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

**Please note that the original journal entry from August 14 has been modified to reflect the vote result from  August 15.


 “Abdication, Distraction, and Deflection.”

 Ontario’s doctors voted NO to the tentative Physician Services Agreement between the Ontario Medical Association and the Wynne government that would have doctors co-manage the Province’s ailing health care system. The results of the vote from August 14 were shared the following day. Of voting OMA members, 63.1% voted Against the Agreement, 36.9% voting For the Agreement. The rejection is indicative of the negative view of Wynne’s overall approach to healthcare in the Province – one of abdication and deflection.

Given that Ontario is at a pivot point in health care that will affect patients, physicians, and the province for many years to come, the vote result will be important.  Simply stated: it is a bad deal, indicative of Wynne’s overall


The Wynne government has demonstrated its abdication of responsibility to patients by limiting the physician services budget for patient care below what can conceivably meet patient demand.  Instead of dealing honestly with the surge in health care need due to our growing population, new advances in science and technology, and an aging population with all of its associated requirements the Ontario Liberals are using health care to balance their budget. They have used rationing of patient care to offset the burgeoning debt that they have created through mismanagement and wasteful spending.

The centrepiece of the Liberal government-OMA deal was Wynne’s design to use  Ontario’s doctors as its collaborative rationing tool through co-management of the Physician Services Budget. This would have bureaucrats and doctors, together, deciding on the healthcare cuts to meet the government’s scheduled budget targets. Obviously, neither the OMA nor the Liberal government appear to have the interests of patients at heart. If they did, they would not be resorting to rationing under the guise of “co-management” and “collaboration”.


The Liberal government-OMA deal included components to address Relativity (the relative difference in the OHIP fee codes of some MD specialities compared to lower fee codes of other specialities). Although some physicians believed this was a positive attribute, it will require Ontario’s physicians to be internally focussed on slicing and dicing their profession – rather than spending time and resources on providing input into major structural issues that afflict health care delivery.

While the OMA is distracted with Relativity, the Wynne government master plan is to bring in more bureaucratic management in the form of Bill 210, The Patients First Act. Doctors kept busy with co-managing the rationing of care allows the government to move forward with minimal resistance to its major expansion of powers that allow it to unilaterally impose accountability agreements. Individual freedom for both patients and providers is at risk with this legislation.


The Ontario Liberals are intent on deflecting blame for costs of their own debt and waste onto the Province’s health care system and its providers. It is harder and harder to provide publicly funded patient services when the government is spending approximately one billion dollars a month on servicing the massive debt it created over the past decade through waste and mismanagement. Consider what can be paid for with a billion dollars per month: the medical staff, operations and procedures, the equipment. With the deal and physicians given a co-management role, the Wynne government has found a deceptive way to deflect public criticism from government decision-making.  

 As a disturbing aside, thousands of physicians who oppose the government’s current rationing plan are not “dissidents” as some government spokespersons and media have referred to them. By branding physicians who perceive solutions differently from the government as non-collaborative the government is attempting to quiet dissenting voices and deflect attention from its own failed policies. It’s a ruse. Differing perspectives could be used to create a more respectful and compassionate plan for health care transformation. It is often at the interface of opposing views that the best solutions will be found. It would be wise for our political and association leaders to do more listening and less deflecting.

The Liberal government’s approach has created a dysfunctional healthcare system

The Wynne Liberal government’s deal with the OMA suggests this government is clueless on how to proceed with its healthcare challenges. Constraining the freedom of physicians in a command and control system where they cannot meet patient demand and then labelling this as being in the “public interest” is disingenuous at best.

This is not the way to create a leaner and more efficient health care system or a way to meet the growing demand for patient care. Instead of squeezing the breath out of our public health care system, as our population grows and ages Kathleen Wynne should be answering the question “How can we provide more care to more people?” If we want innovation and “modernization” of care, it will not be found in rationing or managing wait lists. More management and more bureaucracy are not what we need.

As this deal so clearly illustrated, Wynne’s healthcare legacy is an abdication of duty, deflection of responsibility and distraction from her government’s wasteful ways. Hardly inspiring. Hardly a vision. Ontario can do better – it must do better.  The vision of health care in the future cannot be about rationing care, denying care, and limiting the freedoms of providers and patients.  It must be about empowering patients and empowering providers including Ontario’s physicians in providing more services and more care, not less.

The rejection of the deal was the ethical and appropriate response to a poorly considered health care rationing master plan pushed by the Wynne Liberals. Ontario doctors have spoken with resounding support for patients. However, any celebration of the rejection of this deal should be dampened by the reality that there is much work ahead to be done to shore up Ontario’s hobbling healthcare system. Let’s start with the resignation of Dr. Eric Hoskins.




Reader Comments (290)

" The purity of a revolution lasts two weeks...." ( Jean Cocteau).
August 22, 2016 | Unregistered CommenterAndris
It will take months for a meaningful restructuring within the OMA. Probably strategically best for the Minister to proceed unilaterally and await the next formal meeting in the fall to set up talks with an agenda and April 1/17 resolution target.
August 23, 2016 | Unregistered Commentereklimek
Central has a rapidly building crisis in energy. It can't handle both the doctors and energy in crisis mode.
August 23, 2016 | Unregistered CommenterMovingforwardOntario

<<There is, of course, another way to boost doctors’ pay that may well be the end game: Open up medicare to more of a two-tier system, allowing specialists to bill patients extra on the side for preferential treatment.>> - Martin Regg Cohn

Again...there it is → this whole thing was exclusively about how much doctors are being paid (a.k.a. the greedy doctors syndrome).

There has to be some smart agency out there who can come up with a solid diversion strategy to sell the OMA!
August 23, 2016 | Unregistered CommenterExecutive Lead Blogger
Hoskins seems to have done the medical profession a great favour by attempting to ram through a deal which would have seen the docs take a pay cut and potentially be part owners of health care rationing in Ontario.

Now that he's kicked the wasp nest he has galvanized the rank and file into action but most importantly the resulting collapse of the tPSA deal and the OMA has delayed any new unilateral MOH action until the fall legislature where much of this will have to be debated. It is time Hoskins has to stand up and start answering some questions in public as to his poor handling of the negotiations . To date this guy has been playing hide and seek (hiding at Blue Jays games) rather than facing the music for his poor performance.

If the government also has an energy crisis on its hands then there is even less reason for the OMA to regroup in haste. Take our time, flush out all those whose fingerprints are on the rejected tPSA agreement including the president, and start afresh. If we delay rebuilding the OMA into late fall the government will be increasingly tempted to act unilaterally which will only further rile the profession and reduce the chances that MOH will be able to implement Bill 210 in a timely fashion. This bill should never should see the light of day and needs to be debated thoroughly in public.

It is time to keep the MOH in crisis mode. Let them dish out the bad medicine unilaterally and watch the previously osteopenic MD spines become even stronger and prepare for the next battle.
August 23, 2016 | Unregistered CommenterCanary in a Coal Mine
Moving walk in clinics close to ER? The coalition is out to lunch in my opinion and no better than the OMA. Do we magically just break our leases and teleport within a block of the hospital, where there are higher rental rates and no parking?

I already see patients daily who've left the ER AMA on a regular basis, I also can recall sending back chest pain and patients with unresolved lab findings. Has the MOH or COD stopped by our waiting rooms to see the volumes we already have, oh yea they'll also be capping billings and no more small business deduction per CRA , do we swap doctors at 2pm?

Time to jump ship and start that travel medicine clinic...
August 23, 2016 | Unregistered Commenterdocinthepark
There has to be some smart agency out there who can come up with a solid diversion strategy to sell the OMA! ELB

Exactly this is something the COD should be doing rather than attempting to put out some half baked and poorly thought out schemes to move WICs to the ERs.

The Toronto Sun has some interesting CIHI data in the print version of its Sunday issue showing the median service cost by speciality for all the provinces. Ontario had one of the lowest cost if not the lowest in the category of consultation fees. If I recall the only fee where we came out possibly the highest was for ob/gyn services. In other words Ontario physicians are not the highest paid and especially so when one factors in the volume of patients seen which is the highest in the country.

I have yet to see the average and median Ontario physician gross incomes which I am sure must be quite different. The median income also needs to be published by specialty after excluding anybody not working at least two days a week.

The reason this has not been done, since the OMA would have all this economic information at its fingertips, is that they were compelled to work with the MOH rather than represent the profession's interests ever since it seems that Ron Sapsford quietly moved from the upper echelons of the MOH to the helm of the OMA for four years. Until the current president steps down because she represents the old guard with ties to the Sapsford era these divided OMA loyalties will only continue.
August 23, 2016 | Unregistered CommenterCanary in a Coal Mine

Just let the MOH try and close the FFS WICs. The ER system will be overwhelmed in a heart beat and only further hasten the collapse of the system. Opening an urgent care run by each hospital would be useful but even that seems to be beyond the MOH's capabilities. The Trillium hospital in Mississauga has an urgent care which takes some of the load off the main ER down the road. It is staffed by many of the docs who work in the ER.

The internist spokesman Dr. Slaughter at the COD seems to have forgotten that the new team-trained family docs do not know how to suture or cast. The first thing all those newly minted IMGs tell us is they do not want to suture in the WIC. Casting is not part of the new curriculum.
August 23, 2016 | Unregistered CommenterCanary in a Coal Mine
Here you go ELB at least someone is showing that physician incomes have not increased 60% or whatever the last lie our health minister put out while hiding behind his white board.

"The cost of providing physician services across Canada climbed 3.7 per cent last year to $25-billion, but payments to individual doctors have essentially flat-lined, newly published data show.

The average clinical payment to physicians was $339,000 in 2015, virtually unchanged from the previous year. This reflects the fact that provinces are increasingly taking a hard line with physicians as they try to contain costs, which has resulted in bitter labour battles, such as the one continuing with Ontario doctors."

August 23, 2016 | Unregistered CommenterCanary in a Coal Mine
I was saddened by the Coalition's sad offerings....but what can one expect from a committee?

What doctor is going to sign the lease...or group of them for that matter, as their fees get battered, clawbacks increased...with Professional Corporations about to be kneecapped and the prospect of LHIN managers hovering about snooping into their bank accounts when not lecturing them on following provincial protocols and guidelines...who is going to finance the buying and leasing of equipment in a world where incomes bear no reflection to billings thanks to unknowable claw backs and increased costs such as electricity?
August 23, 2016 | Unregistered CommenterAndris
As Wynne drives up the cost of energy the cost of running a practice increases. Add that to the high real estate costs of md offices in Toronto and environs and some clinics are just scraping by.

Wait until Wynne's energy policies fully ripen...stench will be bad.

It's fascinating that the Liberals brought in a pile of new MDs into action without understanding how to pay them.
August 23, 2016 | Unregistered CommenterMerrilee Fullerton
The CODs "plan" was bizarre, disjointed and would change the system by almost nothing. The" WIC near ER idea" is simply illogical...not sure how the geography saves the system money. And if you plan to do sutures and fractures (the media myth )in WICs, you need to be trained, in 2016, to handle all varieties of them, not pick and choose the simplest. Who does the after care for all these fractures? IMGs at WICs? Frankly, the WICs across the street from my ER do bizarre things, hand out antibiotiocs for pretty much everything, and every time they do an XR for a fracture, they just send them over to the ER for actual care, as they don't really know what to do with most of them. Their xrays are minuscule CD versions, often unreadable, so we often have to repeat them. This means, in order to save money, we are routinely having fractures seen by 2 doctors, with 2 xrays, read by 2 radiologists. This is, as always, a utilization problem, which is not being addressed by the government. Like the myth of NPs, their is no cost savings in trying to filter everything through people who can only do certain things.The COD needs to focus on taking out the OMA old guard before they can suggest policies.
August 23, 2016 | Unregistered CommenterKsy11
No plans from as of now to do anything about the contract mess.It is still summer.No action until after PFA gets voted on. Will be another claw-back.

Still waiting to see how much federal money dumping will occur.Each dump improves things.

Carefully watch energy,it is spinning out of control.Sucking up more money than expected. Problem with energy,it hits everyone. Everyone sees the costs,and their immediate need for the service.Everyday. Politically, it is worse than health,if it is badly managed.

90% of us,don't use healthcare on an urgent basis. We trust it is there, but most are not impacted on a daily basis. Politically, it does not impact everyone of us,everyday.

The energy management issues,may overtake the health care management issues,very soon. If it does,it will become THE political agenda, as it could activate the entire voting population. Health only activates small groups,with various vested interest. Of interest the OMA ,with ?49,000 voting members, may be the biggest single activated group in health care, but central can ignore it, by finding 49,000 supporters elsewhere. Energy is different, badly managed, everyone is affected by some cost increase. Most will be tolerant to some cost increase to deal with global climate concerns. Substantial immediately recognizable large costs individuals, will result in voter backlash.

Energy issues are now sorting themselves out in native remote population,Newfoundland and Labrador,Alberta in major fashion. Watch those places.

Aging and remote issues in health are showing there difficulties in Nova Scotia, New Brunswick, NFLD and Labrador, in major ways.

Federal constant bailouts may not be able to fix this.(ignoring the debt issue).

Interesting,today the CMA supports,in essence,mandatory vaccination for children. We are moving to more authoritarian government. Not only, do we know what is best for you, we will legislate that you will do it. In Ontario, the doctors are the first group getting it delivered to them. Interesting to see how many doctors continue to actively support central and the media, to deliver the "greedy" doctor agenda, with no counter from the OMA. There seems to be no tactics or strategy. A void central and its media supporters have won. The numbers are clear, central is rationing. Get central to "own" rationing.

Stay away from the margins. It is getting tough.

The plan is good.
August 23, 2016 | Unregistered CommenterMovingforwardOntario
N.B. Point of Information. Those plans were drawn up and released by rogue members of the Concerned Ontario Doctors Facebook group.

The Coalition of Ontario Doctors is having its weekly teleconference this evening to discuss the real plan.

Be patient. These things take time. I just read the draft plan. I think you'll like what we come up with instead of the amateur hour stuff those few members of COD sent to the OMA and released to the media.


August 23, 2016 | Unregistered CommenterStephen Skyvington
Let's hope the COD puts a short leash on those rogue doctors.
August 23, 2016 | Unregistered CommenterCanary in a Coal Mine
Working on it as we speak.
August 23, 2016 | Unregistered CommenterStephen Skyvington
That's what we need. Cream skimming clinics near emerg so we can leave all the demoralizing heavy duty patents to the emerg docs. The good news is we won't need as many shifts per day. Bad news is double the night shifts.

Pretty sure (position supported by CAEP) that the problem with ER wait times has nothing to do with the lower acuity patients.

Primary care access is important as well but again is not the problem with ER wait times.

Top three reasons for ER wait times
1) not enough available hospital beds
2) not enough beds
3) no beds
August 23, 2016 | Unregistered CommenterERDOC
And not enough Long Term Care beds.

In the primary care level, more transformation including the Patients First Act is unlikely to make any substantial difference.
Mezzanine care (robust Urgent Care Centres) can make a difference to ER use.
August 24, 2016 | Unregistered CommenterMerrilee Fullerton
Need to present a single plan out. Rogue groups feed centrals plan, and agenda,about greedy doctors.
August 24, 2016 | Unregistered CommenterMovingforwardOntario
Interesting to read the CMA reviewing physicians and autonomy. Agenda being driven by the same group, whom, in the end, want to be agents of the state, not agents of the patient. They don't seem to understand, they are the drivers of the rationing process, and will, as all this grinds through, be the biggest drivers of inequality.
August 24, 2016 | Unregistered CommenterMovingforwardOntario
I have tried to make this same point with people involved in pushing for a national pharmacare program that will as they believe "improve physician prescribing"...What it really means is that government will have to ration government funded pharmaceuticals and some will end without the medication they need.

Despite building a huge bureaucratic system to account for the 10% who can't afford their medications, well intended individuals think they are solving inequity by shifting who is denied medication. They are convinced that EBM will provide the rationing solutions. The lack of insight is amazing.

I'm all for universal coverage but that can be done in many ways that are more efficient than creating a large government system that overpromises, underdelivers and has ever expanding costs. It can be done incrementally. The savings predicted are based on faulty premises and on data that is already out of date or lacking. Not sound decision -making.

Alas, it is often about someone wanting a monument.
"Up coming in September, targeted funding drops to some of the sensitive MD supporters of central. Need to assure that the greedy doctors"story gets told by the right players,to the right source.Media will respond well."-mfO

Your post from Aug 19 indicates gov't $ to flow to "supporters" -is that what you mean by "drop"?
What are you hearing about Relativity being imposed in the Fall?
August 24, 2016 | Unregistered CommenterMerrilee Fullerton
Central has supporters within the OMA membership, who are rewarded by providing stories/writings/talking head sources to the media. Privileges and benefits flow to the favoured few whom tow the line central needs. The line central needs now is "greedy doctors", and avoidance of the rationing discussion.
August 24, 2016 | Unregistered CommenterMovingforwardOntario
Which is why the OMA and if not them the COD needs to frame all future debate about who will own rationing. Rationing will trump the MOH's 'greedy doctor' strategy because rationing affects the public directly whereas what they doctor gets paid does not.

I have noticed with patient, friends, and family a very positive response when the last tPSA rejection is framed as a NO vote against any deal which incentivizes physicians to ration care. The Choose Wisely campaign is one thing (education) but actually paying physician to ration is unacceptable. The public easily understands rationing and they need to be reminded that this is what the debate is really about and not physician incomes.

As we've said here many times before what the MOH is actually trying to create is one big Ontario HMO where the profits from the system are returned to the governing party to do what they like with, which is typically creating more bureaucracy in order to purchase a larger public sector vote. The 80 new sub-LHINS with their new hires are a perfect example of where money from rationing care will be directed.

Money dumps for the chosen few. So lets see Dr. D Martin at WCH and the CBC should be getting a nice dump for her Chatelaine articles on Choosing Wisely and for ramping up the drum beats for the creation of a national pharmacare program.

Drs. P Berger and A. Bayoumi at St. Mike's should expect a large donation for their media articles on the SDOH and for Berger's recent article on the greedy doctors.

I'm sure the architect of the Patients 'First' document, Dr. David Price at McMaster University will also be richly rewarded.

Academic docs will vote yes because they invariably support Central's message of greater controls on physicians and for lower incomes. That message is then instilled into receptive minds of all the students passing through those Ontario university walls thereby ensuring a future yes vote from the indoctrinated graduates.
August 24, 2016 | Unregistered CommenterCanary in a Coal Mine
As for inequality, little point in having the conversation about 40 years of well funded social programming, that hasn't solved core issues. The reality is, as long as you permit independent action, people make decisons that adversely affect their health, to the detriment of the common social pool.
August 24, 2016 | Unregistered CommenterMovingforwardOntario
If you want to see a plan on how the integration of the new sub-LHINs with the various silos in health care will be all merged into one big happy tent have a look at this document.

"Big hair audacious goals" means greater bureaucracy, less patient choice, reducing physician autonomy, and returning all 'profits' from the transformation back to the governing party in order to reward those who support this view of the future. Glad to see several of the docs who have worked for the MOH in the past jumping on board to steer the good ship HMO Ontario.

August 24, 2016 | Unregistered CommenterCanary in a Coal Mine

The plan is good.
August 24, 2016 | Unregistered CommenterMovingforwardOntario
I used to think that SDOHs were a solution to controlling health care costs. They are not.
If you think health care is expensive, wait until the costs of SDOH is tallied. In the end, it will mean even more rationing of care and less opportunity because tax $ will disappear into a big black hole that can't account for distribution of tax $ or lack of improved outcome or value for $.

Opportunity, education, and jobs and a better future for everyone can be created but it can't be created by a government that grows its inefficient bureaucracy and tramples on individual freedoms and that wastes casts amount of $ feathering its own nest.

August 24, 2016 | Unregistered CommenterMerrilee Fullerton
Mfo, you bring the bread and I'll bring the vodka and together we can raise this barn.

August 24, 2016 | Unregistered CommenterCanary in a Coal Mine
"Dear Colleagues,

The OMA has formally requested a meeting with Minister Hoskins and Premier Wynne to discuss next steps for binding arbitration and physician services negotiations.

In a letter to the Minister – sent earlier today, I wrote:

“The ongoing unilateral government actions and cutbacks over the past two years have been some of the most challenging and demoralizing in recent memory for our members. We feel strongly that the power imbalance between the government and our profession needs to be righted.

With our members’ rejection of the tentative PSA, there was an overwhelming call for binding arbitration for physician services negotiations.

As such, I would like to meet with you, and respectfully, with the Premier to discuss the next steps for binding arbitration and a path forward.”

The letter is posted on the OMA website here. I will keep members apprised of the government’s response.

With thanks for all that you do,

Virginia M. Walley, MD FRCPC
President, Ontario Medical Association"

Fortunately, the OMA has moved one subway stop north of Queen's Park to Hazelton Lanes, so can now walk on a nice downward grade to hand deliver it (the previous office one stop south of Queen's Park was unworkable I guess..uphill slog and no cafes...anything further away and cheaper would be better for something important like, say, lowering our membership dues, but that would make lunches with paid meetings so much more boring...)
August 24, 2016 | Unregistered CommenterKsy11
I'd be happier if it was Hoskins going cap in hand to Walley....I don't like the idea of Walley , representing myself, going cap in hand, cowering, to Hoskins...it is a sign of subservience.
August 24, 2016 | Unregistered CommenterAndris

It is not a fixable issue, with the rigid dogmas driving this. 20-30% of the population will not do what you want them to do.Designing systems to provide good services will fail,unless you force participation. Vaccination is our best example. Whether you do, or do not, participate the common pool pays all costs.Hopeless, we pay for good social behavior, we pay for poor social behavior. We just pay!

It is paying both sides that is breaking the system. Just hoping the promised public money lasts to get me through my old age. If is does not,I guess I get signed up for the accelerated MAiD programs.
August 24, 2016 | Unregistered CommenterMovingforwardOntario
Lots of rationing goes on. Central wants the MDs to be the restrictors to access. Do you want that role? Is that your role, or maybe a role,one can transfer to the receptionists?

For the idealists, who don"t get that this about rationing, who , in the system,owns the rationing decision?
August 25, 2016 | Unregistered CommenterMovingforwardOntario
Notice that today's Toronto Star features three negative stories about Ontario physicians: one who groped four patients and got off without discipline, the need to discipline a pain clinic physician and a physician who is accused of OHIP fraud.

Can't be a coincidence...no such thing right?

You'd figure that among the tens of thousands of other physicians in the province, someone could find a good (perhaps even a great) news story to promote the profession?
August 25, 2016 | Unregistered CommenterExecutive Lead Blogger
There is an agenda to all social justice plans. Find the culprit and bring them down, as they own all the responsiblitiity for the social inequity. Doctors are why health care doesn't fix everything for free, perfectly.
August 25, 2016 | Unregistered CommenterMovingforwardOntario

The headline is misleading. Yes the protagonists are doctors. The underlying story is about the actions of the College in all three cases.

I am greatly saddened to see that the allergist is one who was at one time at highly regarded at Memorial University for fraudent publication. And he then came to Ontario? And defrauded OHIP?
August 25, 2016 | Unregistered Commentereklimek
Philpott refers to health care rankings: https://m.youtube.com/watch?feature=youtu.be&v=CHxE3bqMH8M
August 25, 2016 | Unregistered CommenterMerrilee Fullerton
Am unable to access the Philpott clip.
August 25, 2016 | Unregistered CommenterAndris
No movement on anything in Ontario, until the BC challenge is resolved. Both central and the OMA, are in shock. Thus now easier to blame issues on the BC challenge.
August 25, 2016 | Unregistered CommenterMovingforwardOntario

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