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Looking for Solutions in Health Care for 2006 and Beyond

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

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

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

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

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

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

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

 

 

 

 

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« 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)

Andris,

To compare what POWs experienced to what we in a free country experience is inappropriate.
I believe I understand your frustration however. I've edited your comment. I hope you understand.
July 24, 2016 | Unregistered CommenterMerrilee Fullerton
I understand....unfortunately most of the younger readers have not seen the movie ' Bridge on the River Kwai'.
July 24, 2016 | Unregistered CommenterAndris
R

Don't make this about personalities.Make it solely about the agenda of central.This is about "managed market" versus "social justice" funding. The MDs are the first group to get hit with realities of "social justice" funding and monopoly.
July 24, 2016 | Unregistered CommenterMovingforwardOntario
OMA rejects the petition. Says duplicate signatures and blank entries reduce it to just over 2,000 sugnatures.
July 24, 2016 | Unregistered CommenterMerrilee Fullerton
So, 4.7 % will be ignored.
July 24, 2016 | Unregistered CommenterMerrilee Fullerton
Do government clawbacks based on utilization contravene the Canada Health Act?
Is this why the Wynne government wants Ontario doctors to do their own rationing & clawbacks?
July 24, 2016 | Unregistered CommenterMerrilee Fullerton
R

Big agenda.not on the table. OMA doesn't get the agenda.
July 24, 2016 | Unregistered CommenterMovingforwardOntario
The MDs are the first group to get hit with realities of "social justice" funding and monopoly. Mfo

Probably first and last. What other group in society has been targeted with actual pay reductions and been made to absorb funding overages in their respective
departments other than physicians?
July 24, 2016 | Unregistered CommenterCanary in a Coal Mine
CICM:

No other group in Ontario. You are targeted as "elite" whom have been packaged into a group which can be identified, and controlled by central.
July 25, 2016 | Unregistered CommenterMovingforwardOntario
CICM:

No other group in Ontario. You are targeted as "elite" whom have been packaged into a group which can be identified, and controlled by central.
July 25, 2016 | Unregistered CommenterMovingforwardOntario
The OMA was between a rock and a hard place. Unilateral, significant, permanent cuts to a variety of Schedule of Benefits services were coming, in fact were delayed while negotiations continued.

The OMA executive (rightly I think) decided it would be preferable to 'co-manage' the 'relativity adjustments' than to let Hoskins and his lieutenants go it alone.

So anyway a NO vote will simply delay the inevitable, in fact will likely result in deeper, wider cuts to the price of SOB services.
July 25, 2016 | Unregistered CommenterTragically an OHIPster
Tragically

Exactly. It is going to hurt.
July 25, 2016 | Unregistered CommenterMovingforwardOntario
The objectors to the agreement don't want their profession's finger prints on the agreement, they don't want coownership of the inevitable coming health care debacle....yes the fee schedule will be slashed....and there will be negative consequences anticipated and unanticipated.

Younger colleagues are looking abroad....they tell me that an office visit fee in Alberta is twice as much as an Ontario office fee with house prices far more reasonable in the present economic climate....another told me, having returned from a tour of Australia that a patient pays an user fee of over A $50 to see a FP....how true these statements are I don't know...but our young colleagues are looking around....rightly so...I advise them to go to where they are valued and appreciated.
July 25, 2016 | Unregistered CommenterAndris
Most will stay, and just work as widgets.
July 25, 2016 | Unregistered CommenterMovingforwardOntario
(First time poster, thanks Dr. Fullerton for this forum!)

A widget perhaps, but for me 4 years of relative stability is something I'd welcome as a doctor and for my patients. Not sure how one knowingly expands their practice to new patients or signs a 5 year office lease unsure what billing model they'll be under in 3 months? A political stalemate and the further uncertainty that follows a no vote may be the worst case scenario if one is truly concerned about serving their patients.
July 25, 2016 | Unregistered Commenterdocinthepark
We don't want our fingerprints on any agreement which makes physicians responsible for cost overages but where the patient and MOH have no responsibilities. Who in their right mind would agree (other than OMA toadies looking for a job at the MOH when they retire) to a PSA where the MOH knowingly underfunds the system, adds more doctors, more patients, all of which will clearly result in overages and further unpredictable clawbacks.

Oh the irony where the MOH wanted a 'budgetable' PSA, but now wants to have physicians sign off on an agreement where our revenues are not budgetable and will become potentially very unpredictable. You cannot run a business in this environment.
July 25, 2016 | Unregistered CommenterCanary in a Coal Mine
They’re heading for a showdown.

After a flurry and meetings and e-mails over the weekend, a splinter group representing doctors who are unhappy with the tentative Physician Services Agreement (PSA) negotiated between the Ontario Medical Association (OMA) and the Ministry of Health is claiming victory in halting the non-binding referendum on the deal.

http://www.torontosun.com/2016/07/25/doctors-opposition-stalls-oma-deal-with-province
July 25, 2016 | Unregistered CommenterCanary in a Coal Mine
The OMA elites are in trouble.
July 25, 2016 | Unregistered CommenterCanary in a Coal Mine
Careful strategy is needed here. Make sure you can deal with the competing agendas. Central needs this resolved before Queen's Park reseats in september.
July 25, 2016 | Unregistered CommenterMovingforwardOntario
It won't be resolved by September. Deal with it.
July 25, 2016 | Unregistered CommenterCanary in a Coal Mine
The current system is rigged and corrupt.

Time for a new organization to represent front line physicians' interests. The OMA's gig is up and the membership is not going to fall for the doublespeak any more.
July 25, 2016 | Unregistered CommenterCanary in a Coal Mine
There is still too much complacency in the medical ranks.
It's unfortunate but it is often pain and discomfort that drive change.
July 25, 2016 | Unregistered CommenterMerrilee Fullerton
docinthepark,
Good to hear from you.
Attempts to make all MDs think the same and all patients to be the same will never happen. More options are needed.
July 25, 2016 | Unregistered CommenterMerrilee Fullerton
Looks like the coalition of Ontario Docs may have forced a general meeting of the OMA.
July 25, 2016 | Unregistered CommenterTom Nuc Med
2016 Tentative Physician Services Agreement (PSA)
July 25, 2016

I have important news to share regarding the tentative Physician Services Agreement.

The OMA has received a petition calling for a general meeting of the membership - to vote on the tentative PSA. We have accepted the validity of this petition and your OMA Board has initiated planning for that general meeting.

We do not yet have details for the general meeting, such as the date or location. More information will be available in due course, and I ask for your patience as we determine those logistics.

The general meeting will provide all members an important opportunity to have their voice heard on the tentative PSA. As I have said since the tentative Agreement was announced, I will continue to welcome the opportunity to engage with members about what the tentative PSA means for the future of our profession.

I know you will have questions about the process for voting and the impact on the referendum and ratification process.

Today, I can share with you that with the general meeting now taking place, the August 6 Special Council meeting has been cancelled. So too is the referendum process which was recently initiated. I will update you daily as matters relating to the general meeting are determined.

The tentative PSA has prompted energetic and thoughtful conversation among members across the province and I thank everyone for your focus and your commitment to the profession’s best interests.

This is a big decision and certainly isn’t an easy one. I thank you for your continued interest in listening to the facts and for your openness to engaging in a serious discussion about the future of our profession.

"Alone we can do so little – together we can do so much."

VIRGINIA M. WALLEY, MD
President
Ontario Medical Association
July 25, 2016 | Unregistered CommenterCanary in a Coal Mine
The doctors alarmed over this tentative PSA should prepare for successs.

Having no agreement will definitely pick the millionaire's pockets. Others
may be collateral damage, but on the bright side it will accelerate relativity correction. When the tide goes out all ships sink but the biggest hit bottom.

A hard progressive cap is needed to generate bona fide public outrage at underfunding of health care. Doctors should be prepared for this.

Ratifying this tentative PSA with the pain shouldered by doctors ensures re-election of the current Liberals in 2018.

Rejecting the tentative PSA will result in two more years of grief for us. It will also result in a new government and a supreme court challenge may award us arbitration as an essential service. It may also change the OMA for the better, I hope.
July 25, 2016 | Unregistered CommenterEklimek
Watch out for proxies.
July 25, 2016 | Unregistered CommenterMovingforwardOntario
How to balance the four major agendas?

Central: cap the doctors -Social; justice agenda
Doctors (high earners): Earn more
Doctors (low earners): Even it out.
Public: free care
July 25, 2016 | Unregistered CommenterMovingforwardOntario
I'm with eklimek.
July 25, 2016 | Unregistered CommenterMerrilee Fullerton
watch the proxies. 43,000 votes-or 33,000?
July 25, 2016 | Unregistered CommenterMovingforwardOntario
" After victory, tighten the cords of your helmet".

Ieyasu Tokugawa.

At this time the membership has to be extra vigilant...the powers that be in the OMA and the government still have their ultimate goal....they had a strategy to achieve that goal, they had an objective to achieve that strategy which was to win the referendum ...it became evident that they were going to lose the referendum to the ' freedom fighters', so they cancelled it...they will have to think of another objective to win and to devise new tactics to achieve that objective and so achieve their original goal.

They will be concentrating on how to gain the upper hand at the General Meeting, how to sway the masses ....how to pack it with their own supporters and how to dissuade the 'freedom fighters' from attending...proxy votes are going to be an obvious tool...as Stalin pointed out, it's not the voting that counts but the counting.
July 25, 2016 | Unregistered CommenterAndris
How many members?Ho many proxies?
July 25, 2016 | Unregistered CommenterMovingforwardOntario
...I don't know....but I suspect that proxies can and will be generated out of thin air.
July 25, 2016 | Unregistered CommenterAndris
Andris,
I expect the OMA will count honestly.
The real question is how much do MDs want to continue to believe that the Liberal government will treat them fairly after so many failures to do so.

Wishful thinking doesn't provide health care.
July 25, 2016 | Unregistered CommenterMerrilee Fullerton
"Desperate times call for desperate measures"....never understimate the desperate , one never knows what they might do to achieve their goals...both the OMA and the Govrrnment are desperate....as Mfo points out , the government doesn't like the idea of a General meeting and is desperate to get on with Bill 210 after September 12 2016 ...I believe that both have put on their Machiavellian hats to achieve their common goal.
July 25, 2016 | Unregistered CommenterAndris
"For those watching the conflict unfold: save your sympathy.

Instead, get mad.

Your elected government, the Ontario Liberals, made a mockery of our health-care system. They outsource services to the U.S. — services that now cost more than they would if provided here. They waste much-needed health-care dollars on bureaucracy and failed ventures. They ignore ordinary people as they die on ballooning wait lists. They offer Band-Aid solutions to complex problems, igniting a massive fight among doctors. This is not acceptable.

Get mad. If doctors cannot afford to maintain or upgrade their equipment, you are the one who loses. If doctors cannot afford to keep their clinics open, you are the one who loses. If doctors leave, you are the one who loses.

So I vote No.

Your turn: make this government fear the vote and the voice of the ordinary person."
July 25, 2016 | Unregistered CommenterMerrilee Fullerton
“It’s nice to see the power put back where it belongs — in the members’ hands, rather than in the upper echelons of the OMA,” she said.

Under OMA bylaws, under special circumstances, if 5% of members ask for a meeting on a specific topic, the organization must do so."

http://www.torontosun.com/2016/07/25/doctors-opposition-stalls-oma-deal-with-province
July 25, 2016 | Unregistered CommenterCanary in a Coal Mine
An email I received today from a nurse in a GTA teaching hospital. Very sad as this nurse has only been working for 5 years. Don't get sick in Ontario.


"Now a days I dread going into the hospital. Things are bad.
The liberals are running the healthcare system to the ground. For example one of the units where I occasionally work at is funded for 22 patients and now have a patient load of 29 and some times 31. This usually results in dangerous levels of work load when you take into account patient acuity levels. Looks like they will only start noticing when people start dying (avoidable deaths) in the hospitals."
July 25, 2016 | Unregistered CommenterCanary in a Coal Mine
GTA teaching hospital
Centre of Excellence
July 25, 2016 | Unregistered CommenterMerrilee Fullerton
Ontario can do better.
A billion a month spent to service the debt would go a long way to health care and other areas of need.
July 25, 2016 | Unregistered CommenterMerrilee Fullerton
It reflects the steady and relentless downward spiral of the Ontario health care system....it won't be long before the general public becomes truly aware of its increasing deficiencies....no wonder that the Ontario government wants to have coownership with the medical profession of what is unfolding under its guidance...to which it could transfer responsibility when the public marches on Queen's Park with their pitchforks.
July 26, 2016 | Unregistered CommenterAndris
The theory goes, ...

centres of excellence assume larger volumes of high acuity complex care and permit a critical mass that allowed expertise to develop and flourish. In exchange smaller centres would cease to provide the same services and refer up the ladder. Presumably volumes and expertise would offer better care with lower risk. Transfer by a bed monitor service such as Criticall would facilitate the transfer.

In reality peripheral downsizing occurred but the centres of "excellence" are all over capacity and underfunded. Now the peripheral hospitals are bed blocked and have no where to refer. Patients in ER are told to hold overnight if possible or transfer out of country if otherwise unavoidable.
July 26, 2016 | Unregistered CommenterEklimek
"In reality peripheral downsizing occurred but the centres of "excellence" are all over capacity and underfunded. Now the peripheral hospitals are bed blocked and have no where to refer. Patients in ER are told to hold overnight if possible or transfer out of country if otherwise unavoidable."

Repeat this....over and over again.
July 26, 2016 | Unregistered CommenterMerrilee Fullerton
"Bed blocked" because home care is inadequate to deal with "acute on chronic" events and long term care is often inaccessible in a timely way.

As the dependency ratio shifts from 5 workers to 2.5 workers, what happens to Ontario's productivity when family members are pulled away from their jobs to help maintain people at home in a crisis or for chronic reasons ex Dementia?

It becomes a vicious circle. Save the system by pushing more care to the community and then into the home then wonder why our GDP is stagnating. Now, it's more complicated than that but as more and more family members are pulled out of the work force we can expect economic repercussions especially when we have only 2.5 workers per dependent in or around 2026-30.

Reducing costs to single payer has many repercussions including potentially worse GDP. Not good.
July 26, 2016 | Unregistered CommenterMerrilee Fullerton
We have a system designed for the 1960s not for what is coming.
July 26, 2016 | Unregistered CommenterMerrilee Fullerton
I will never vote yes until Hoskins and the OMA negotiators are turfed. The OMA and MOH have underestimated the anger and resentment towards the provincial Liberals and the OMA. To bring back the same people who sold us the last agreement in 2012 is unbelievable. Time for change.

Any further unilateral action would be a big mistake and I say let them try and suffer the consequences. We can hold off until 2018 if we have to.
July 26, 2016 | Unregistered CommenterERDOC

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