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)

All things take time to reveal themselves.

Co-management may not be the panacea the OMA wants. The goals and practice of medicine, may be fundamentally altered by this vote. Going from the best care one can provide, to the use of the rationed resources to get me through the day.
July 21, 2016 | Unregistered CommenterMovingforwardOntario
If the PSA were imposed on a minority of doctors, there are fore seeable problems. An untoward outcome due to denial or delay in diagnosis is a cause of action. Contributory to the delay or denial will be the PSA which lists the financial inducement irreconcilable with the duty of care and advocacy for our patients.
July 21, 2016 | Unregistered Commentereklimek
"financial inducement (to deny care) irreconcilable with the duty of care and advocacy for our patients."
July 21, 2016 | Unregistered CommenterMerrilee Fullerton
The signing of the PSA, a comangement document, may bring central in the malpractice arena as a side effect. If rationing can be viewed as malfeasance, the crown loses its protected status.
July 21, 2016 | Unregistered CommenterMovingforwardOntario

The failing of the MoHLTC to assume responsibility for the budget in off loading onto the physicians through a contractual arrangement for "comanagement" is self evidently an effort to discharge responsibility onto others.

I think this is improper. It is in principle an inducement for doctors to not discharge their duty of care impartially.

In defense of the OMA, the MoHLTC sat in on previous meetings of the Central Tariff Committee and observed physicians discuss and make recommendations regarding modernizing the schedule of benefits. These rarely were implemented.

If the current Min of Health is a practicing doctor he will know the skeletons in the closet. It seems everyone else does.
July 21, 2016 | Unregistered Commentereklimek

It is improper, but central wants to draw the doctors in with comanagement. The doctors, don't get what they are doing to themselves by taking the ownership for the current, and future, rationing required because of the funding shortfalls.

When you go to your physician, after the signing of this, your first thought will now be, am I getting the best care, or the one that saves the most money so he/she gets more money.
July 21, 2016 | Unregistered CommenterMovingforwardOntario

One additional item will be those who don't vote. How many just have accepted they are widgets in the system?

What both the NOs and YESs need to fully understand is there will not be any negotiations of any significance.The OMA deal is the first of the new "social justice" policies that are coming. Society , as represented by central, has decided you need to work harder,for less. Your pot is too big. Because of the monopoly, you are hurt worse as you have no other silo to go to.Teachers,police,nurses, etc can go to parallel private systems. It relieves the tension. Doctors are just going to keep being beaten because of the move to "social justice"management.

Turn out - under 60%. Vote goes YES by over 60%, driven by youth,and various salaried groups.
July 21, 2016 | Unregistered CommenterMovingforwardOntario
Well that was a cheery read. So the Council could just ignore the membership? If that's the case, why even bother to let us vote, if they know best. It's disheartening that the OMA is nothing more than another division of MOHLTC, except that it's funded by our dues (I guess similar to MOHLTC and the unilateral clawbacks). We have no say; the money flows from our pockets into theirs.

Looks like we need need some new representation....
July 21, 2016 | Unregistered CommenterGracchus Maximus
the social justices are set. Physicians,allowably ,are fixed costs.
July 21, 2016 | Unregistered CommenterMovingforwardOntario
Consider having your say:


Please share.
July 21, 2016 | Unregistered CommenterMerrilee Fullerton
The actions of the OMA, although not perfect, are not where the core issue is. How policy is decided has changed. Under the new rules of "social justice", the physician pot has been deemed to be overfilled, and will be reduced. Deal with the policy, not the personalities.
July 22, 2016 | Unregistered CommenterMovingforwardOntario
The worst part of a Yes Vote for the tentative physician services agreement is that it will delay real reform even further as MDs are cajoled into accepting the "stability" promised by a Yes Vote. It is nothing if the sort.
A Yes Vote will lead to greater uncertainty, greater long term instability and greater patient suffering.

One can't even say that the agreement "buys time".

A Yes Vote drives us faster into a brick wall. Not good.
July 22, 2016 | Unregistered CommenterMerrilee Fullerton

With the unilateral cutbacks, the wall has been hit. The wall won.pick up the pieces, and do as you are told. The rules got changed a while ago, with your buyins.
July 22, 2016 | Unregistered CommenterMovingforwardOntario
It's not about me.
It's about understanding the growing upfront costs of care, the growing costs of acute/chronic/curative care, the growing costs of long term care simultaneously with lower productivity, limping economy, and Liberal governments who have over promised, over-regulated, and over-taxed.

Things must change.

Ignorance is bliss until reality hits.
July 22, 2016 | Unregistered CommenterMerrilee Fullerton
The medical profession might well have struck a brick wall....but the health care system itself hasn't hit it ....yet....it won't be pretty.
July 22, 2016 | Unregistered CommenterAndris

One knows it isn't about you as an individual, or the collective of MDs. It is about the changed rules.For the foreseeable future,Ontario will operate on social justice decsions,not managed markets. The decision has been made. Doctors will be squeezed to bring down their incomes.The public gets free care, and then get to "bring down"the elites. They love it.

The surprising things is how many doctors are prepared to ration or provide less than optimum care.
July 22, 2016 | Unregistered CommenterMovingforwardOntario
Today the Section on Emergency Medicine has advised their members to vote NO.
The Section of Gastroenterologists did the same earlier in the week.

I predict all the specialist sections will recommend a NO vote.

A Rejexit is a real possibility. The OMA/MOH elites think they know what is best for the profession, but the front line providers are going to vote otherwise.
July 22, 2016 | Unregistered CommenterCanary in a Coal Mine
Family Docs make up about half of all MDs?

Who did the back room talking? Dr Wooder and Dr Bonin?
July 22, 2016 | Unregistered CommenterMerrilee Fullerton
If you look at the video on the COD Facebook page today at the end it says that the SGFP does not endorse the deal. That is half the docs in Ontario being told to vote NO.

Somewhere in that video it also states that negotiations were begun in secret by Dr. Wooder and Dr. ? with the MOH. I suspect both are looking for an MOH job when they retire from the OMA.

This deal is all about ensuring the survival of corporate OMA and keeping the LIberals in power and nothing to do with putting Patients First. It is all smoke and mirrors.
July 22, 2016 | Unregistered CommenterCanary in a Coal Mine
Aneuryn Bevan of the Welsh Labour Party in introducing the National Health System to the UK in 1948 , corrupted the British medical hierarchy to sell out their colleagues and future generations of British physicians and surgeons... He stated "I'll stuff their mouths with gold" ...they signed off on the NHS and were awarded knighthoods and lordships as well as posts in the NHS , so ' lording over' the profession that they sold with their signatures.

Human nature does not change....one should not be surprised to see those who deliver us to the abattoir eventually lording over us in well compensated elevated positions within the system with pensions and golden parachutes.
July 23, 2016 | Unregistered CommenterAndris
Human nature doesn't change, and we repeat the struggle of balance of power over generations.This is a situation were the power is all now own by central. It is not going to change regardless of how the vote goes. The wealth available to the doctors is hard capped. Deal with it.
July 23, 2016 | Unregistered CommenterMovingforwardOntario
Those of us in the process of retiring will taking their MD hat off and donning the 'patient' hat...the patients will certainly have to " deal with it".
July 23, 2016 | Unregistered CommenterAndris
There is a financial wall that has driven all of this. That coupled with the monopoly has created the impasse that the doctors pot is full.The OMA has done the best they can with reality as it now exists.

Without more resources, pinnacle of care has passed. The patients will feel it. In the era of restricted resources, social justice demands freezing the doctors pot.
July 23, 2016 | Unregistered CommenterMovingforwardOntario
Dr Bonin
July 23, 2016 | Unregistered CommenterMerrilee Fullerton
The bloated Ontario health care bureaucracy seems not to be affected by the socalled "social justice demands".

Canada has 1 health care bureaucrat for every 1,400 Canadians.
Germany manages with 1 for every 15,000 Germans.
Ontario has 1 for every x Ontario citizens?
Under Bill 210 Ontario will have 1 for y citizens....y being greater than X?
July 23, 2016 | Unregistered CommenterAndris
The hiring of staff helps assure more staff share the tax base. Thus,"social justice".
July 23, 2016 | Unregistered CommenterMovingforwardOntario
General Meeting of Members petition was submitted yesterday. 2300 signatures were received.
July 23, 2016 | Unregistered CommenterMerrilee Fullerton
SGFP has released a letter urging docs to study the issues and to vote. It's not a bad outcome given the people on the SGFP Exec. They did not encourage a yes vote.
Yesterday was a momentous day in Ontario Medical history. A group of COD docs held speeches at QP then walked in over 35 degree heat to the OMA offices, kids, dogs and all. They attempted to speak with Virginia Walley and were offered a PowerPoint presentation, all 138 of them, in the OMA Boardroom - which while swank, will not seat 138.
The stood in the reception area of the OMA offices waiting for Virginia Walley. She never came out. She refused to meet with 138 doctors, some of whom had travelled hours to Toronto, some pregnant, some with their kids in strollers. All videotaped, on COD FB site.
This is not leadership.

The OMA will lose this vote.
July 23, 2016 | Unregistered CommenterNimble
What if the OMA loses this vote?
The decision is binding on the OMA?
July 23, 2016 | Unregistered CommenterMerrilee Fullerton
The real vote is at Council. I will of course be there. If Council overrules the membership the OMA will explode.
July 23, 2016 | Unregistered CommenterNimble
"General Meeting of Members petition was submitted yesterday. 2300 signatures were received. "

That was incredibly fast given we're right in the peak summer holiday season and indicates the degree of anger out there on the front line. Ten percent of physicians signed or thereabouts in less than 24 hours.

I have yet to meet anyone who will vote yes, but I don't hang around in the halls of academia or the OMA offices.
July 23, 2016 | Unregistered CommenterCanary in a Coal Mine
"OHIP deviates from every other insurer in assuming an equal cost for health care for every Ontario citizen, he said.

“Any actuary would tell you this is nonsense.

“OHIP is nothing like an insurance program, rather the OHIP health card is more like a Visa card whose bill never comes due,” he said.

Rotenberg’s worried the proposed OMA contract makes doctors “co-managers,” of the system."

July 23, 2016 | Unregistered CommenterCanary in a Coal Mine

The acknowledgement that we each have different, unique, biological weaknesses exposing us to disease,will collapse OHIP, which was based on the premise we all have equal risk, thus should pay equal premiums.85% of the costs go to 5% of the population.
July 24, 2016 | Unregistered CommenterMovingforwardOntario

Central is not happy with the general meeting of members. This needs to signed off before Queen's Park resumes, as a done deal.
July 24, 2016 | Unregistered CommenterMovingforwardOntario
"The real vote is at Council. I will of course be there. If Council overrules the membership the OMA will explode."-Nimble

Council members/"delegates" have been carefully selected since the OMA undertook its last governance review. The Branch Societies were attacked under that governance review and there was clearly an alignment with hospital oriented "physician leaders" and "physician leaders" who were supportive of the OMA. Those with conflicting perspectives were made to feel unwelcome and pushed out. So much for diverse opinion and perspectives that can lead to the best results when hashed through respectfully.

Instead the new OMA governance is all about alignment, and thinking the same. Groupthink at its worst.
Is it any surprise then that what we have as a 6 page "tentative deal" of a multi-multibillion dollar portfolio was orchestrated by two family physicians in a back room with the Ministry of a government that is desperate for a showing of power?

Is it any surprise that the deal has no definition of "co-management"?

How could any MD vote for an agreement that was created this way? Except if they are in a paid position as a "Physician Leader" and part of the Groupthink and Governance structure that absolves itself from responsibility to the OMA membership and the patients doctors serve.

This is NOT good governance.
In short:
Since when is it considered good governance for 2 MDs to essentially ignore a defined negotiating process and come up with a deal in a back room to satisfy the needs of government?

Just asking.

Janice, where are you now?
"Well come out to a roadshow event. I've done 6 in the last 6 days-open to ALL"-Scott Wooder

Is there no other OMA representative other than Scott or perhaps Pete who can address membership's questions? Why?
July 24, 2016 | Unregistered CommenterMerrilee Fullerton
Judging by my emails ( to the general membership) from the OMA and the various blogs , the OMA is putting on the full court press...pulling out all the stops in its efforts to get a Yes result....it would be humiliating for it to fail in this regard...because if it does fail, then , as mentioned above, an over riding yes vote from Council would expose the fact that Council has been packed with loyalists to itself and not the membership.
July 24, 2016 | Unregistered CommenterAndris
It appears that the OMA is a government organization.
It is no longer a representative organization other than in pretense only.
July 24, 2016 | Unregistered CommenterMerrilee Fullerton
"Emergency conference call this aft by the brass at @OntariosDoctors to figure out how to deal with brewing mutiny over tentative agreement."- from S Paikin
July 24, 2016 | Unregistered CommenterMerrilee Fullerton
I see a bright and prosperous future in the Ontario health care system with benefits, pensions and golden parachutes , and most important of all power over their former colleagues, for the two of our colleagues who precipitated this sequence of events.

"The lust for power leads men into dark and empty places"....
July 24, 2016 | Unregistered CommenterAndris
They lost their perspective somehow. I do not know their personal agenda and will not comment on that.
Are unilateral actions imposed by government worse than OMA imposing them on its own members and on patients? Yes? No? Why?

The fear of the effect of unilateral actions imposed by government pales in comparison to the impact of legitimizing a government-driven rationing process destined to be carried out by our own profession against patients.
It will contribute to the negative optics of our helping profession and negatively impact patients.

Divided loyalties have implications.
July 24, 2016 | Unregistered CommenterMerrilee Fullerton
Realist : they remind me somewhat of the character Colonel Nicholson played by Alec Guiness in the movie the 'Bridge on the River Kwai' , who displayed a distorted sense of duty.
July 24, 2016 | Unregistered CommenterAndris

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