the cancellation of the gas plants. Money that would have gone a long way to helping alleviate some of the pressures our healthcare system is now facing. Instead of blaming doctors for the Government's inability to balance its budget, and making misleading claims that doctors have received a raise in salary of 61% since 2003, Dr. Mark suggested that the Premier and Treasury Board President would be wise to take a long look in the mirror.



“We have it on good authority that the Liberal Government presented the OMA with an offer sometime in December, 2014, which the Liberals threatened to withdraw should the OMA Board not accept it without first consulting the membership," Dr. Mark said. "To their credit, the Board refused to do so, which is why the Government imposed an even worse deal on doctors. This isn't bargaining in good faith. It's extortion, plain and simple."



Dr. Mark concluded his comments by saying that although his organization will encourage doctors to speak out on behalf of their profession and patients, he urges they do nothing to put their patients' health at risk. DoctorsOntario will be providing doctors with talking points, however, so they can discuss with their patients the ramifications of the Liberal Government's imposing a deal on Ontario's doctors instead of negotiating one. While these dialogues with patients may take up a lot of time and create significant log jams—which could have the unfortunate consequence of making it even harder to get an appointment or a referral with a doctor in a timely manner—Dr. Mark said he believes it is a small price to pay to help patients understand just what we are all up against, thanks to the Liberal Government's reckless decision to go it alone.



DoctorsOntario is a member-driven, grassroots organization dedicated to protecting the rights, freedoms and independence of Ontario physicians and their patients by promoting sustainable healthcare policies and practices that safeguard accessibility and the highest standards of medical care. For more information, please visit its website at www.doctorsontario.ca.

- 30 -



Contact: Stephen Skyvington

Phone: (416) 859-2239
January 21, 2015 | Unregistered CommenterStephen Skyvington
What was PWC thinking other than Wynn can now funnel government consulting contracts to them and with a Liberal insider keep the final reports to her liking.
January 21, 2015 | Unregistered CommenterCanary in a Coal Mine
CICM

Exactly.
January 22, 2015 | Unregistered CommentermovingforwardOntario
http://news.nationalpost.com/2015/01/22/sometimes-there-is-no-cure-doctors-machines-and-technology-can-keep-us-alive-but-why/

Ramping up the PR campaign. The public needs to accept, central will make the value of your life its business. Some lives ARE better than others, even economically.
January 22, 2015 | Unregistered CommentermovingforwardOntario
Despite the animosity, we need a rewrite of health on both sides. What are the reasonable medical expectations from a pooled system, what the responsibility as a patient to draw fairly from the pool, what to do with those who, knowingly, abuse, what to do with those, who biologically, can make it back to reasonable restorative care?

All the reasonable folk know, what we have is broken, so broken we are hurting the marginalized even more by our lack of clarity.
January 22, 2015 | Unregistered CommentermovingforwardOntario
Rumination 3:

Some areas of medical care are accelerating at much more rapid rates than other. We already have a care "gap" as our OECD rankings show. That is building. For those rapidly changing areas, this will only increase the gap.

One can likely agree that measuring a blood pressure could be a frozen, or flat service. One would likely reasonably state, access to targeted effective chemotherapy should be expanded.

Central is wrong with the imposition. It is regressive, and people will be hurt., who could have been helped.

Central is now purely an insurance company, trying to minimize its expenses, while maximizing profits, for central to disperse. Internal profits are as bad as external profits.

We all get, the complexity of infrastructure and process design. We are now firmly moving into a repressive system. Not a clever decision.

"the plan is good"
January 22, 2015 | Unregistered CommentermovingforwardOntario
http://www.thestar.com/life/health_wellness/2015/01/22/splinter-group-of-ontario-doctors-planning-a-protest-job-fair.html




Life / Health & Wellness
Splinter group of Ontario doctors planning a protest ‘job fair’
DoctorsOntario, a break-away group unhappy with the Ontario Medical Association, says it wants to help MDs find jobs in jurisdictions "friendlier" than Ontario.

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Dr. Douglas Mark leads a breakaway group unhappy with the OMA's representation of doctors in Ontario.

RICHARD LAUTENS / TORONTO STAR FILE PHOTO

Dr. Douglas Mark leads a breakaway group unhappy with the OMA's representation of doctors in Ontario.
By: Theresa Boyle Health, Published on Thu Jan 22 2015

A splinter group of doctors, angry with the outcome of the province’s negotiations with the Ontario Medical Association, is planning a job fair to help physicians find work in “friendlier” jurisdictions.

DoctorsOntario (formerly the Coalition of Family Physicians and Specialists of Ontario) will hold a job fair this spring to help doctors find jobs in “places where doctors are cherished and respected and not made to be scapegoats for the failures of others,” said the organization’s interim president, Dr. Douglas Mark, a Scarborough family physician.

The province last week imposed a new payment scheme on doctors after a year of negotiations with the OMA resulted in an impasse.

It will see a 2.65 per cent cut to all physician payments, including fee-for-service, salaries and alternative payment plans.

The pay cut will grow if doctors don’t stay within their budget of $11.4 billion this year and 1.25 per cent more in each of the next two years.

Health Minister Eric Hoskins has said that physician compensation has jumped by 61 per cent since the Liberals took power in 2003, with doctors now earning an average of $360,000 annually.

From their payments, doctors must pay overhead costs that amount on average to about 30 per cent of their billings.

DoctorsOntario is a small group of physicians unhappy with how the OMA has represented the profession. Mark said it has 1,000 members, up from 500 last year. The OMA, the recognized bargaining agent for doctors, has 28,000 members.

Mark said physicians are paying the price for the government’s inability to balance the budget and charged that it has “blown several billion dollars on various boondoggles,” including eHealth, ORNGE and the gas-fired power plants cancellation.

Former OMA president Dr. Doug Weir said DoctorsOntario “is not taken seriously by the majority of physicians in the province.”

Weir called the group’s approach “destructive” and said it’s important for physicians to try to work with the province.

On that note, he said he hopes the government will come back to the bargaining table, and said doctors are willing to take a pay freeze.

Even with a pay freeze taken into account, overall spending on physicians needs to grow at about 2.7 per cent annually to meet demands from a growing and aging population and to pay 700 new physicians who are graduating from medical school, Weir said.

Given this, it’s inevitable that doctors won’t be able to stay within their budget, he said, warning that patient care will ultimately suffer.

Weir said family physicians are getting the rawest deal because the province is not allowing any more doctors to join family health teams.

That might result in new grads going to other jurisdictions, he warned.
January 22, 2015 | Unregistered CommenterStephen Skyvington
Central is now purely an insurance company, trying to minimize its expenses, while maximizing profits, for central to disperse. Internal profits are as bad as external profits. Mfo

This is what needs to be said loud and clear by the OMA and others.
January 22, 2015 | Unregistered CommenterCanary in a Coal Mine
http://www.cbc.ca/player/Radio/Local+Shows/Ontario/Up+North/ID/2649458646/


Doctors' group concerned about lack of contract with the province

DoctorsOntario is encouraging physicians to look elsewhere for employment due to the current financial situation and suggests the province start offering options for people to pay for service.





Dr. Douglas Mark,
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Dr. Douglas Mark




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January 22, 2015 | Unregistered CommenterStephen Skyvington
"All the reasonable folk know, what we have is broken, so broken we are hurting the marginalized even more by our lack of clarity."-mfO

This is important.
January 22, 2015 | Unregistered CommenterMerrilee Fullerton
Without criticism, we need to acknowledge we have create a monopoly, that now has money issues, as a result of it having "money" issues, it needs to restrict access. By restricting access, some of us will die earlier than we need to.
January 23, 2015 | Unregistered CommentermovingforwardOntario
How the Ministry of Health or general public can think that doctors will continue to work as usual once the global cap has been reached for the fiscal year is beyond me. Why would anyone work for free and assume all the medical liability that their services provide? This has never to my knowledge been used against any public service provider in Canada.
January 23, 2015 | Unregistered CommenterGasman
I recall several decades ago a Swedish MD wanting to buy the house next door to me....with Swedish supertax he would work the second half of the year for nothing ( 95% + tax) so he wanted to set up a business in Canada to occupy him the second six months of each year.
January 23, 2015 | Unregistered CommenterAndris
Wait to see the details and terms of the contract. Not all known yet.
January 23, 2015 | Unregistered CommentermovingforwardOntario
The devil is usually in the details....when will they be sprung?
January 23, 2015 | Unregistered CommenterAndris
With all the leadership knowledge available today, it's obvious that the Ministry of Health hasn't learned any of it. You cannot dictate to people in this day and age and expect to conduct business as usual. The demoralizing effect will be huge.
January 24, 2015 | Unregistered CommentermovingbackwardOntario
On becoming a capped contract work of the state:

Although some believe the bell can be unrung, it won't be.

Four big issues to address:

1. the state will decide what services that will be delivered.
2. An overall cap will be in place.
3. Desired, top edge technology/therapies, will become harder to access.
4. Taxes/fees will go up
January 24, 2015 | Unregistered CommentermovingforwardOntario
As the HMO (or managed care organization) or MCO squeezes, next step will a transfer of the OHIP pool to LHIN management., given the LHINs more ability to manage resources in their regions - a co-management approach.
January 24, 2015 | Unregistered CommentermovingforwardOntario

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