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

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

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« Wynne's Dysfunctional Approach to Solving Ontario's Healthcare Challenges | Main | Dr Hoskins' "Patients First" Transformation-More Bureaucracy in Disguise »
Wednesday
Jul132016

The Tentative Ontario Doctors' Deal-What it means to you

Whether you are an MD, a patient, or an Ontario resident, you should know what the tentative deal between the Ontario Medical Association and the Ministry of Health means to you. In essence, this deal will not provide greater access to care, nor will it meet the growing demand for care. With the proposed co-management arrangement, the Wynne Liberals will be dictating doctors’ services to an even greater extent, making it harder for many patients to get the care they need and harder for physicians to provide it.

It is clear something had to happen as Ontario MDs have been without a contract since 2014. Of the contract details, two proposed aspects are being heralded as breakthroughs: the 2.5% “increase” for doctors and the “co-management” of the system by physicians and Ministry of Health officials.

The sudden news of a 2.5% “increase” annually for four years arriving on the coat tails of the hard-nosed negotiations by the Ministry seems too good to be true. Understanding the details is critical to understanding what this contract really provides.

The 2.5% “increase” is for total services to be provided by physicians via the “Physician Services Budget” or PBS. Just as the name implies, this is a pool of money that government provides for physician services. It does not mean that your local physician will receive a 2.5% pay increase. This does not signal that s/he will now be paid more and able to provide more patient services or that patients will have improved access.

So, what does it mean then?

The 2.5% “increase” is simply an expansion of the funding pool to be spread across more people and more services as our population ages and expands over the duration of the four-year contract. However, this falls short of the demand for physician care. It is estimated that the need for physician services rises on average by 3.1% per year. That 2.5% “increase” per year is simply a continuation of the underfunding of the health care system by the Wynne Government.

Once again, hidden behind the headlines we see that political optics drive the self-serving Liberal agenda. This deal is not about access for patients or empowering front-line providers to meet the demand for care. If it was, it would have taken a very different form. Instead, the tentative agreement is all about self-preservation, by both the Ontario Medical Association and the Ontario Liberal government. It’s about how best to sell the public (and the physicians) on the merits of a possible contract that will continue to underfund health care.

The harsh reality across Ontario has many medical clinics struggling to stay viable and hospitals being forced to cut front line workers in order to meet their budget obligations required by law.  Meeting the growing need for patient care is being made harder and harder under the Ontario Liberal government. As costs of overhead continue to rise due to flawed provincial energy policies (and now we all must brace ourselves for the introduction of the provincial carbon tax), costs of operating medical facilities will grow—whether they are hospitals or community clinics. Under the Wynne Liberals, it is harder and harder to provide medical care to a larger and aging population.

It is an understatement to state the Ontario Liberals have been undisciplined in their management of tax-payer dollars. The waste, spending scandals, and mismanagement are well-reported over many years. Ontarians have a billion dollars a month siphoned off to pay interest on the Wynne Government’s debt instead of addressing patient need and funding for patient services. Now, under this tentative contract, physicians will be co-opted into “co-managing” the health care system hand in hand with this reckless government. Is this something to be celebrated as the headlines suggest? Where is the independent physician organization that can stand up to government’s self-serving political agenda?

Co-management of Ontario’s health system is a slight of hand given the government’s ability to pay for the services Ontarians require is diminished with every monthly billion dollar interest payment. As is the Liberal tradition of naming their legislation, the new deal is being sold to physicians and to patients as “The Best Deal Ever for Everyone.” But it isn’t—far from it.

Physicians, patients, and the public in general should understand that the tentative agreement as it currently exists will not provide more access to care or meet the growing demand for care. What it will create is further rationing of care required contractually to be done by physicians. And, unfortunately, Ontario’s physicians, through their provincial association and the new “co-management” arrangement, will be co-managing our health system’s retractions.  

Ontarians and the province’s medical community are to learn more about the details of this Ministry of Health-OMA agreement in the weeks ahead. One can only hope that there is a more serious review of both the inadequate funding and proposed "co-management” arrangement. Our doctors deserve better; Ontarians deserve better.

 

Reader Comments (449)

The vote will be a 60% or more NO.

Then the OMA Board will do the sleazy thing yet by accepting the deal in spite of what a majority of its members wants.

Mark my words.
July 15, 2016 | Unregistered CommenterStephen Skyvington
This is a clear central win. It is a clear lose for the doctors. If they are unhappy now, they will be miserable in the future.
July 15, 2016 | Unregistered CommenterMovingforwardOntario
I hope the "NO" vote wins because it will bring about a more principled solution.

I've seen this scenario before. The MDs that are not in paid positions as "Physician Leaders" or in some other salaried position are vocal in denouncing the agreement. They see lack of process and lack of transparency and a deal that is intended by OMA to align with government agenda even if that agenda railroads MDs, damages care to patients, and damages the profession.The lack of ethics and vision bothers them. They can't vote for the deal.

On the other hand, many medical students have limited context and allow the paid "Physician Leaders" to influence their decisions. They simply can't know any different than what their trusted mentors tell them. I can't blame them, they just have limited experience and context. No matter how bad the contract might be for their futures they just can't see it.

The Drug Bribe canned a tentative deal about 10 years ago but I believe that was before medical students were given a vote. I might be wrong on that timeline.

To be clear, I'm not blaming medical students if there is a "Yes" vote. I'm
just saying that the block of medical students is something that the OMA seems to depend on for the contract sway as it aligns with government.
July 15, 2016 | Unregistered CommenterMerrilee Fullerton
This just hit the Medical Post web site. The Medical Post will be emailing it to all doctors in Canada as the lead story in Monday's electronic newsletter.

I'd say the OMA and the YES side is in a wee bit of trouble.

Oh, and by the way, DoctorsOntario has been contacted about helping to lead the NO coalition which is growing by the day.

Cheers.

Stephen



http://www.canadianhealthcarenetwork.ca/physicians/discussions/opinion/another-vote-for-no-in-ontario-45784








Another vote for ‘no’ in Ontario


Written by Dr. Douglas Mark on July 15, 2016 for CanadianHealthcareNetwork.ca

Email Print Text size Comment

“We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.”
— Elie Wiesel, Holocaust survivor and Nobel Peace Prize winner

Dr. Douglas Mark
Dr. Douglas Mark
By now, most everyone has seen the movie Groundhog Day. In it, Bill Murray plays a TV weatherman who reluctantly agrees to cover the story of Punxsutawney Phil for the fourth year in a row. Making little effort to hide his disdain, Murray does his job and moves on, ready to forget all about Phil for another year. However, when he wakes up the following day, our hero discovers it’s once again Groundhog Day, and the nightmare repeats over and over again.
Dealing with the Ontario Medical Association and the province’s Ministry of Health and Long-Term Care is a lot like that movie. No matter how hard we try, Ontario’s doctors find themselves trapped in a nightmare from which we can’t awake.
Take, for instance, the latest Physician Services Agreement foisted upon the medical profession July 11.
This deal, which was negotiated in secret by the OMA and the government, is but the latest failed agreement our association has negotiated on our behalf over the past decade. Only this time, they’ve really outdone themselves.
While the OMA would like us to believe it has negotiated a 10% raise for Ontario’s doctors, what it has really done is sold us out again just so it can “co-manage” our healthcare system with the government.
As if this wasn’t bad enough, doctors will now be asked to help the OMA identify a minimum of $100 million per year in cuts to the fee schedule. This will not only hurt doctors, it will also hurt our patients, who will bear the brunt of the government’s recklessness and the OMA’s thirst to justify forcing every doctor in Ontario to pay mandatory dues via the Rand formula—whether they wish to be members or not.
All of which would be funny, if only so many lives weren’t at risk.
This is why, after careful consideration, and full acknowledgement of what a “no” vote would mean, the board of DoctorsOntario has unanimously reached the conclusion that for the good of Ontario’s doctors and our patients, we recommend our members vote “no.”
While there are a number of reasons to reject this deal, we’ve narrowed it down to the following five:
1. The new OMA president, Dr. Virginia Walley, promised the OMA wouldn’t resume negotiations without the government first agreeing to binding arbitration. Dr. Walley broke this promise, not only to her members but also to OMA council, who made it clear that without binding arbitration there would be no deal.
2. While the OMA and the government will spin this to the media that Ontario’s doctors are receiving a 10% pay raise over the next four years, the truth is this new agreement actually makes permanent the 15% cuts to our fees the government unilaterally imposed on doctors the past two-plus years we’ve been without a contract.
3. By agreeing to “co-manage” the health-care system with the government, the OMA has now put every doctor in the province in the position of helping the government ration care, thereby forcing us to throw our patients “under the bus” in order to help the government save money and win the next election.
4. Should the province find it has spent too much money on physician services at the end of each fiscal year, this agreement will make Ontario’s doctors solely responsible for that over-run, which may result in clawbacks as high as 10% to 20%.
5. By signing this agreement, and urging Ontario’s doctors to support it, the OMA has placed its own interests (i.e., the $50 million to $60 million per year in mandatory dues from doctors) above those of its members and our patients.
For these reasons and more, we urge our colleagues to reject this offer and vote “no.” We also encourage them to make sure they let the OMA know how they feel by exercising their franchise and taking part in the upcoming referendum.
We need a huge voter turnout to be successful, and will likely require at least a 60% “no” vote in order to ensure the OMA doesn’t ignore the will of its members and accept the deal anyway. Remember, this is a “non-binding” referendum; it’s only meant to “advise” the OMA board. It can choose to ignore the results.
Should we succeed in voting down this agreement, however, DoctorsOntario will demand OMA president Dr. Walley and Ontario Minister of Health Dr. Eric Hoskins do the right thing and resign. We will also petition the OMA to stop forcing doctors to pay dues and to hold a new referendum, asking Ontario’s doctors who they would prefer to have as their representative.
In the meantime, we need everyone’s help to get our message out to as many doctors as possible before voting starts on July 27.
As someone once said, “Those who don’t learn from history are doomed to repeat it.”
It’s time to wake up.
Dr. Douglas Mark is the interim president of DoctorsOntario. Follow him on Twitter @DocsOntario.
Opinions expressed in this article are those of the writers, and do not necessarily reflect those of CanadianHealthcareNetwork.ca, or its parent company.
July 15, 2016 | Unregistered CommenterStephen Skyvington
The difference this time, with regards to the medical students, is that many are members of COD, who are educating them about the reality of the deal. It won't be an easy 5,000 votes for the OMA this time. I think they've made a bad miscalculation. Again, those who don't learn from history, are doomed to repeat it. Don't be that guy.
July 15, 2016 | Unregistered CommenterStephen Skyvington
Plan A; Do nothing
Pan B:Accept the deal,take the money,and actively participate in the further rationing to come.
Plan C:Reject the deal by 65% or more,with the stipulation since no negotiation process was followed,that both the OMA CEO and Minister of health resign,within 1 week of the vote.If not gone within a week.A one day sick day occurs. Only hospital EDs,and in patient care will be spared the sick day.
July 15, 2016 | Unregistered CommenterMovingforwardOntario
mfo, are you coming over from the dark side?

I love your strategic advice.

Cheers.
July 15, 2016 | Unregistered CommenterStephen Skyvington
The medical student vote could be the deciding factor.

The majority is often silent. We'll see.
No not moving from dark side,but do recognize what a mess this will become.

One must separate out the issues.

The OMA has not handled its internal processes well. Those internal issues will need to get addressed. Those issues are separate from the proposal on the table.

The proposal turns MDs,formally,into rationers,whom make more money the more they ration. One does not support putting these individuals into such a daily conflict of interest issue.It is stressful and wrong. The issue is unnecessary utilization and centrals afraid to discuss that.Thus it seeks to get the OMA to support a proposal making the MDs the scapegoats for utilization.

Central has run out of ideas. That is why it bullys. It bullied the OMA board to "endorse" the deal. If they didn't endorse, deal comes off the table. The MDs do have an opportunity to change things. Central is worried.This deal goes down, central will beat the MDs viciously for 2 years, but the MDs can beat back, by constantly referring delays and shortages issues back to centrals cuts. Sorry about the delays,gaps, and other issues, call 1 800 MOH solves for immediate central correction!.
July 15, 2016 | Unregistered CommenterMovingforwardOntario
Read the comments.
Are the by-elections the reason for the sudden appearance of the tentative agreement?

http://shawnwhatley.com/new-deal/
July 16, 2016 | Unregistered CommenterMerrilee Fullerton
R

This is government desperately trying to maintain a majority.
July 16, 2016 | Unregistered CommenterMovingforwardOntario
Ignoring the obvious issues within the OMA, there are two major issues the proposed deal will do to impact the future.

First, centrals' openingly acknowledging it discriminates. It has targeted the MD group,publicly stating, we know the growth is above 3.2%,we will only fund you at 1.25% and the difference will we take from you. This behavior,on its own, is completely unacceptable from a government. On its own, it is a reason to vote down this deal, and demand the Minister resigns.He is shown to be a government representative who discriminates against a group.

The second,of course,is that it turns each physician into an overt rationer. Each time you contact a physician, their first action is- how do I deny you care, to save money.
July 16, 2016 | Unregistered CommenterMovingforwardOntario
" The doctor will be denying you care to save the health care system money"....might as well put that sign in all doctors' offices and hospital/ ER entrances if there is a " Yes" vote.
July 16, 2016 | Unregistered CommenterAndris
mfO,
Exactly. Well said.

There is no way that this is a long term approach. We are rapidly approaching 2025. Now that it appears the Federal Liberals will cut the rate of health care transfers, the MDs who I've heard say "All we need is a Federal Liberal government to get the funding we need for health care" are choking on their fairy dust.
True enough, those who voted for the politicians responsible and who fell for their promises , unless they are in complete denial, must be regretting their actions.
July 16, 2016 | Unregistered CommenterAndris
I see Concerned Ontario Doctors are organizing a rally Friday July 22 to end at OMA.
July 16, 2016 | Unregistered CommenterMerrilee Fullerton
R

One can only hope the physicians get what is really gone on here.

This is an ideological fight. This government wishes to assure the status and role of physicians is massively changed. There is no support at any level of the government for fair and balanced negotiation,and central is being driven by ideological groups of all types to "put physicians in their place."
July 16, 2016 | Unregistered CommenterMovingforwardOntario
I spent some time discussing this deal with physician acquaintances. I have never seen so many people anger,and demoralized..We will not recover from this.
July 17, 2016 | Unregistered CommenterMovingforwardOntario
As I have repeatedly mentioned over the years , the main cause of crises in our health care system have been solutions to previous crises which were themselves caused by solutions to prior crises which were themselves generated by solutions to previous perceived problems in the health care system.

This latest non solution may well be the coup de grace....the health care system would have been better off if the powers that be had left it alone as it was, let's say , in 1970.

" Any intelligent fool can make things bigger and more complex....it takes a touch of genius and a lot of courage to move in the opposite direction".( EE. Schumacher and Einstein).

Presently we have cowardly intelligent fools at the helm of our own health care system who have the bit between their teeth...they are building a health care system that will destroy initiative, a bureaucratic maze that requires navigators, a bureacracy that will force the profession to practice nonsense.
July 17, 2016 | Unregistered CommenterAndris
Andris,
Put more simply the current Liberal efforts play to the bureaucratic ego as well as to academia. There is an entire industry being built around the bureaucratic maze of measuring and monitoring and yet the very basic kinds of care by the most vulnerable are lacking.

What is the point of growing the bureaucracy to measure what you cannot afford to fix? Just to know you can't afford to fix it? Hardly helpful to patients.
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
Would some industrious sleuth inclined poster like to dig up where the former OMA presidents went after they left the OMA? What government positions did they take? Which hospital position ? Which government funded agency did they move to?

Just asking.
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
http://oma.drjjw.com/



assuming this is for real, 91% of respondents are voting no to the oma deal.



worried the oma is going to cancel the referendum so they can ram the deal through anyway without the embarrassing referendum results.
July 17, 2016 | Unregistered CommenterStephen Skyvington
Hmmm.

Read this. Be informed. Consider different perspectives beyond the OMA "opinion". Be a critical thinker.

From a source:

"On the Tentative Physician Services Agreement Endorsed by the OMA, July 2016

Recently, I wrote a brief article entitled: “On Bill 210, Patients First Act, 2016”. In that article, I attempted to increase awareness of the true nature of the proposed legislation as it seemed to me that there was a disconnect between what was being said about the legislation and what it actually says.
I have now reviewed the tentative Physician Services Agreement (“TPSA”) and, again, I am concerned that what is being said about the TPSA is not what the TPSA actually says. So, as a doctor and a lawyer, I again feel compelled to comment.
Regardless of whether you ultimately vote “no” or “yes” in the upcoming member ratification vote, it is essential that all physicians make an informed decision.
Please read the TPSA for yourself.
Here are some points to consider.
• Under the TPSA, the government will not repay any of its unilateral cut-backs
• The government will not undo any of its unilateral changes to the Schedule of Benefits
• Physicians will have no right to binding arbitration
• Physicians will be forced to continue to fund protracted litigation to gain binding arbitration
• Physicians will water-down the Charter challenge by giving up claims to damages and costs even if the case is successful
• The TPSA imposes an arbitrary annual cap to healthcare funding that likely under-funds healthcare needs every year
• The TPSA sets its baseline healthcare funding at 2015-2016 levels, thus cementing the about 7% (or more) physician payment cut-backs that year
• It appears likely that the TPSA will guarantee further cut-backs to physicians each and every year
• The TPSA shifts all of the downside risk of funding shortfalls in the province’s healthcare budget from the government to a small segment of society: physicians
• The TPSA’s one-time annual payment scheme seems illusory; one-time payments will likely be clawed-back each year
• Simplifying for the sake of brevity, the TPSA essentially provides increases to baseline funding of 2.92% in year one, 3.5% in year two, 3.46% in year three, and 3.28% in year four (increases = 2.5% + one-time payment annually)
• Fact-check for yourself, but actual annual funding needs to increase by at least over 3% (and could be much higher given our growing and ageing population)
• As such, it appears likely that the one-time payment in year one ($50 million or 0.42%) will be clawed back
• Claw-backs could be even worse in years two to four as the TPSA allows claw-backs in those years to exceed the value of the one-time payments
• The TPSA provides that excess amounts could be recovered by reducing future one-time payments
• However, the TPSA leaves the door open to the OMA/MOHLTC to address any additional overages “through the co-management process”; thus, physicians are left with no certainty as there is arguably no ceiling limiting the magnitude of potential claw-backs in years two to four
• Should physicians somehow not exceed an arbitrary annual cap, one-time payment surplus amounts will not be shared equally; rather, the OMA/MOHLTC will handpick who receives funding
• Physicians will “modernize” the Schedule of Benefits by accepting new, permanent fee reductions of $100 million by 2017 and another $100 million by 2019
• A new, bilateral “physician supply and distribution” group will produce recommendations by 2017 to assist the MOHLTC to plan e.g. where physicians may practice
• By November 2016, the parties will amend primary care physician agreements to “improve” e.g. evening, weekend, and holiday coverage, and same or next day urgent access (essentially enacting portions of Bill 210)
• While some applaud these initiatives, the TPSA provides no new funding to support them
• The NGEP will be scrapped, and “Managed Entry” to FHN/FHOs will be reinstituted
• This does not equate to the PEMs being “open again”; rather, entry is still on a limited first-come first-served basis and can take an indeterminate amount of time to approve
• Further, some maintain that joining PEMs now may be a Pyrrhic victory given the potentially significant changes to be visited upon primary care under Bill 210
• It is unclear to me whether Income Stabilization is being reinstated or not
• The TPSA fails to provide more funds to ameliorate new Specialist under/unemployment
Some other points to bear in mind:
• By refusing to ratify the TPSA, physicians are not prejudicing the Charter challenge; the parties’ Memorandum of Understanding specifically provides protection
• Under the TPSA, the annual budget will be monitored regularly and cut-backs will be made periodically and “as soon as possible” throughout the year; thus, Specialist colleagues will not escape future cut-backs by working part-time in other jurisdictions
• One suggestion for future negotiations: when endorsing an agreement, please consider negotiating the wording of a joint press release instead of ceding control of the narrative
• The MOHLTC was quick to publicly proclaim that “doctors have agreed to a deal with pay raises”; a joint statement may have obviated the need to counter that perception
Finally, some say that the TPSA is: “the best we’re going to get”, and that worse cut-backs will be imposed if we do not ratify the agreement. That may be the case.
However, when weighing these arguments for yourself, I suggest that you ask yourself the following:
• Does the business case for the TPSA makes sense for your practice, your employees, your colleagues, and your patients?
• Do you agree with entrenching the approach of arbitrarily pre-determining capped healthcare budgets with overages offloaded for payment to a small segment of society (physicians)?
• Are you comfortable ratifying an agreement that legitimizes the unilateral cuts and that, arguably, enables the government to continue doing what it was doing unilaterally but now with your express imprimatur?
• Will you be failing in your ethical duty to protect your patients by agreeing to knowingly under-fund the healthcare system?
• Does the TPSA provide you with any additional benefit (this is a negotiation after all), or will you still be required to work longer and harder for less?
• Two years ago, doctors proposed a wage freeze. Are you now willing to accept the new normal of claw-backs? Is that reasonable given the essential nature of physicians’ work and given that sufficient funds are apparently available to increase funding now for other organizations?
• Are you comfortable with the publicly-espoused position that the TPSA represents a raise for doctors?
• Has sufficient time been provided to fully review the TPSA now, and why is there suddenly time-pressure to ratify this TPSA when doctors have already waited for years for an agreement? Who actually benefits from this accelerated timeline?
• If further cut-backs are inevitable, would it be preferable to require the government to own them and accept the political repercussions, if any, as a result?
Please read the TPSA for yourself now.
This article is not to be read as providing legal advice in any way – please consult your own lawyer"
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
Stephen,
The real danger to patients and providers is that the OMA and government will work together to ration care. If you fit the advantageous politically beneficial groups then you may be supported. If you are in a quiet, voiceless group your MD will no longer be able to advocate for you. The rationers will determine thumbs up or thumbs down.

Intriguing how unfair "equality" can be when distorted for political gain.
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
"Has sufficient time been provided to fully review the TPSA now, and why is there suddenly time-pressure to ratify this TPSA when doctors have already waited for years for an agreement? Who actually benefits from this accelerated timeline?"

By-elections as a pressure for government to push this through?
Results of the vote will be buried in the first few days of Olympic coverage. Sneaky way to stay out of the media and out of the public eye.

It grows more obstreperous by the day.
What was the OMA thinking? Perhaps the OMA is overwhelmed by its own Groupthink or perhaps it is so entwined in the government that it is unable to disentangle its morals. Perhaps both.
" I am concerned that what is being said about the TPSA is not what the TPSA actually says. So, as a doctor and a lawyer, I again feel compelled to comment."
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
"Will you be failing in your ethical duty to protect your patients by agreeing to knowingly under-fund the healthcare system?"

And not only under-funding the system but simultaneously legally forcing patients to be dependent on an under-funded system
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
Thank you to Dr Jacobs for his honesty and courage.
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
Ask the MOHLTC what the out of province/country service bill was for fiscal 2015-2016.Needed medical services now being purchased because Ontario can't provide them.It is a public figure.
July 17, 2016 | Unregistered CommenterMovingforwardOntario
Good question mfO.
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
mfO,
Are you referring to the out of province costs related to patient requests for out of country coverage?
July 17, 2016 | Unregistered CommenterMerrilee Fullerton
Yes
July 18, 2016 | Unregistered CommenterMovingforwardOntario
As for the purposed deal:

Either a 1.25% increase by central,to fund health care growing at 3.3% (about),with the gap covered by claw-backs (the current status).

0r

A 2.5% increase (about) by central, identify cuts and impose them on some segment of current healthcare, with any shortfall covered by claw-backs.

Why would anyone stay with a government so hateful towards a group of its citizens?
July 18, 2016 | Unregistered CommenterMovingforwardOntario
https://www.thestar.com/opinion/commentary/2016/07/18/new-md-deal-means-co-managing-health-systems-retractions.html
July 18, 2016 | Unregistered CommenterStephen Skyvington
Nice article R. For balance below is the OMA .

Dr Walley said, "Ultimately, the Ministry and the OMA were unable to agree on a Mediation-Arbitration process."

If indeed this is the best deal the OMA can get, then it's time to get a better negotiating body..



---------------------------------------------------------------------------


VM Walley 15 July at 13:45

Dear David Jacobs,

I want to respond to your posts point by point with some clarification and corrections. I regret having to do this publicly but I will, so I may reassure those others who may have seen your original post.

1. Process Council directed the OMA to demand a binding dispute resolution mechanism – which the OMA did.

As we have said to members, the OMA held a number of meetings with government to explore if there was an opportunity to return to negotiations under a Mediation-Arbitration framework, and we presented several possible frameworks to government.

We had a thorough discussion on Mediation-Arbitration with the Ministry, who felt that any agreement on Mediation-Arbitration would require exploring a range of possible conditions with respect to a fixed and reasonable physician services budget (PSB) and growth.

With the direction of the OMA Board, the OMA did explore the opportunity to see if there was a range of outcomes on the PSB growth that would be satisfactory to both parties.

Ultimately, the Ministry and the OMA were unable to agree on a Mediation-Arbitration process.

As our discussions progressed, it became apparent that, while there was a wide gap between the parties with respect to Mediation-Arbitration, the two sides could come to agreement on a specific set of numbers.

It is in this context that the discussions for a possible return to negotiations under a Mediation-Arbitration framework moved into the negotiation of a possible Physician Services Agreement (PSA).

These discussions were held on a confidential, without prejudice basis.
We could not have shared those discussions with members without compromising the potential agreement and our Charter challenge

2. Transparency

These discussions were not conducted by the Negotiations Committee. The small group holding the discussions did update both the Negotiations Committee and Negotiations Advisory Committee on the discussions, including the exploration of Mediation-Arbitration with the Ministry.

Members of the Negotiations Committee and Negotiations Advisory Committee are bound by confidentiality rules and are “non-representative positions with a fiduciary duty to represent the profession at large” and not any particular section or other group they belong to (this is clearly stated in their Terms of Reference).

Significant cuts to medical supply were not part of the PSA discussions with the government. The OMA does have an OMA Human Resources Committee (OHRC). The OHRC reported at the Council meeting in May (below).
OMA Physician Human Resources (OHRC) Update (Agenda #12.1)
92. The OMA Human Resources Committee (OHRC) has been re-constituted to provide advice to the OMA Board on existing and emerging physician human resources issues. The OHRC membership consists of Dr. Gail Beck (Chair), Dr. Lesley Barron, Dr. Stephen Cooper, and Dr. Deborah Hellyer. The OHRC has been meeting regularly since last Fall. It is reviewing the OMA position on physician human resources which was developed approximately a decade ago. The OHRC is also assembling research examining the supply and distribution of physicians in Ontario. 93. Council will be provided with a presentation on the major demographic trends related to Ontario’s current and future physician supply.
The presentation clearly laid out the current oversupply for physician – see slide 39, below. This information is posted on the OMA website, and accessible to all members. https://www.oma.org/…/Comm…/Council/Pages/Presentations.aspx

There are no Board or Council motions associated with the presentation just referred to. It is an issue that needs to be looked at and understood, and that is what the tentative PSA calls for - a committee to do just that, future-directed, and with the interests of those currently in Ontario’s training programs in mind.

3. Outcome
It is incorrect to state, “Based on growth estimates, THERE WILL BE CLAWBACKS”.
As we have shown in the Financial Impact document, currently posted on the OMA website, under current utilization, the negotiated funding for growth, one-time payments and two SOB modernizations, is expected to keep expenditures within the planned PSB and one-time payments without need for any other adjustments. https://www.oma.org/…/Doc…/FinImpactTentativePhySvcsAgmt.pdf

It is important that we all know the facts and I hope this helps in that regard.

Sincerely,
Virginia @VirginiaWalley
VIRGINIA M. WALLEY, MD President Ontario Medical Association
July 18, 2016 | Unregistered Commentereklimek
" Ultimately, the Ministry and the OMA were unable to agree on a Mediation- Arbitration process....as our discussions progressed..."

Why did they progress?

They could have , should have, walked off.
July 18, 2016 | Unregistered CommenterAndris
"Compromise" takes on a new meaning.
"Abdication" comes to mind.
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
and "expected" is such a convenient word.... come on. Groupthink at its worst coupled with abdication of responsibility to both patients and physicians.

The winners in this contract? The OMA secures its existence as a rationer and the government gets the semblance of making up with health providers before important by-elections.

Vote No.
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
As a province, we must move past the inertia that health care "transformation" is creating. The current transformation under the Liberal government is just building bureaucracy.
Ontario can do much better. We have to do better than this.
<<Put more simply the current Liberal efforts play to the bureaucratic ego as well as to academia>> - Dr. F

and

<<The real danger to patients and providers is that the OMA and government will work together to ration care.>> - Dr. F

Question:

How can any of this possibly reconcile with the "Putting Patients First" direction clearly enunciated in the Minister's September 25, 2014 mandate letter?
https://www.ontario.ca/page/2014-mandate-letter-health-and-long-term-care

Answer:

It cannot.

We are en route towards an epic fail.
July 18, 2016 | Unregistered CommenterExecutive Lead Blogger
Excerpt from today's TStar article:

"Whether you are an MD, a patient, or an Ontario resident, you should know what the tentative deal between the Ontario Medical Association and the Ministry of Health means to you. In essence, this deal will not provide greater access to care, nor will it meet the growing demand for care. With the proposed co-management arrangement, the Wynne Liberals will be dictating doctors’ services to an even greater extent, making it harder for many patients to get the care they need and harder for physicians to provide it.

It is clear something had to happen as Ontario MDs have been without a contract since 2014. Of the contract details, two proposed aspects are being heralded as breakthroughs: the 2.5 per cent “increase” for doctors and the “co-management” of the system by physicians and Ministry of Health officials.

The sudden news of a 2.5 per cent “increase” annually for four years arriving on the coat tails of the hard-nosed negotiations by the ministry seems too good to be true. Understanding the details is critical to understanding what this contract really provides.

The 2.5 per cent “increase” is for total services to be provided by physicians via the “Physician Services Budget.” Just as the name implies, this is a pool of money government provides for physician services. It does not mean that your local physician will receive a 2.5 per cent pay increase. This does not signal that she or he will now be paid more and able to provide more patient services or that patients will have improved access."
"We are en route towards an epic fail."-ELB

Blunt but succinct.

I wish reporters and journalists truly understood what we are facing. They have power in their words and should be attempting to understand how quickly we are speeding toward the brick wall. Instead, we have health care legislation that doesn't provide solutions but which sounds good. It's all so superficial.

Freedom is needed and so far undervalued in Ontario health care.
It won't fail. But the doctors are being set up. Health involves the three groups, the funder, the provider, the patient. The funder and provider are cutting a deal about the patient. The patient has been advised they have unlimited free access. The funder, once the deal is cut, walks out on the provider, whom then takes all the heat, and internal angst.
July 18, 2016 | Unregistered CommenterMovingforwardOntario
https://drscottwooder.wordpress.com/2016/07/17/i-vote-yes/

What is he actually saying?
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
Why YES will win.

It is a very bad deal, fought over issues resolved already. Physicians are viewed as overpaid, and the amount of money will be reduced. You are a targeted group. You allowed that to occur. You will remain targeted.

Given that, the OMA lawyers have pointed out you have no chance of getting past clawbacks back, nor any future clawbacks even if the Charter fight is successful. So you can vote NO, and take more clawbacks, or take the extra 1.25% that central is offering as a bribe, and divide it up. Last easy money hitting the table. Not much, but it is out there.

The young ones are stuck, those over 45 can squeeze a little more out, and maybe find greener pasture, but don't count on it. You are targeted and the OMA got you one last dribble of cash. Take it.

In 4 years, it will be a mess. Right now just the patients are going to feel. You wait in four years, the real reductions hit.
July 18, 2016 | Unregistered CommenterMovingforwardOntario
mfO,

You write:
"You allowed that to occur". Agreed...for all the wrong reasons.

So, now you suggest "Take it"? I think your tongue is planted firmly in your cheek mfO.

Swaying in the wind means doctors stand for nothing---nothing.

Stand for something. Stand up for yourselves. Stand up for Patients.

In the end, we all live with our consciences, that's it, that's all.

Grabbing for the "one last dribble" is hardly an act driven by conscience.

Stand up for yourselves and for patients. MDs must not become henchmen for this very badly flawed government.
Everyone with a vested interest in this important issue (literally, almost everyone in the province) has to understand that the government of the day has offered this agreement to the OMA for one sole purpose: to button down a diminishing but still influential stakeholder group in order to maintain its majority position in the legislature.

That is all.
July 18, 2016 | Unregistered CommenterExecutive Lead Blogger

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