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)

Ksy11, couldn't agree more, an academic physician totally out of touch with the reality of medicine in the community.

Don't worry but I give the Star at most a couple of years before they go bankrupt.
The sooner the better. Nothing more than a mouthpiece for the provincial Liberals.

August 9, 2016 | Unregistered CommenterCanary in a Coal Mine
Thanks for your post.
I understand your sentiments.
August 9, 2016 | Unregistered CommenterMerrilee Fullerton
Vote is going to highly influenced by medical students, paro, and salaried academics. Still looks at least 60% yes.

Regardless, as of augyst 14th, medical care changes.
August 10, 2016 | Unregistered CommenterMovingforwardOntario
Sent as letter to the ed

The day after the PSA is ratified you meet the first patient.

"I'm not a civil servant, however I am an agent of the state's social approved policy, and your doctor."

Some have wondered about my open support for the Coalition of Ontario Doctors. This is what I say to my colleagues.

It seems natural that "high rollers" are aligned against the tentative PSA. If I billed a million dollars I would be mightily upset. But, I don't. So it may seem strange bed fellows are generated when a "have not" section of specialists in Neurology aligns with the vote NO coalition.

Firstly, I can't accept the irreconcilable conflict of interest in co-managing the health care system. When a government off loads its responsibility or duty to others, it is called malfeasance.

(tip of the hat to mfo. I had to look that up. Malfeasance - failure to discharge public obligation through an act that gives rise to, or somehow contributes to, the injury of another.)

I don't think it is possible to be rewarded for reducing services when one is ethically and morally obliged to provide the same in the therapeutic relationship. Worse, unlike the protection one has in mandatory reporting of unsafe drivers to the Registrar of Motor Vehicles in Ontario, I see no evidence of immunity for doctors who actively comanage the system to keep a budget in line.

Secondly, if OMA co-management were simply cutting fees of high rollers, this dog won't hunt either. The track record of the OMA in addressing relativity, the inequity of income for doctors, is abysmal. Without dedicated funding for "have not" sections, why would this PSA be any different? There is no dedicated money in the tentative agreement to address relativity.

Finally, please stop dressing up the tentative PSA as "the best deal possible". This refrain has lost persuasion and makes me think, "is this the best deal possible ... with the OMA at the table?" The deal is conciliation not negotiation. It reads more like the Justice Winkler's conciliator report with government easing up in the third year as per his recommendations.

It makes one wonder, who is the winner?

With this tentative PSA we accept there is no recovery of existing cuts and promises of future increases are dependent on doctor cooperation keeping the budget in line. The unfunded liability of future physician services budgets will be our problem. The MoHLTC has a capped budget by the doctors taking on the budget over run.

This is a blank cheque or personal indemnity I see benefiting only the MoHLTC. How is this a deal? Ratifying this PSA we enable the current government for 4 years and we get what?

So what is the best alternative to a negotiated agreement?

The sky is not falling. Negotiations carry on and government keeps its current plan and cuts us again, and again, every year, for the next 2 years. That's the next election. Maybe my $2,000+ annual OMA dues could go to something meaningful? I let you reflect on how the money could be better spent.

That's my plan, anyway. Two more years and we have a vulnerable, if not new, government that we can work with. A government that may not be wedded to ideology that prevents patients from getting the care they need.

Ed Klimek

PS, the OMA has been unsuccesful in addressing relativity for how long? Read this from page 34 CAN MED ASSOC J 1992; 147 (1)

Toward integrated medical resource policies for Canada: 6. Remuneration of physicians and global expenditure policy Greg L. Stoddart, PhD; Morris L. Barer, PhD

"Regarding internal equity, members of the profession and provincial ministries of health are concerned about various inequities in provincial fee schedules, including interspecialty differences in implicit hourly "wages" and the slow pace of adjustment of fees to the diffusion of new procedures and technologies. For the profession this results in interspecialty conflicts over relative incomes. For ministries of health the concern is much broader and linked to other issues. In particular, the perception is that fee-schedule inequities promote undesirable utilization patterns (for example, a rapid increase in procedures) as well as choices of specialty (and therefore often of geographic location) that do not match population needs."
August 10, 2016 | Unregistered Commentereklimek
Judging by the volume of emails etc., from the Yes vote side I'm not too certain about the 60%...there seems to be panic in the air.

One wonders what would happen if the yes camp did win by a very thin margin....let's say 51%?
August 10, 2016 | Unregistered CommenterAndris
60% yes.In the bag.

Medical students, PARO, FHT,and salaried academics.
August 10, 2016 | Unregistered CommenterMovingforwardOntario
Heres what I dont understand: how does PARO get to vote on my deal,which will effect me for 5- 6 years,but then gets a secret side deal agreement with the MOH (the cheap " seat at the table" token,the cheap bait we knew was coming)? Did the OMA partake in this as the legal representative for doctors? Its clearly a side deal meant to influence a large voting block in the main deal. How is that legal? The residents are OMA members who are voting on the PSA...how can they get a separate deal yet still vote for the PSA? Using the same precedent, the MOH could approach any section it wants, give them a bonus of some kind, and do this until they have everyting they want vote wise,without the OMA being involved at all, yet still calling the shots and negotiating as our sole representative! I really think this should be challenged. If there is a new agreement out there directly tied to the tPSA (and the PARO side deal is) then in the least it should be merged with the tPSA. This means the document changes,and due process must occur for this to happen. What kind of cheap legal outfit are we running for such a critical item for all the people of Ontario? Again,using the exact same precedent, could the MOH strike (as an example) 7 different side deals with 7 different Sections,with the OMA (our "only negotiator")not involved,then allow all those sections to vote for the PSA whilst the groups who did not get a bonus cannot vote for/ against those side deals? Is this not bribery? We are Randed. Can the government secretly approach all Grade 1 teachers,tell them they will get a special privelage,without either the Government or Teachers Union declaring this to the rest of the membership, then allow all members to vote on a contract?
August 10, 2016 | Unregistered CommenterKsy11
Real time politics to deal with a union, that isn't a union. Buy off vested interest subgroups,enough to assure the vote you need.

It's why a 6 page tPSA is so vague. Central has an agenda. It has enough money to buy the groups it needs.

Do not underestimate central's social agenda agenda.

Technically,PARO has cut a "side deal",and is excluded from voting by the Deputy Minister's letter. Option for OCD to go back to the legal system,which will support OCD,and invalidate the vote on August 14.

This thing is dying..
August 10, 2016 | Unregistered CommenterMovingforwardOntario

I'm not going to provide any further comments,until after August 14.Time for people to digest available information,without being bombarded with new comments.

Again,I want to thank you for this site,which I find remains civil, and reasonable.

I think the physicians are screwed if they support this pTSA, and those issues have been openly expressed on this site by many. The information is available. There is no recourse if the vote is "YES". You accept and support rationing, and denial of needed care. You own it.

It will pass with at least 60% in favour. Predetermined.

The social justice agenda is predetermined.
August 10, 2016 | Unregistered CommenterMovingforwardOntario
Thank you mfo....the die is cast....all will be clear on the 15 th. of August when the dust starts to settle....the government propagandists who had fore knowledge of the results will flood the media with its feel good perspective with a yes and doom and gloom with a no....of course, it will be doom and gloom no matter the result...this is the last throw of the die by the OMA/ Ontario government cabal to prevent the collapse of this monopolistic health care system ...if it fails, as it will, then they already have their skapegoat.
August 10, 2016 | Unregistered CommenterAndris
Thanks mfO.
and Ksy11, you make an excellent point confirmed by mfO.
August 10, 2016 | Unregistered CommenterMerrilee Fullerton
From the OMA,

"Through co-management of the Physician Services Budget and utilization, we will now hold the government accountable for decisions that affect us, doctors."-Dr Albert Schumacher


Someone should ask How?
August 10, 2016 | Unregistered CommenterMerrilee Fullerton
Schumaker's reminds one of the fable where the mice voted that the cat should wear a bell...great in theory...impossible in practice.

There is no bell going to be placed around the neck of this government to hold it accountable for anything.

Speaking of rationing ...the British mother ship , the NHS , is now rationing statins amongst other meds and treatments ( daily telegraph) ....soon to come to Ontario?
August 10, 2016 | Unregistered CommenterAndris
Who was the letter to PARO from? Bob Bell?
August 10, 2016 | Unregistered CommenterMerrilee Fullerton
To the medical students and medical residents of Ontario:

Re: the tPSA

I have followed your organizatons comments, recomendations, and many of you have spoken out on social media, as well as written pieces as columns in various forums.

As you hopefully have learned by now, or hopefully will eventually learn (and not under bad circumstances), one of the most important things you can ever do in our profession is say " I don't know" when you honestly don't know something. To act within the confines of ego, bias, pride and enthusiasm without being armed with thorough knowledge is often devastating. If any of us can't objectively look at ourself and admit we are thinking of doing something which might be wrong, then we are not worthy of this profession. And when the consequences are great, that principle is so much more important. Make no mistake about it: the consequences of implementing this tentative PSA (tPSA) are great. So how many of you can honestly say you are armed with a thorough knowledge of what this tPSA will really mean? Beyond what your PARO and OMSA leadership have told you with mere summaries, what do you really know about the economics of running a medical practice? Put ego,pride and bias aside, and answer that question honestly.

I speak to you as a brother of the medical clan. I too was a student and resident. I have worked full time in busy hospitals(ER, multiple sites,urban and rural) and with office practice, all under FFS, for 25 years. There are many people who are speaking out against this tPSA who also bring decades of experience, across all specialties and payment models, and they have all given their arguments which some of you have seen. But without revisting those arguments, I would ask you take a different approach to this quagmire.

You are being asked to vote on a 6 page document that the OMA and MOH claim will create stability in our health care system. The OMA has admitted it is not ideal, but it's main message is clear: it is the best we can do in these times, and it brings stability. The MOH has promised your groups "a seat at the table", stability, and a new world of co-managing the sytem. There are no actual details as to how this will be done; just the promise it will be figured out somehow. Not a true contract with details- just a handshake between 2 groups with clearly different wants and needs. A number is given for a total budget increase package, with incentives to not go over budget, or more money gets taken back,on top of money that will be taken back (200 million), on top of money that has already been taken back these last 2 years;  the budget increase itself seems unlikley to cover increased needs for patients (population,aging,immigration complexities,expectations of more advanced care), let alone inflation or COLA. But you can look at the arguments on those numbers elsewhere.

For all of this, you are being told to "excercise your right" and vote Yes or No. 

Make no mistake about it: this "agreement" is about money. It is not about figuring out the best patient care-its about how to pay for it, while denying we can no longer afford best patient care. And for a governing party, it's about money; the main goal of any modern political party is to control opinion- and few things sway that opinion more than how a party handles it's money. And once you have a housing debt to add to your student debt, and maybe a business with staff and bills to pay, and maybe a family to deal with, you will quickly lose your current ideals and, while being tired and exhausted from work while trying to deal with these added burdens, you will eventually admit to yourself that it is not always about (as every group in all of this disingenuously reminds you ad nauseum) patients. Eventually it is, like most other professions, about money. This tPSA is the document which will decide what most doctors will earn, how they will earn it, and where they will earn it. It will dictate the specific values for all medical treatments in the Schedule of Benefits (SOB), a title many of you have never heard of, is carefully never mentioned, yet is the main thing all the 'upset' doctors are really worried about. It is where relativity gets fought over. But the smokescreen here has been this tPSA is all about other high-minded ideals and ideas. So before you vote Yes or No, have the courage and honesty to address these ideas and questions: 

1. Many doctors, and all of you trainees, are paid income outside of the SOB. But the pillars that hold this entire system together are based on the Fee for Service(FFS). I am not being condescending when I explain this as I am confident many of you students don' t know how this works. Why would you? 

Since your vote will be mainly to generate the details of it, do you actually know what the Schedule of Benefits is?

If you do, have you read it enough to know the specific details of how you will be paid in your specialty?

If you are expecting a salary, or other payment model (do you know really know all your options?), does this tPSA detail what that will be, and how much?

Do you understand the repercussions when certain aspects of the SOB are reduced or increased?

Do you know the OMA has its own SOB? 

Do you know it has had minimal increases 

(using inflation/COLA) that nicely displays how much your work is valued in a real market, and that since the OMA took over as your "sole representative" (like it or not) in the early 90s, the negotiated OHIP SOB (that will dictate most of your world for years to come) has become a fraction of what the OMA SOB is?

Do you really know what it takes to run a business, staff,a mortgage,your own family?

Do you really know what percentage cuts in income will do to any of these?

(Do you understand what maternity/ paternity coverage you have when you want to start a family?)

Despite being promised a look at 'relativity' "this time" , are you aware this issue has been fought over for decades, including being written into a PSA, and has never been solved by the OMA?Do not be fooled by this one- most of us laughed when we saw it on the napkin.

2. Why all this talk about payment schedules?The point of a union, or association like the OMA, that is "Randed" is to secure maximal income and ideal working conditions. There are laws and regulations that guide this principle. Autoworker unions do not try dictate the safety standards of highways, and all other matters involving cars, in order to feel 

important and powerful.

Do you actually know what Randing is, or why you are being forced to have the OMA be your voice? Do you know how this arrangement came to be, and how that event was deceptively done?

Do you know thousands of doctors dont want to belong to the OMA, but have their dues taken directly from their bank account anyway? (Did you also know the OMA keeps those figures secret, self- declaring everyone who has "paid" a dues-paying member of the OMA, i.e. every doctor in Ontario?)

Do you know that the usual safeguard against an employer abusing it's employees, including those with Randing, is a neutral 3rd party, i.e. the government (legislative and judiciary)?

Do you realize with this quasi- Randing of Ontario doctors there is no protective 3rd party (the government and employer are one and the same)?

Did you know the entire OMA's monetary existence is due to the agreement (legislated as needed) between the OMA and government to force you to accept the OMA as your only representative, with the membership dues taken by your employer and given to the OMA, with the only oversight of this being your employer? (As stated,the importance of neutral legal protection on this matter has been conveniently removed by the OMA).

Did you know if you don't like your "union" or the pay it generates, you cannot (unlike any other professional) quit and work for someone else in your trained skill? (The OMA is your only option).

3. A lot of the sell on this agreement has been the apparently new idea of "co- management" of the system with the MOHLTC. This is beyond disingenuous. The OMA has been co-managing the payments to doctors since the early 90s, and did so until 2 years ago,when the MOH enacted a unilateral attack on the profession. It is preposterous to claim there is a new relationship, when the exact same relationship, with the exact same parties, resulted in the worst treatment and cuts by government I have seen in my 25 years. Perhaps your entire view on medical politics has been what you have seen the first few years of medical school (because you read about it in undergrad and high school, right?),so it's easy to see why the pronouncement of a new co- management partnerhip can be sold to you as new and marvelous. When the OMA announced its Charter challenge for binding arbitration, many doctors were both stunned and proud...it was the first time in almost 3 decades the OMA seemed willing to take on it's monetary master...many of us were willing to dig in and fight. It didn't last long of course... a few backroom talks in secret and it was the old partnership again. There is absolutely nothing new here: the MOH meeting with the OMA to decide who gets paid what,as long as the MOH pays for the existence of the OMA. So lets talk OMA co- management on your behalf:

Did you know there has been no effective pay increase  in a decade?

 Did you know the actual figures show a loss of 30% or so on average? (The details are too complicated to adress here- do some research)

Did you know relying on the OMA to co-manage physician incomes has been the continued worst drop in incomes, for our profession,over decades, in history?

Did you know the same legal team that is saying we are protected against unilateral action this time also claimed we were protected against it with the last PSA? (It's a new kind of protection- it's called a "facilitator", apparently having more magic spells than the previously all powerful 'reconciliation' mage...and all this side-show stuff about binding arbitration is more of the same. Did you know when BC doctors were awarded a huge amount, I believe around 20%,by binding arbitration,the government simply legislated the award away? )

Did you know the claim "these are difficult financial times", and many variations thereof,has been claimed by the MOH (and OMA)in every single negotiation for decades? (Your leadership sure bought that one...)

3. So what about the OMA, your only representative?

Did you know members are paid for committee and other meetings? (I am not saying there are not those who don't put in hard work, often for free...but do you really know the pay structure of the OMA?)

Do you really know anything about the bureaucratic structure of the OMA, or how long many of it's leaders have been working their way up in the club?

Do you know it took decades for the OMA to even get a professional negotiating team? 

Has the OMA really ever explained how this recent deal went down all of a sudden?

Did you know the OMA broke a lease with their previous space and uses its membership fees to fund new offices in expensive Yorkville, a move it declared necessary "to be closer to Queens Park" (you know,for the daily walks there over the last 2 years, even though the Minister of Health wouldn't reply to a letter fir many weeks).

Do you think the spokespersons for a huge part of the Ontario budget, which affects all Ontarians, should be doctors, given their apparent extensive backgrounds in negotiating with professional government staff, and their expertise in labor and economics?

Do you know if any of the OMA careerists acquire government positions?

Do you know how many of them actually rely on the income negotiated in the SOB, or how many are facing the cost of living/debt crisis your generation is feeling?

Did you know the OMA shut down its website chatrooms because it couldn't stand the ongoing outcries against it?(This was before the uprise of Facebook and before Twitter existed).

4. Finally, your leadership has been sold by guarantees of being treated fairly, and having a " seat at the table". Many of us predicted the MOHs standard game of 'divide and conquer' would play out in the usual fashion here. And there it was: in the face of a groundswell against the tPSA, the medical students suddenly had a seat at the table and PARO had an actual document promising the MOH promised to be nice to them. Quite the coincidence. The FHTs were taken away, then handed back contingent on your votes to pass all the rest of the tPSA napkin agreement. And that's all it took. I completely get it- I would be freaked out about getting a spot, maybe a FHT type thing, if it's all I ever knew. And current FHTs don' t want to give it up. It's far easier for GPs then the old days.So it's back,for now, a carrot stick to be used again in the future.

Did you know the OMA has previously passed PSAs that basically assaulted new grads, handing the savings to other groups?(you will get to know the divide and conquer thing quite well in your future years...many of us called out the OMA/MOH on this,simply on principle).

Do you really think the MOH wants to keep paying docs in FHTs? (Lets not even get in to how non- universal care is for payients who do not have access to one).

Do you really think the MOH will care who is at the table when decisions on med school mumbers are made? (And will that napkin agreement really protect you? Will you honestly care since you are already in med school?) 

Will the OMA really step up on your behalf, given it did nothing to stop all the recent FHT attacks ( don't recall a 3 million dollar publicity push on that one)?

Did you know the reason there is a clerk stipend is because the MOH/OMA badly needed your votes on a previous contentious PSA?

So there you have it, a late night missive from an old pro using 2 big thumbs and a cell phone and no spellcheck. Because we've all been where you are. Because you have to stand up and act on principle, or money issues will destroy you. It is beyond ironic how our OMA president uses a phrase decrying how strong we are all together, then allows a secret deal, excludes groups, and says nothing when clearly many thousands of experienced doctors are calling this the worst deal in the history of the OMA. Do you really have the knowledge to argue with them? Can you really listen to the voices of OMA careerists or doctors from academic sites, many of whom don't run businesses, don' t see nearly the amount of patients the FFS are seeing to prop up the line up disasters, and are riding salaries and personal interests, not to mention s desire to have their name in the paper(as is their perogative) . The students, residents,FHTS and academics are bought; the numbers are secured. The worst line ups in the Western world will continue.

 But you will have a piece of cake at the table,right before they slaughter you at will.

So if you have been unable to answer some, or many, of the questions above, you need to ask yourself truthfully and honestly if you should be voting on this. Is your seat at the table  worth screwing thousands of us who have been at it for decades, and who have seen the real OMA and MOH? If you vote Yes, do you really have the requisite knowledge to make a decision that will affect everyone in Ontario for the next decade? Have you really done your due dilligence while tryibg to navigate med school and residency?Do you and your very young leaders really know more than the thousands of experienced doctors who are giving so much time to fight this tPSA? If you vote No, do you really think the MOH will attack us even more? I' m ready to fight for you- can you say the same? It will mean a new negotiation- nothing else. We really do have strength together...put your ego and bias and enthusisdm aside and admit you don't really know.

And there is a 3rd way: abstain. It's that simple.This is not a democratic vote for one thing or another,like a leader. It is a vote on a document, and it requires knowledge of all aspects of it; if you don't have it, you need to abstain. You are still at the table. Do not eat the cake like the child the MOH is making you out to be. Stand together until we all agree it is right.


Sent from my Samsung Galaxy smartphone.
August 11, 2016 | Unregistered CommenterOMA god!
Thank you God.,

Unfortunately as the saying goes " you learn something when you suspend a cat by the tail that you can learn no other way".....the medical students and residents have been under the influence of the ivory towered Kantian ethicists who have indoctrinated them through their training...they have been trained to treat medical doctors in the field, the grass roots , with contempt, as being greedy self serving ignoramuses ...the very opposite to their saintly self sacrificing hyper intelligent and all knowing teachers and instructors, whose example they should follow throughout their professional lives.

After most enter the real world ( some of the most fanatical ideologues will be immediately absorbed into the ivory towers and the most government favoured alphabet soups) ....the scales will start dropping from their eyes...and the penny will drop...that they were duped by confidence persons, lied to, deceived....that the representative structures that they had , at one time , such confidence in....had sold them and their futures to the self serving political and bureaucratic class.
August 11, 2016 | Unregistered CommenterAndris
Wow. Wow. Wow.
Thank you OMAg!
This needs to be spread far and wide.
Let's see what we can do.
response to Dr Walley

Dear Dr. Walley,

A lot of us feel that uncertainty is not such a bad thing.

A lot of us feel that uncertainty is preferable to the certainty
that the OMA will continue to ignore the issue of inter-section
relativity. Our section continues to be underpaid and undervalued. EEG
codes have barely budged since 1989 (attached, EEG-Technical-Fee-Trend)
-- when the Berlin Wall fell. In 2012, ICES found that Neurology's
take-home pay after overhead was second last, above only Pediatrics
(attached, ICES-2012). More data from 2012 shows how flat-lined
Neurology's payments have been between 1992-2012; compare this with
cardiology and ophthalmology (attached, MOH-ICES-Neuro, -Cardio,
-Ophth). Although I do not have data from 2012-2016, we all know that
these disparities have worsened, not improved; the situation is worse,
despite the OMA's ongoing lip service to improving relativity.
Nonprocedural medical specialties like Neurology have stagnated while
more procedurally-oriented specialties have begun raking in money. Why?
Because we use our brains and not our hands to help patients? It
doesn't make sense.

A legally-binding April 2012 OMA council resolution (attached,
"CouncilResolutionsSpring2012") stated that "the principle of relativity
be applied to negative allocations" (top of page 2), and yet when the
negative allocations came in 2015, the OMA instead did its utmost to
ensure that highly paid specialties were defended (attached, OHIP
Billings Do Not Equal Salary - OMA) instead of protecting lower paid
specialties and advocating for relativity as the OMA had promised to do,
even in times of negative allocation. As a result of this stubbornness,
all specialties took an across-the-board cut. When there is a fixed (or
shrinking) health care budget "pie", then disproportionate gains by some
specialties followed by across-the-board cuts is the same as cuts to the
poorer specialties. This is the OPPOSITE of "the principle of
relativity being applied to negative allocations".

A lot of us feel that uncertainty may help.

To paraphrase you: as a neurologist, I know better than most that
unilateral government actions could not possibly make things worse for
us than the OMA's ongoing neglect of the elephant in the room:
inter-sectional relativity disparities.

Alex Fraser
Tariff Chair, OMA Section of Neurology
August 11, 2016 | Unregistered Commentereklimek
Email just in.from the OMA President...." Good news....the Toronto Star endorses a yes vote".

That is the final affirmation that one should vote NO.
August 11, 2016 | Unregistered CommenterAndris
O MAGod,

Thank you for the post and voice of experience. I Hope that some of our young physicians take your advice and consider abstaining from voting. I Remember when the OMA used the resident/student votes to counteract physicians who were critical of the OMA at the time. Many of us us felt that residents should only be given a vote if we could vote on PAIRO contracts.

The OMA has been a terrible negotiator and they always justify their poor performance with "We did the best we could in these tough economic conditions".

Consider that initially OHIP fees as negotiated by the OMA were 90% of the OMA fee schedule. The OMA schedule has kept up with inflation so it is easy to see just how poorly the OMA has negotiated on our behalf. Now they are LESS THAN HALF of what they should have been to just keep up with inflation.

Other government funded groups (nurses, police, even MPs and MPPs) managed to keep up with inflation despite "tough economic conditions".

To make matters worse, the OMA consistently failed to re-adjust fee inconsistencies in it's own OMA schedule. The OMA has always published it's own private fee guide based on a net hourly rate. It had the data to determine an approximate net hourly rate for every procedure in the OMA schedule (duration, average overhead, level of training required etc) yet it continously ignored making the needed changes to achieve consistency in the OMA schedule. To this day there are many fee codes that are still below the OMA's own recommended hourly net rate while other codes are many multiples of this recommended rate.

To make matters worse the OMA expense rate to show up to a meeting pays more on an hourly rate basis than many fees in the OMA fee schedule. Furthermore the OMA dues have also gone up far more than what the OMA has negotiated for our fee increases. Thanks to the benefit of RANDed members, there is very little incentive to become a more representative organization.

Hence young physicians should review the OMA's past performance and think long and hard whether they should be supporting it's current recommendations.
August 11, 2016 | Unregistered CommenterDr. Inflation
Merrilee, thanks for all you do...sorry about my long missive but it was a long bout of insomnia fueled by frustration over how the future of Ontario will be decided by the MOH cunningly buying off the students,a bunch of kids who (like s back then) have no clue what this is about. To the mighty Doc Klimek's points, if there were 3000 neurologists, they would be sitting pretty while the students would be taking a hike courtesy of the MOH . All us vets know this to be true. And I am brutal with facebook and twitter so woukdnt even know how to get a message to them! Too late snyway i guess....keeping my fingers crossed on the vote...
August 11, 2016 | Unregistered CommenterOMA god!
Stunning inaccuracies in 2 Star pieces today...the editors actually said doctors have had a 60 % increase to their individal billings in the last year...INDIVIDUAL!!
This lie must be deliberate....or the current quality of journalism doesnt get past googling Hoskins lying speeches for statistics...or does his office have a direct link to them?
August 11, 2016 | Unregistered CommenterKsy11
OMA god!
I absolutely loved your post...insightful to the bones!
Yet I struggled with how to promote it on social media. It seems attention spans are short these days...measured in seconds I think.

It is a keeper. I'm grateful you posted it here.
It may need a more prominent location...Hmmm.
August 11, 2016 | Unregistered CommenterMerrilee Fullerton
I know what you mean. It's as if the understanding of the complexity of how MDs are paid is beyond what many reporters or others what to endure.
I've gradually given up trying to explain it and moved on to envisioning a future where providers can provide care that people need and have the freedom to provide it.
August 11, 2016 | Unregistered CommenterMerrilee Fullerton
Dr Inflation,
I missed your post somehow! Good to hear from you, curious moniker...
August 12, 2016 | Unregistered CommenterMerrilee Fullerton
There is nothing to prevent job action in the event of a yes vote. One can expect uncovered Er shifts once again as physicians bolt from the ER.
August 12, 2016 | Unregistered CommenterERdoc
I'm already seeing relatively young MDs with at least 10 years of practice left in them retiring. With dual incomes, some families just say enough is enough....on to other things.

Can Central government control pull out the shackles I wonder.
August 12, 2016 | Unregistered CommenterMerrilee Fullerton
I note that even younger FPs are making plans to protect themselves....the Ontario's Central Planners expect the medical widgets to stay in place and that they will sheepishly follow the instructions given by their overseers ...the plans of the central planners depend on obedient pliable widgets doing what they're told, when they're told.

They will find out that the widgets they had in place may not be there and won't be doing what the central planners thought that they doing....they will discover that they have been herding cats....cats that vote with their feet even if they had misguidedly vote yes in their initial naïveté.
August 12, 2016 | Unregistered CommenterAndris
Sent to Star...as if they would print it! Nice to vent though....

Dear Editor,

Re: Doctors Deal

It is remarkable that in order to drive your control of opinion on this matter, you see fit to quote ridiculous statistics to mislead your readers.

Ontario doctors did not have a 60% gain in their individual incomes over the last decade, as you say. There has been a gain of this amount to the overall pool paid to physicians, all of which is due to increased population, increased costs of more elderly care, increased expectations in the standard of care and treatments, and an increase in doctor totals to match this. The number of these doctors is completely in the government's control, is actually still under-servicing the needs of patients, and the increased utilization of doctors services is completely in the  control of patients; if they arrive for care they can never be turned away, and for political and ideological reasons the citizens of Canada have never been held accountable for any over- utilization.

Perhaps you could consider research beyond googling Minister Hoskin's speech, which also quoted the same wrong numbers for the same reasons you did. Personally, I've had no effective individual (the word you misuse) pay raise over that same decade you mention, and have in fact been rewarded for that decade with a pay loss. Perhaps you would like to spend a night with me in the ER, where myself and health staff (including nurses) have spent the last 25 years burning out their minds and bodies for the people of Ontario you imply are being cheated by me. I wonder if you would call it a "party" after doing so. Perhaps you are partially right: If this deal is passed, the party will certainly be over for me, as I will be looking for anyway I can to take that 25 years of ER experiece elsewhere.
August 12, 2016 | Unregistered CommenterKsy11
Well said Ksy11. Let us know if the Star publishes the letter but don't hold your breath.
August 12, 2016 | Unregistered CommenterCanary in a Coal Mine
Either way, yes or no, OMA elections just became more important than ever. How long would it take to replace an entire board (except one)?

The coalition would be wise to run strong candidates in each district election, section executive election/council..
August 12, 2016 | Unregistered CommenterERDOC
August 12, 2016 | Unregistered CommenterStephen Skyvington
ER....the OMA political pole is very greasy and near impossible for the politically incorrect to climb, in particular to the top....the key seems to the moment they sign onto the Board ...the OMA being a corporation , their loyalty goes to the corporation as opposed to the membership...the interests of the corporation trumps the interests of the membership.
August 12, 2016 | Unregistered CommenterAndris
Vote must be close:
"If you didn’t vote on the tentative Physician Services Agreement (PSA) by proxy, you can still vote ‘FOR’ stability and predictability by attending the General Meeting of Members this Sunday, August 14. You can vote at any time after you have registered in person for the meeting."
August 12, 2016 | Unregistered CommenterMerrilee Fullerton
Heartfelt Ksy11.
August 12, 2016 | Unregistered CommenterMerrilee Fullerton
Good idea ER DOC.
August 12, 2016 | Unregistered CommenterMerrilee Fullerton
She's fair:

August 12, 2016 | Unregistered CommenterMerrilee Fullerton
OMA email message said the results would be out on Monday.

What gives?
One more sleep.
August 13, 2016 | Unregistered CommenterCanary in a Coal Mine
The electronic result are in and run. The votes at the meeting will be done within hours, but final results likely aren't out until the right press cycle.

A "YES" will get a legal challenge based on the side-deals with OMSA an PARO

Unclear if the OMA, directly,would challenge legally a "NO" vote.

Is going to a dramatic vote, with huge split between FFS grouping, versus salaried/student groups. Votes will be polar opposites.

Central,in the end, will win and put through a fixed budget, and reductions in selected areas.
August 14, 2016 | Unregistered CommenterMovingforwardOntario
Awaiting the results with baited breath.

Comparing the plight of Canadian doctors to their Belgian counterparts.

Belgium's health care system is rated by the WHO at #21....Canada at # 30.

Belgium has 1 Doctor for every 220 Belgians.

Ontario has 1 Doctor for every 522 Ontarians.

Belgian doctors are the 4 th., highest earning doctors in the world ( #1 Being the Netherlands, #2 Australia, #3 USA) ....adding insult to injury the Belgian doctors have pensions retiring at around age 65 and the average Canadian Doctor retiring , pensionless, at around 71.

Ontario's MDs should be given medals than the abuse that they are receiving.
August 14, 2016 | Unregistered CommenterAndris
Andris that post should be on the current thread.
August 14, 2016 | Unregistered CommenterCanary in a Coal Mine

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