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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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)

You hit the nail firmly in the head.
The by-elections coming are creating an urgency for the "cash-for-access-Wynne-Liberals".

The OMA has been overcome by Groupthink and Egos.

Stand up for yourselves and Stand up for Patients.

OMA presidents and board members should be required to vow a 5 year cooling off period before taking the next cushy government funded position.
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
Should read hit the nail "on the head" but maybe it has been hit "in the head"...
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
Reposting ELB's comment. It should not be buried.

"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"

One appreciates your true belief in a vote of conscience for the system based on clear policy and good function.Sadly it is about politics , as ELB has summarized, and the billion dollar bribe. Either way the vote goes, physicians still will be a direct target of this government. They have openly discriminated against MDs, alone. You are individually clawed back, based on your associations and beliefs.The definition of discrimination. Substitute any racial/ethnic/religious/etc epitaph you want for "MD", and it would be seen for what it is. Because of the "income", no one cares.

Across the board, each person in the MD, is being "clawbacked" because of their grouping.

If the vote does go NO (which I doubt), make sure you have an alternative plan for release as the vote comes out, and a strategy to deal with the political spin you will need to counter central,which will beat you unmercifully. ( don't mean you as an individual,I mean the collective MDs).

The billion dollars will win. The patients get further hurt immediately, the MDs, much worse,in 4 years.
July 18, 2016 | Unregistered CommenterMovingforwardOntario

Again a word of thanks for this site. I have always found it respectful and polite, despite some of the issues discussed. This OMA/MOHLTC deal is complex. One is surprised how quickly non conformance is viewed as destructive negativism. I hope you have wide readership.
July 18, 2016 | Unregistered CommenterMovingforwardOntario
"Ontarians have every right to wonder at the priorities of a government that readily defends rich salaries, benefits and retirement packages for executives who spend a few years overseeing large institutions and utilities, while calling press conferences to denounce physicians for the “crime” of earning a healthy living while keeping Ontarians healthy. There is no question that health costs must be controlled, but it’s curious that the Wynne government seems fixated on doctor incomes while spending an equal amount servicing the bloated debt it has amassed"
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
You asked what is he saying.

"I would much rather negotiate these items together than have the government impose changes." Says Dr Wooder.

His position is conciliatory.

We all choose the role we play in life and our time is allotted to us. Some choose to cooperate. They are not commonly catalysts for change.
July 18, 2016 | Unregistered CommenterEklimek
There are solutions...but the Liberals don't have them.
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
Government has imposed change, does impose change, and will impose change.

To think otherwise is extremely naive.

Can't help but ask:

How many OMA presidents go back to full time patient care?
Why don't they?
What happens?

Just asking.
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
"One is surprised how quickly non conformance is viewed as destructive negativism. I hope you have wide readership."-mfO

Thanks mfO. Yes, I do.
It is unfortunate that when there is a different perspective, the name calling begins.

Perhaps Premier Wynne has been giving lessons.
"We all choose the role we play in life and our time is allotted to us. Some choose to cooperate. They are not commonly catalysts for change.- eklimek

Very true.

And we need change.
Dr. Fullerton, I echo the thanks offered by mfO. Hopefully, this site is followed (and lurked) by more than just the physician side of this important discussion.

Once never knows who or how those in power are truly influenced.
July 18, 2016 | Unregistered CommenterExecutive Lead Blogger
One never knows.
Thanks ELB.
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
mfO, what do you mean "an alternative plan for release"?
July 18, 2016 | Unregistered CommenterMerrilee Fullerton

One tries to stay ,directly, about of party issues about issues in Ontario. It is too disturbing..

The debt issue is too complicated, the total authoritarian approach overwhelming, and bluntly,the dishonestly is unfathomable.

I am a simple person. Tell me the truth. Already the OMA has exposed the original reveal, is untruthful.

It will be a YES,it should be a NO. Money wins. The OMA members will vote for money.
July 18, 2016 | Unregistered CommenterMovingforwardOntario
A "balanced" budget by the Wynne government does not include the cost of pent-up demand for care created by years of putting off services while blowing billions of dollars on waste and mismanagement.

July 18, 2016 | Unregistered CommenterMerrilee Fullerton
"The Board of Directors of the Ontario Association of Gastroenterology (OAG) has reviewed the proposed Physician Services Agreement (PSA) between the Ontario Medical Association (OMA) and the Ministry of Health and Long-Term Care (MOHLTC) and unanimously recommends that the membership vote NO on the agreement in the upcoming member referendum, being held between July 27th and August 3rd. This is a very bad agreement for both patients and physicians. A bad deal can be worse than no deal at all so it is incredibly important that you make your position plain by voting.

A negotiation that has occurred in secret and has been approved by the OMA Board of Directors without consultation is extremely concerning. The agreement simply perpetuates the Ontario Medical Association’s ability to negotiate on behalf of Ontario physicians. It is self-serving."
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
I would prefer that the government imposes its will on us against our will, immorally denying us natural justice, no matter how oppressive, rather than giving it permission, a legal fig leaf, to do so.

We must occupy the moral high ground, we must maintain the moral high ground in the face of governmental oppressiveness....the government will try to draw us down from the high ground....we must refuse to be drawn down by those in our ranks who keep on making conciliatory offers to negotiate with the oppressor.
July 18, 2016 | Unregistered CommenterAndris
Pleased to present my COD FB Page Summary Post.

The OMA is imploding on COD. There are regular posts by the President, by Dr Doug Weir, and Dr Scott Wooder. Dr Cathy Faulds also makes an appearance.

The posts are greeted by a torrent of negative comments, some analytical and rational, some insulting.

Unfortunately the OMA Brass are responding very politically and in general not engaging with people and not discussing. Perhaps something they learned in their Leadership Program, I dunno, but the group is feeling very patronized and very "talked-at". They expect different from their colleagues who happen to be in positions of leadership. The posts are in general, a single post without any subsequent discussion by the poster, a kind of hit-and-run which is not what you do on FB, just gets people riled.The posts repeat the same talking points over and over; by now everyone has counterarguments for those. They are failing and they have not changed strategy.

It aint all about money. many posters are tired of the extraordinary disrespect from the Minister toward the profession. Many members express their concerns about how this will impact their ability to care for their patients. Some of it is about the money: there's a deep seated resentment about the expectation that MDs should absorb further cuts to provide adequate patient care.

There's a strong NO feeling on the FB group and the OMA are making absolutely no inroads on this. Membership is increasing daily. More and more people are commenting. Email chains are flying around at dizzying speed as people write mass emails to every person in their professional address book. The OMA said it wanted engagement, they got it.

These are interesting times with lots of lessons for Leaders which I hope you absorb well Dr Fullerton. We need good leaders who will listen. We need leaders who will stand up for their constituencies. And we need leaders who will treat us with respect.

Our OMA leaders are failing. This vote will be NO.

I remain, etc
July 18, 2016 | Unregistered CommenterNimble
Thanks very much for this update.
I've been around for a long time. I watch the machinations in Ontario Health care "Lite" and wonder what it's going to take to improve understanding of what we are facing in health care. I really wonder.

You have to know that you are doing what you need to do to avoid being walked all over. Respect yourself. Stand up for yourself and for your patients and for your freedoms.

At some point, the pendulum will swing and change will come. It will have taken all of our efforts.
July 18, 2016 | Unregistered CommenterMerrilee Fullerton
" Leadership is a combination of courage and judgement, neither of which is of much use without the other ".

The OMA's hierarchy have exhibited neither...we are beginning to see elements of it at the grass roots...the OMA 's own structure is much like a very slow escalator and cannot absorb this awakening of the grassroots in the membership within itself, it cannot coopt them into its paid ' leadership position'...they may well form their own rival structure.
July 19, 2016 | Unregistered CommenterAndris

"alternative plan"

Central has publicly announced it is under funding health care services, as a policy. It has placed on the table, a bribe, of about 1.5 billion dollars, to get the MDs to go quiet. If you do not do quiet, show how you can use the needed 1.5 billion plus, to get it to work better! Have an alternative plan!
July 19, 2016 | Unregistered CommenterMovingforwardOntario
The OMA is incapable of coming up with its own plan...it is married to the government's plan....and the government won't allow any plan to trump its own no matter how superior, how much more effective , how much more efficient....in particular any plan that in anyway reflects the health care structures of the world's top rated health care systems of which Ontario is not one...more specifically a hybrid plan in which public and private systems work symbiotically together.
July 19, 2016 | Unregistered CommenterAndris
"If you do not do quiet, show how you can use the needed 1.5 billion plus, to get it to work better! Have an alternative plan! " - mfo

The alternate plan limits the government to regulation and inspection. It frees government from burden of delivery and direct oversight of health care. Political expedience is no longer the prime mover of health policy.

Deconstruction of the current MoHLTC removes literally tens of billion dollars from government expenses, reduces the tax burden in Ontario, promotes private enterprise and frees tens of thousands to seek positions outside of the civil service.

It's a good plan.
July 19, 2016 | Unregistered Commentereklimek
We could learn a thing or two from Brad Wall and Saskatchewan-the birthplace of Medicare in Canada..
July 19, 2016 | Unregistered CommenterMerrilee Fullerton

Physicians are the target, and the public supports it!
July 19, 2016 | Unregistered CommenterMovingforwardOntario

The OMA openly supports the deal, and has legimate points. The core issue really is central has made the decison the doctors have too much wealth, and they need to take it. That deal is done. You can't reverse it. You can try to co-manage your wealth reduction, but there will be a wealth reduction. Grab that last crumb. It is all that is going to be available, forever into the future.

This is not about health care. It is about wealth redistribution.
July 19, 2016 | Unregistered CommenterMovingforwardOntario
According to Ontario's Financial Accountability Officer Ontario set to rack up another 50 billion in debt over next 4 years:


We will pay more and more for less and less as interest rates rise and debt grows.
<<This is not about health care. It is about wealth redistribution.>> - mfO

I can only partially agree. It definitely not about health care...but it definitely not about wealth redistribution, either.

As I said before, it is only...only about maintaining a Liberal majority in the Spring of 2018.
July 19, 2016 | Unregistered CommenterExecutive Lead Blogger
Which is maintained by wealth redistribution.
July 19, 2016 | Unregistered CommenterMovingforwardOntario
From the Philip Cross article in the National Post:

"What explains the ubiquity of left-wing ideology in Toronto? Start with an intolerance of dissenting ideas. William F. Buckley Jr. quipped that “a liberal is someone who claims to be open to all points of view — and then is surprised and offended to find there are other points of view.”"
The first two blows.

The first, a YES to the deal. That acknowledges that physicians have too much, and further cuts are planned,involving the OMA. Accepting the deal accepts the underlying policy decision, to cut back the physician pot.

The second,the 4 years of meetings to pick the "targets" within the OMA, to cut.
July 19, 2016 | Unregistered CommenterMovingforwardOntario

Here's where the first $100 million cut in the TPSA is going.

Hoskins isn't even bothering to wait for the ballots to be cast.
July 19, 2016 | Unregistered CommenterStephen Skyvington
the best description yet of what's wrong with this picture . . .

July 19, 8:45 pm by CELESTE.COLLINS.1 (ON)

You know what I am fed up with? Words that mean nothing…discreet, high-level agreement, modernize….creative ideas….energetic leaders….
All of it fluff. Let’s call a spade a shovel for once. For instance, a patient with terminal cancer. How do I tell him that? ” Well, sir, your health has reached the discreet stage ( there is a cap on it, you are going to die); but with our modernized medicine ( there are cuts to funding and you will be dead by the time you get your oncology appointment) and creative ideas on how to treat your cancer ( how we can make your life a misery and then you die), our energetic leaders in oncology and family medicine ( they don’t know when to give up and make you comfortable), you have nothing to fear. While I have no hard plans on how to go forward, this whole process is permissive…feel free to bring forward your ideas and just before you leave this world, I will tell you it was all for nothing.” I will be called all kinds of names, and I would deserve them if I offered that to my patient. And this is exactly where it is going. Working from 8am to 6 pm ( when not on-call), then come home, eat, clean up a few things and go back to administrative work for 2-3 hours I have no energy left for fluff. After a day of doing the bidding of patients, pharmacists, nurses, nursing homes, preceptoring residents, overseeing NP’s and following every yota and tittle sent to me in the specialists’ report I do not want to hear a lot of meaningless, fancy words. I love my job….but overhead of 40% is too much. Doing all of the above? It is my job and I love it….but not when I am funding the patients and the government while working ‘for them’. And now I have to vote ‘yes’ so my overhead can go up to 50%. Seriously? Like the kids would say, what are you smoking, bro’?
July 19, 2016 | Unregistered CommenterStephen Skyvington
I've followed all this for a while and have been polling colleagues. I think we're going to see a "No" vote. The cuts scare me, as a father with two young daughters and a ton of debts. That said, I'd much rather the government own this toxic brew than to somehow have the cuts sasanitised by having the profession, under the auspices of the OMA, co-manage the bloodletting. Essentially, I'd rather be murdered, than be forced to commit suicide with the OMA helping to guide the blade.

What gives me hope is that I keep getting more email from the OMA that are trying to "clarify" the deal for me. This deal is not that complicated. It's perfectly clear that the only thing the OMA is fighting for at this time is its own relevance...
July 19, 2016 | Unregistered CommenterGracchus Maximus
Very well said Gracchus. I also predict a NO vote. I'm sure once the OMA's own polling shows the nays are winning the more panicked they will become . Expect to shortly go from one email a week from the new President to one a day when a possible Rejexit becomes reality.

Are not most of the medical students away for the summer (except McMaster) so they likely will not be voting? I'm sure half of them are over in Europe backpacking from country to country while recharging their batteries while the other half are working in summer jobs while recharging their bank accounts.
July 19, 2016 | Unregistered CommenterCanary in a Coal Mine
Since when do medical students get time to backpack except after first year??
In any case, good to hear from you Gracchus M.

The OMA is very strategic in how it packages its deals. It would not put any deal forward unless it had carefully counted sufficient shiny baubles for the needed tally.

I've seen it happen multiple times when we hear dissatisfaction for a deal only to find it gets a Yes vote. This is mainly because the OMA will aim to appeal to enough MD groups. It shifts the favoured groups from deal to deal. Seen it.

So, if it a no vote I will be relieved to know that MDs have found their moral compass....If it's a yes vote I know that we've got the status quo.
July 20, 2016 | Unregistered CommenterMerrilee Fullerton
Ah yes, the medical students. What- they're not studying the details of the SOB this summer? Oh that's right- they get to vote because its not the SOB that matters...it's just being included in the greater OMA family that we all really care about. Oh yes- forgot to mention patients too (have to remember to ALWAYS mention that when discussing our incomes)..The bribe (sorry, stipend) first introduced to win a previous contract is still in place...now what?...

The Guv taketh away the FHTs, etc, so it can giveth them back as an "offer". Will that be enough to sway Family Residents and GPs? That is the bottom line here...Fear always dumbs down rational thought and principles...

I expect a bribe to the students soon, or if this travesty of a pamphlet/agreement gets a NO, it will be inserted in Round 2...
July 20, 2016 | Unregistered CommenterKsy11
Back in the day med students were off for the first three summers of med school. The trustafarian kids backpacked around Europe while the rest of us worked to fund the upcoming year. None of us would ever have followed OMA politics at the time.

Maybe things have changed but I doubt it.
July 20, 2016 | Unregistered CommenterCanary in a Coal Mine
It will be YES. Enough want access to the last one billion on the table, at all costs. They don't care about the policy decision.
July 20, 2016 | Unregistered CommenterMovingforwardOntario
Regardless of the vote decision, , four years out, there will be less money available per capita MD, than available in 2015. In addition,the OMA will be targeting its own members to identify those whom have too much. It then will deliver those identified to central, for "management".
July 20, 2016 | Unregistered CommenterMovingforwardOntario
"I 'd preferred to be murdered than forced to commit suicide"....Graccus ( ? from Warcraft, " the greatest battles are won not by strength of arm, but strength of will)...but we are expected to cut our own throats on the mere threat of getting murdered.

The wise never threaten, the weak do...neither the government nor the OMA are in as strong a position as they pretend...the trouble is that our profession has buckled before their threats in the past and the government has every expectation that it will buckle yet again...as Mfo pointed out, it is already spending the money ($100,000,000) as if the surrender has already occurred.

Vote no....it would cause mass confusion in the ranks of the government and the OMA's hierarchy....yes the flustered blustering government will thrash out....let it do its worst...any victory on its part will be Pyrrhic...it is a matter of courage and will power on our part that matters.
July 20, 2016 | Unregistered CommenterAndris
Rally July 22.

Under 10,000, confirmation of strong YES vote. The money will win.
July 21, 2016 | Unregistered CommenterMovingforwardOntario
Rally July 22.

Under 10,000, confirmation of strong YES vote. The money will win.
July 21, 2016 | Unregistered CommenterMovingforwardOntario
I am unprepared to accept an agreement that trades my financial interests for patient care by making me personally responsible for cost over runs of a MoHLTC budget constrained by this government. No patient should ever be seen by a doctor and wonder if the doctor's motive to save hundreds of millions of dollars contractually outlined in this tentative PSA affected their care.
July 21, 2016 | Unregistered CommenterEklimek
It would appear by accepting the proposal, the physicians in Ontario may become the first group of physicians to agree to the position, that their first level of alliegence is to the system, not the patient. It will be a dramatic shift, even impacting malpractice law. When the first step is the comangement of cost, not care, a real shift in culture is being driven.
July 21, 2016 | Unregistered CommenterMovingforwardOntario
<<It will be a dramatic shift, even impacting malpractice law.>> - mfO

Interesting concept - however we have all witnessed the length of time it takes for case law to adjust to new paradigms.

This may lead to a risk of professional victimization in the transition.
July 21, 2016 | Unregistered CommenterExecutive Lead Blogger

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