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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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Main | Ontarians Should Be Very Wary of Bill 41- "The Patients First Act" »
Tuesday
Feb072017

Resignation of the OMA Executive-What Now?

So, the Executive of the Ontario Medical Association has resigned...sort of. The Executive is resigning to sit on the Board of Directors and then will go through an electoral process. At least that is what we are told currently.

This follows after a 55% non-confidence vote in the OMA Executive at a special meeting of the OMA Council but at which other motions failed to win the required two thirds majority to pass. These other motions if they had been successful would have led to the resignations at the individual executive level.

In the face of the quasi-win by the groups challenging the OMA's representative performance, there had been murmurings of requiring the OMA to hold another General Meeting of Council to address the non-confidence vote which had initially been arrogantly passed off by the OMA as a demonstration of support. Another General Meeting of Council would have been disastrous for the OMA. It managed to avoid that through this resignation process.

However, the OMA should know that this result was not the end of this non-confidence wrangling. It is just the beginning.

The Ontario Liberal government should also understand that the advocacy efforts of front-line physicians are not going away. These physicians are not dissidents as they have been labelled by some reporters. They are simply aware that the Liberal government's cuts to front line health care and patient care in Ontario will cause more and more hardship for patients as time goes on. It's not the 1990s anymore.

Fact is that we are up against the demographic wall made even more challenging due to a sluggish economy affected by the shift in aging--a double whammy. Instead of cuts to care, government ought to be planning how to allow more care for more people. Cuts do the exact opposite of what is needed. Even if the deficit is eliminated for 2018, growing health care need will not be eliminated. The pent-up demand for care will be even greater after 2018 due to the current Liberal cuts.

Physicians are becoming more vocal. Despite government-created positions for paid "Physician Leaders" to push through the government's self-serving and short-sighted version of transformation, many physicians see the negative impact of government's efforts to balance its budget on the backs of patient services.

Physicians I know and have known care deeply about their patients. They see that health care access is becoming more and more difficult. They want to continue to provide much needed services but they may differ on how those services can best be provided. We should be able to differ on the "How" and value different perspectives and approaches and still be united in providing quality patient care.

We must ask the "What if" questions.

What if the government is not forthcoming with more and more funding for care to adequately serve citizens who are dependent on it?

What if government providing  more funding leads to higher debt and greater interest payments resulting ultimately in fewer services?

Billions of dollars going to interest payments every month are one reason why Canada has fewer physicians and hospital beds per population than most developed countries and which results in lack of timely care, delayed diagnoses, and patient hardship--even death.

A couple years ago a fellow physician told me not to worry--all that was needed was a Liberal federal government and the money would flow. They were surprised to discover that the Trudeau Liberals are no health care saviours.

So what now?

I have no doubt that some of the former OMA Executive members will be re-elected to a new Executive. That will change nothing. Some new MDs may find themselves elected and in a position to create change from within the OMA but it is external factors beyond the OMA that have brought us to this point of upheaval. It is only by addressing external  structural health care system issues BEYOND the OMA that substantive, sustainable change can occur.

I'm hoping that a new OMA Executive will understand that their most important role is not to align with the government transformation flavour of the day. Instead, it is to give critical input on how more care for more patients can be realistically achieved while supporting our human providers who deliver that very necessary care.

We need to be asking the hard questions.

As always, thank you for your continued insights and thoughtful comments.

 

Reader Comments (724)

Align with central. Come to the dark side and enjoy what few perks you can, before you as forced to hit the "coal face",or leave. If staying, find the LHIN you wish to die in. Once assigned by central, you can not leave.
February 7, 2017 | Unregistered CommenterMovingforwardOntario
How sunny of you mfO.
Ah, here we go. More begging for money from the Feds after Wynne has squandered tens of billions.
http://m.torontosun.com/2017/02/07/growing-concerns-about-health-care-systems-sustainability
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
More postcards for patients to fill out?
"The association has been threatening unspecified job action as the government refuses to accept their term of binding arbitration as a pre-condition to negotiations."
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
From The Toronto Star:
https://www.thestar.com/opinion/commentary/2017/02/07/more-proof-our-health-care-system-is-broken-opinion.html
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
One suspects that this is nothing more than a cunning stratagem carried out by the OMA Board , seemingly giving up power without giving up power.

Having this Board devising a strategy to take on the government somewhat resembles that of Benedict Arnold who obtained command of the West Point fortifications planning to deliver it to British forces --- his plan exposed he switched sides and was commissioned as a Brigadier General in the British Army leading them to battle against the troops that he once commanded.

He lived the remainder of his life comfortably on a British government pension.

There is no way that the membership would rise out of their trenches , bayonets fixed , under their command---their loyalty is questioned--- their judgement is questioned---their courage is questioned ---their leadership is questioned.

I recall, sometime ago on this forum , that we speculated that future leaders would rise from the grass roots of the profession, from the coal face
February 7, 2017 | Unregistered CommenterAndris
Hah!
Meanwhile in BC, government lawyers in the Charter challenge seek to prevent the health minister from testifying:
http://vancouversun.com/opinion/columnists/ian-mulgrew-health-minister-testify-at-medicare-trial-go-jump-in-the-lake-says-province
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
"I recall, sometime ago on this forum , that we speculated that future leaders would rise from the grass roots of the profession, from the coal face"- Andris

Government paid-for and created "physician leaders" distort leadership.
Same with the developed taste for sitting on bipartisan and tripartite committees. $$$
February 7, 2017 | Unregistered CommenterMerrilee Fullerton
Merrilee: the OMA and the government by creating such sinecured positions such as "physician leaders" doesn't make them into leaders.

If a government appointed "leader" attempted to give me orders/instructions I would tell him or her to " get stuffed".

They are pseudo leaders, faux leaders,....National Socialist Germany (Nazi) gave them the title of "labour trustees" whose function was to maintain labour peace, to keep the workers docile----in the USSR , the Communist Party had a similar structures,"control-distributive commissioners" with similar goals--- in both top down systems unions were subordinated to the government, the needs of the state trumping that of those at the coal face.

Dr. Nadia Alam's revolutionary group looks promising as leadership material.
February 7, 2017 | Unregistered CommenterAndris
The overwhelming evidence is that it is too late for the MDs. They delayed too long To much legislation has(and is being) been created to control them in a command and control structure.
February 8, 2017 | Unregistered CommenterMovingforwardOntario
https://www.thestar.com/news/queenspark/2017/02/08/oma-is-a-union-out-for-more-cash-for-mds-bob-rae-says.html

Bob Rae, the man who gave us the OMA Dues Act.
February 8, 2017 | Unregistered CommenterStephen Skyvington
Rae said giving doctors more money won’t fix the health system.

“No one should think by giving the OMA more money for doctors, it’s going to resolve the health-care challenges facing the country or the province,” he said.

Good one Bob. And the question remaning is - what challenge and what will resolve it?
February 8, 2017 | Unregistered Commentereklimek
Bob, did you steal it from Irwin Corey?

"If we don’t change direction soon, we’ll end up where we’re going,”

https://www.nytimes.com/2017/02/07/arts/irwin-corey-comedian-and-foremost-authority-dies-at-102.html
February 8, 2017 | Unregistered Commentereklimek
The OMA dragged its feet ( deliberately? ) as the government legislated the chains that will bind the profession.

One notes that Wynne continues to put her ducks in line for the Provincial election in June 2018 as she hikes the wages of teachers by 4% over two years ( the OECTA) and more monies for professional development and supplies.
February 8, 2017 | Unregistered CommenterAndris
and the feds plan to tax dental and health benefits....
Who voted for these people?
February 8, 2017 | Unregistered CommenterMerrilee Fullerton
Expect another Hoskin's unilateral cut to OHIP fees to pay for this vote buying.

"A tentative deal with the Ontario English Catholic Teachers’ Association (OECTA) to extend the current contract, a copy of which was obtained by The Globe and Mail, shows that educators would receive a 4-per-cent wage hike over the next two years. Additionally, teachers would receive a lump sum payment of 0.5 per cent for expenses related to professional development or supplies."

http://www.theglobeandmail.com/news/toronto/in-continued-pre-election-bid-for-peace-wynne-offers-union-wage-hikes/article33948315/
February 8, 2017 | Unregistered CommenterCanary in a Coal Mine
Ain't that the truth.

"To be honest, I’m not sure what was more of a shock—the New England Patriots erasing a 25-point deficit and coming back to win last Sunday’s Super Bowl, or the announcement the following day that all six members of the Ontario Medical Association’s executive committee were finally prepared to do the right thing and resign, following a non-confidence vote at a special council meeting held in Toronto on Jan. 29, 2017."

Sky Skyvington (CHN op-ed above)
February 8, 2017 | Unregistered CommenterCanary in a Coal Mine
Could some one post the restricted access article from can health network?
February 8, 2017 | Unregistered Commentereklimek
Physicians » News
Former OMA treasurer speaks out after his and rest of executive’s resignation
Dr. James Stewart explains that it was the full board's decision for the executive to step down
WRITTEN BY TRISTAN BRONCA ON FEBRUARY 8, 2017
Email Print Text size Comment
Dr. James Stewart
Dr. James Stewart

After being wracked by a non-confidence vote and the subsequent resignation of the six-member executive, the Ontario Medical Association has entered a period of uncertainty. With about half of the board positions up for election in May, it remains unclear who is going to fill those roles or how they’ll be selected. Dr. James Stewart, the former OMA treasurer who was one of the executives who resigned after the special council meeting, spoke with the Medical Post about why he and the others didn’t resign at the meeting and what he sees for the future of the association.

Can you give us any details about how the executive decided to resign? What happened?

Well I’d be breaking the board privacy if I were to give you details but essentially there was a consensus that it would be worthwhile for us to change the game. We were hoping that after the special council meeting there would be more unity in the profession but it was clear that wasn’t going to happen.

Some people felt that there should have been a break at the meeting after the non-confidence vote passed to let the executive decide whether to step down then and there. Why did you wait?

You’re in a position of responsibility, you don’t want to make rash decisions. We didn’t want it to drag out either, but we knew we were having a board meeting in the next few days so it gave us a chance to reflect on the impact it would have if we were to leave. In the past, some of us have offered to resign several times but, at those points, the board thought it was in the best interest of the association to continue on. After the meeting, we saw that we weren’t going to move forward unless we made some changes.

When you’re dealing with a majority government that doesn’t care about physicians’ opinions you can jump up and scream all you want, it’s not going to matter.
I mean just looking at the news release, it made it seem as if everything was fine. It didn’t even acknowledge the non-confidence vote. As an outsider looking in, the decision to wait seemed to become a bigger problem than it needed to be…

And I can tell you that as an insider looking out, I as confused by that same release (laughs). So I hear you. It didn’t help relationships. It’s something that we as an executive get painted with even though we weren’t involved in some of that.

If the entire executive hadn’t resigned, might you or other individual members have resigned? Or was this always going to be an ‘everyone or no-one’ deal?

When we started having these discussions, everything was on the table. If we had collectively thought there would be some benefit if some stayed and others went then we would have considered it.

So you’re on the board still. How does your role change, practically speaking?

That’s a very interesting question. There is some belief that the executive functions separate from the board but it doesn’t. So although I may not be the treasurer, I’ll still be a board member as I always have. It’s just that we don’t sit down as a group of six to answer business of the association while the board isn’t meeting, which is what the executive’s function is.

What exactly was the executive doing that will now be especially difficult for the board to handle as a whole?

It might be responding to requests to fill committees. It might be speaking to the public, since the president acts as the official OMA spokesperson. But the executive would never make any decision of significance without board input.

What kind of representation would you like to see in a new executive?

It would probably be premature for me to answer that. Whatever it is, it has to be something that doesn’t become a lightning rod for the association.

Do you think that the entire executive’s decision to step down is more important symbolically than ensuring that, functionally, whoever fills those spots knows what they’re doing?

I think the symbolism of the move may improve the function, because I think we’ve become distracted by anger. The government has treated doctors badly. They’ve been intransigent, they don’t want to work with us, and physicians are frustrated. We know that we need to see change in the health system but we don’t have a mechanism to show that to the government. So if we need to step down to send a signal to members—‘if you think this will make the difference we will do this’—then so be it. There may be some bumps in the road but we have some very bright people within the association and I’m confident that we’ll be able to move forward as long as we can get the profession to unify.

Do you think that a stronger approach from whoever steps up at the executive will be any more effective? The former executive that you were on was heavily criticized for not being forceful enough.

I’m not sure, but I guess we’ll see. I don’t think that the executive can be any more forceful. When you’re dealing with a majority government that doesn’t really care about physicians’ opinions you can jump up and scream all you want, it’s not going to matter. Now, heading into an election cycle, that may change. Not necessarily because of a new executive or a different approach but because they need to do something to start getting noticed.

I’m wondering how/whether these resignations will interrupt the current initiatives at the OMA? Like job action, for example…

One of the problems we may run into is the lack of a central spokesperson that can rally the members at the coalface, but I think we can still mobilize board members to get more involved at a local level. All politics is local. We need to address these issues in our communities where we have direct relationships with patients and the electors.

Right, but how important is an executive to making that happen?

Any activity that is going to force the government to take notice needs to be implemented through the members themselves. It doesn’t necessarily require an executive. But it does requires an organized association with representatives who are willing to take this to the street.

Edited for length and clarity
February 8, 2017 | Unregistered CommenterGasman
Central's major plan is the politics of envy. Constant stressing that the MDs draw too much from the tax pool. And now they what more. Expect, and plan, for lots of publicity about the "greedy rich doctors". It plays very well in the urban areas. Centrals goal is to hold the urban areas at all costs.
February 8, 2017 | Unregistered CommenterMovingforwardOntario
mfO...and what about "greedy rich" teachers? Are they next?
February 8, 2017 | Unregistered CommenterExecutive Lead Blogger
There are around 75,000 elementary teachers and over 40,000 secondary teachers---Ontario has around 14,000 FPs and 11,000 specialists (2016..CMA data center) .

The Liberal government gives the 115,000 and takes away from the 25,000 so earning the loyalty of the 115,000 with the bonus that they indoctrinate the young--- - as the Jesuist maxim goes " Give me the child for the first 7 years and I will give you the man" ( cribbed from Aristotle) .
February 8, 2017 | Unregistered CommenterAndris
And in most cases the spouse will also vote to maintain the status quo so that is actually 230,000 bought votes.
February 8, 2017 | Unregistered CommenterCanary in a Coal Mine
The OMA is done. If it can come back,it can only come back as union.It will take years.

In the interim,consolidations and restriction of options by central. If you thought the current government is authouritarian, the next will be much worse.

Parts of Ontario, and Canada, are dying as the recent STATSCAN population numbers confirm. In some areas the dependency ratio is 1 worker, for 5 dependents! Yet central continues to pick the winners and losers based on its need to "do something".

One notes in the GTA area, local fees and licenses and increased charges, are running at least 7% higher, on a FFS "increase" of less than "0".

Next, targeted increases in charges on the "wealthy" retirees. Central needs to get at those "locked in" resources.

Meanwhile, it seems more whom have resources, are seeking care in the US,if they are near the border.
February 9, 2017 | Unregistered CommenterMovingforwardOntario
So the mantra is " keep away from the fringes---but if you are in the fringe, let it be close to the US border" as occurred to that cardiac patient in Manitoba who received an emergency cardiac procedure --he developed chest pain in Sprague Manitoba and got rushed to the closest hospital in Roueau , Minn, --could not get transferred back to a Manitoba hospital so he was flown to Grand Falls North Dakota were he got stented at a total cost to him of C$118,000.
February 9, 2017 | Unregistered CommenterAndris
The seeds of a Trump-esque populist government are being sewn with the demographic changes mentioned. Young men without post-secondary education and older men laid off are not finding work which is what is behind the rise in addictions and anger.

As the video alludes to job loss overseas is less of the problem rather robotics and automation are taking their toll on the job market. Schools are not preparing these young males for the reality they will face without post-secondary education.

http://www.cbc.ca/news/thenational/why-some-men-are-not-adapting-to-the-changing-job-market-1.3973465

http://www.cbc.ca/news/business/men-boys-falling-behind-1.3962316
February 9, 2017 | Unregistered CommenterCanary in a Coal Mine
German study of left wing activists carrying out politically motivated offences: 84 % male; 72% between 18-29; 92% live with their parents; 1/3 unemployed.
February 9, 2017 | Unregistered CommenterAndris
"Nevertheless, that little financial spin exercise paved the way for this buy-a-teachers-union contract and one with the Elementary Teachers Federation of Ontario (ETFO) so far.

I will just note here that Ontario’s doctors have remained without a contract for four years now."

http://www.torontosun.com/2017/02/09/buying-labour-piece-with-ontarios-teachers
February 10, 2017 | Unregistered CommenterCanary in a Coal Mine
1.OMA: Will struggle to reorganize, whileBill 87 winds its way to being passed, thus introducing more loss of control, and the ease of complaint on those whom would be foolish enough to do physical exams on the"naughty and not so naughty parts'. Soon to be followed by the third leg of the stool, the MD reallocation system to assure more MDs get forced out of urban areas, and reduce"urban fees". Quebec and Manitoba have already put in place their reallocation plans.
2. Contract - there will be another contract offer, after the squeeze in the spring.It will, again,be a revenue reducer. Central is alreday contacting its trusted internal troops,and its trusted media sources, to continue to assure those "sex driven greedy neoliberal colonialist MDs" are shown in their true light.
3. Where to go - despite statements to the opposite by the various governments, the Maritimes are dying, population is (has) gone into negative group, and despite federally supported ship building money, it is only new immigration that can stabilize group. Quebec, for most, is not an option, Alberta is not going to thrive even with the new oil issues, leaving realistically, BC. If you are 50 or lower, better move now. What you see in Ontario is going going to slowly become even more restrictive. Methinks, a number of "imagers" are leaving for the US, given the technological assault they are facing.
February 10, 2017 | Unregistered CommenterMovingforwardOntario
Dependency numbers:

https://www.thestar.com/news/gta/2017/02/09/qualtrough-pushes-for-accessibility-despite-cost.html

With 17% of the pop'n 65 or older, and 14% with option for disability pensions,it means,as of today, about 30% of the population is eligible for state entitlements.

Thank goodness for the immigrants devoting their future to support us entitled ones!
February 10, 2017 | Unregistered CommenterMovingforwardOntario
The profession remains unaware of the content and significance of Bill 41---and is oblivious to the same for Bill 87.

Any decent representative organization would have been up in arms over their content and the consequences of their application ---the membership would have been whipped up into a frenzy by a vigorous dissemination of their content and the consequences for all concerned.

The days for old style physical examinations are over---
February 10, 2017 | Unregistered CommenterAndris
Given this is such an important topic here is a portion of the above CHN article by Dr. P Zalan.

"1. Under the new legislation, the Minister of Health will have discretion to assign members of the College of Physicians and Surgeons of Ontario’s complaints committee that investigates the complaint. No longer is a physician guaranteed to be judged by peers who understand his/her profession and issues.

2. After the CPSO panel sends a complaint of inappropriate sexual touching to the discipline committee, and even before the case is heard, Bill 87 requires the CPSO to publicize on its website the name of the physician and the accusation leveled.

3. After the CPSO receives a complaint and even before the case is heard, Bill 87 gives the CPSO panel permission to suspend the accused physician’s licence. It can take years for a given accusation to be head by the discipline committee. In the interim, the theoretically “innocent before being proven guilty” physician will have their reputation destroyed and potentially, their livelihood suspended.

4. Even before any finding of physician wrongdoing, Bill 87 gives the complainant a right to access healthcare to remedy their suffering at the physician’s hands. It becomes the responsibility of the CPSO to create a pool of funds to pay for this remedy. There is no provision made for the government to provide these funds to the CPSO.

5. Bill 87 replaces the penalty for sexual touching (temporary suspension of licence and re-education) to equal that of intercourse with ejaculation (permanent revocation of licence).

6. Should a physician appeal a finding of guilt by the discipline committee, penalties meted out continue to be in force during the appeal process.

In their eagerness to be seen as the defender of patients, Ontario Premier Kathleen Wynne and Health Minister Dr. Eric Hoskins in my view bulldoze three principles of law:

1. Innocent before being proven guilty,
2. The punishment should be proportional to the crime, and
3. The Blackstone Principle that “it’s better that 10 guilty persons escape than have one innocent man suffer.”

With Bill 87, the Wynne government implies the following: Rather than let one guilty offender go free, even before a hearing of their defense, it is better to punish all innocent physicians by removing their licences and ruining their reputations."
February 10, 2017 | Unregistered CommenterCanary in a Coal Mine
It is pretty obvious that the dictatorial Hoskins is taking full advantage of the fact the OMA is in complete disarray to ram through these very blunt instruments ( a la Trump) to deal with policies that require some nuanced thought.

It is time for the OMA to accelerate its elections in order to get out of this MOH choke hold. We need the most aggressive negotiator we can find who will take use a hard line take no prisoners approach with this health minister who clearly has a hate on for his own profession.
February 10, 2017 | Unregistered CommenterCanary in a Coal Mine
The OMA

You can not reverse the upcoming legislation, and the third leg of the stool will likely hit this year (reallocation, physically of MDs). Central is extremely authoritarian, and is comfortable that more will driven the urban vote yo vote them back in. It seems, andonerepeat seems, that the over 60s (in age) MDs will be OK, in that things take a while to really change, the under 40s, for the most part have accepted their duty is to the state, not the patient, and only those between 40-60 really be hit. Half on them have bought into salaried, or subsidized incomes, so really over 5000 or so MDS will REALLY be feeling this change.

In the urban areas,housing and hydro, are much higher on the list, than giving the "greedy" MDs more money. One only needs to wander around Queens' Park to see the youthful social justice campaign worker carving out their special interest grants to correct are the historical evils that have lead us to the "hopeless"society we have created where all are suffering, and led miserable lives!

Meanwhile, many at central are planning their March break trips to warmer climates (including the social justice folks!).

This is not about health. It is about the "new" group craving out their control of the budget, to use as they see fit.

One thing is certain - in health in Ontario. The old general family physician role is done. Took just 20 years, and was lead by the FD consultants.
February 11, 2017 | Unregistered CommenterMovingforwardOntario
You've got that right Mfo. I've been at this game for 25 years and started out in rural Ontario doing it all. We're still old school in the urban environment and can't keep up with demand,....paper charts for high security, touch medicine, lots of suturing, etc.

The sad thing is the patients still want old school. At some point a disrupter will come along to allow a hybrid system. The public system will become so dysfunctional that the population will demand a non-US private tier. We allow a private tier in education and it will eventually become reality here out of necessity.
February 11, 2017 | Unregistered CommenterCanary is a Coal Mine
The entire economic system is out of whack in Ontario. With housing prices pushing 10x average family income in Toronto for a detached home when historically it was 3x to 5x one knows this is not sustainable.

One sees this housing stress in the office. Generational families looking to move up cannot so one sees dysfunction as kids become teens and still have to share bedrooms. Younger couples cannot even afford a condo purchase these days unless a parent helps out with the down payment so again you end up with 30 year olds still living with mom and dad in order to save money and pay down student loans.

There is a lot of anger out there being driven by financial stress and unrealistic expectations. As the standard of living falls from one generation to the next it shows up in all sorts of ways in the physician's office.

http://www.theglobeandmail.com/real-estate/toronto/a-million-dollars-now-buys-a-tear-down-in-torontos-greektown/article33957589/
February 11, 2017 | Unregistered CommenterCanary is a Coal Mine
They will kill " old style" Family medicine just as the Soviets destroyed "old style" farming , where free farmers knew their land, it soil and properties , which crops and farm animals would flourish, which would not, far better than any politician/ bureaucrat/ central planner in the Agricultural ministry, a thousand miles away.

The private farmers and their families were abused and eventually deported or killed off ---agricultural production collapsed under the collective farm system---the decline was blamed on droughts and natural causes and sabotage since the plans of the highly educated and insightful central planners were absolutely "brilliant" and could not be faulted.

Following its collapse , agriculture had to be reinvented since those with the old skills and know how no longer existed---interestingly old style Russian farmers who had been exiled still existed---' Old believers" still farmed in Canada, the USA, Alaska, skilled in farming, fishing, bee keeping, hunting etc., and have been invited to return to the old country, Russia with their old " outdated" skills to reintroduce them.

The Russian army is presently learning wilderness survival skills from the ' Old Believers'.

Modern era Russians have to reinvent the wheel that the Communist ideologues destroyed---one day the same will occur in Canada, future generations will try to reinvent the health care wheel that this and previous generations of central planners and social justice activists have and still are destroying---unappreciated "out dated" skills will have to be reinvented.
February 11, 2017 | Unregistered CommenterAndris
From the comment section of the article above. This illustrates my point and how economic stress due to high housing costs in the GTA now shows up in the office as marriages fail and people's dreams are dashed.

"My marriage ended because I refused to take on that level of mortgage debt. My ex thought that I was being unreasonable when I did some simple projections of all of the things that would have to be cut in order to make the mortgage payments on the "forever" house.

Now a few friends of mine marriages are disintegrating for those reasons. Case in point, the weekly gatherings at the local pub have long stopped because those friends "don't have the" luxury" of buying a domestic pint" as they have mortgage payments to make." Izzy
February 11, 2017 | Unregistered CommenterCanary is a Coal Mine
CICM:

Although housing is a concern, the GTA will survive as have all "world class" cities. The "born in" just get use that the middle class no longer have separate freestanding homes within 80 km. of the city centre. Paris, London, Berlin, Hong Kong, Singapore etc. all handled it. A permanent underclass, a permanent mobile elite, and a middle class that commutes in to service both.

The politicians are just learning how to cater to the three groups, the permanent underclass, the elites, and the newly established imported middle class. Isn't racism, sexism or any "ism". Just politics.
February 11, 2017 | Unregistered CommenterMovingforwardOntario
How sad canary.

I am working with young FPs in their 30's , still living at home , no regular girlfriends ( too busy to date) often financially supporting their retired parents and siblings---watching house prices soar---aware of dark clouds gathering over their profession and their futures.
February 11, 2017 | Unregistered CommenterAndris
DrL:

All will be fine. The Premier, and Prime Minister, have promised.
February 11, 2017 | Unregistered CommenterMovingforwardOntario
General summary: Absolutely fricking amazing!

First, let me just applaud all of you who continue to contribute to this blog. The level of information sharing, analysis and future-casting is exceptional. You are all to be congratulated.

Regretfully, this isn't making the right news. All we see/hear/read are Trump tweets, Trudeau travels and who is pregnant with twins this week.

As such (and as noted previously) Bill 41, Bill 87, and the upcoming imposition of a fee schedule clawback will go near-unnoticed by the mainstream media because of high electricity rates or housing (as was reported in today's T.Star) a 1,500 square foot home in Don-effin'-Mills that was listed at $1.19M sold for $2.3M.

Ontario is going to wake up in the not-so-distant future, rub its eyes of sleep and will suddenly realize that - from a health care system perspective - it has become a monstrous dystopian reality where most will have to travel to one of no more than eight major centres (perhaps as low as five) for truly comprehensive health care. Look at all the large community and teaching hospitals who are struggling to stifle news that they are running at 110%+ capacity right now.

Care in the home will soon largely depend on how much friends, families, and neighbours will be able to supplement the tightening-and-shrinking home care allocations. And in the wake of an RN who allegedly killed at least eight residents in Southwestern Ontario, new stringent regulations (in addition to the current stringent regulations) will force many private, municipal and non-profit operators to abandon long-term care home operations.

If the public only knew...but no one really cares as long as they aren't sick. So long as their electricity bills are kept artificially low through the application of government subsidy (i.e., our own taxes) ...who cares?

Hate going so 1984-y on all y'all, but holy crap...it sure sounds like a shitstorm is visible on the horizon.

Again, I salute you for all your incredible insight and I also salute all those who continue to toil and innovate at the front lines and create work-arounds to provide service to the people in our communities.

Where is this ultimately leading and (apart from the margins...which really appeal to me by the way) where can we go?
February 11, 2017 | Unregistered CommenterExecutive Lead Blogger
One has a series of globalization issues going on, that one can't reverse.

Urbanization vs. rural. You can judge how that goes based on those areas that are "world class". Those areas (and there are about 20 "world class cities to examine),have uniformally divided into the globalized rich, the permanent underclass, and the commuting middle class. Vancouver was first hit, and overwhelmed by a rich global elite that needed to park its resources. It really had little time for the middle class to recover. Toronto will figure it out, with middle class wishing frees standing homes commuting in from Barrie, Kitchener, and Cobourg.

Second is the rural issue, Ontario is based on selling physical resources, which are no longer selling. Silicon Valley isn't moving to Ottawa (too cold), and mining is not going to expand. High intensity manufacturing won't be back (wages are too high, and hydro is pricing Ontario out of the market. Ontario is surviving because the GTA is doing well with financial jobs,investing, and a booming housing market.

The immigrant population splits into two groups - those economic immigrants who come with resources and buy into housing, and those who come poor, who will not want to be personal home workers very long.

Wait until the 40 year olds find out their state pension is held off until they are 72.

The skilled MDs will survive and thrive, it is the average ones who will struggle with their new role as just primary care health care workers.

Stay away from the margins, and if bowing out, settle near a major teaching hospital. Sorry, that is basically Ottawa or GTA.

Watch the Maritimes carefully, they waited to long change.
February 11, 2017 | Unregistered CommenterMovingforwardOntario
ELB

Not good at the future thing, but the issue is here for me daily. A tale from the margins. I will change the facts to make the case unrecognizable.

50 yr old has a nuisance of a headache and impresses the family doctor without going to ER that maybe a month of his too much. The FP is a conscience competent fellow, like I think CICM is likely to be. A CT Head is obtained in a few short weeks. The person works and pops tylenol to maximum allowance.

Of course the CT shows only a shadow for which the rad inserts boiler plate differential. Good enogh to get "urgent" on the referral and I see 4 days later (Monday). The urgent triggers a MRI locally next week.

"What's a night sleep worth if you may have ....." becomes the topic of practical discussion. I see the person the nxt day with the Buffalo MRI in hand. (565$ US)

The entourage is informed this has taken a definite turn for the worse with these findings. In my world deserving souls ask, "Can I go to work?"

This deserving soul sees my colleague in surgical neurology at a teaching cantre within walking distance of Queen's Park 6 days later. The surgery will be "squeezed in" in 3 - 4 weeks.

In an America the delay would be malpractice. Here this is making a dysfunctional system burn over time. No kudos to Prince Hoskins here. I need to go to the gymn to get an attitude adjustment.
February 11, 2017 | Unregistered Commentereklimek
In an America the delay would be malpractice. Here this is making a dysfunctional system burn over time. No kudos to Prince Hoskins here. I need to go to the gymn to get an attitude adjustment."-eklimek

It is so sad to hear. I know it goes on regularly and the politicians and hc status quo champions hide it and dismiss these "anecdotes". More measuring and monitoring they say!

If only the public really knew and could feel what is happening.

Thanks so much to all of you who contribute and share here and tell it like it is.
As ELB writes, we have been good at anticipating.

I read in the Ottawa Citizen how a large bureaucratic effort is being rallied to prevent falls in the elderly. Full histories and investigations and risk analysis is going to be done for people appearing to be at risk,
Falling is not part of normal aging they say.

Folks, we live in the land of ice and snow..As we age our vision, hearing, balance become less than ideal and probability of falls increases.

When people are dying without modern cancer care because of lack of beds,when dementia patients are left calling out for help continuously in their rooms alone because staffing is so low, or elderly are being told their heart attack is "palliative"
what level of bureaucratic measuring are we supposed to defend?
February 11, 2017 | Unregistered CommenterMerrilee Fullerton
ELB/ MFO -- it is likely that the " average"/ docile widgetted MD's , lacking initiative, will fit nicely in the new collective polyclinic health care system---the "skilled" will move to wherever their skills are best appreciated and where they can improve their skills, where they can access state of the art equipment and work with and be intellectually challenged by fellow skilled in supportive fields.

One "skilled" practitioner I know of lives in a rented basement apartment in TO, for all of her skills--- I simply see her like moving South where their skills would be better appreciated and their standard of living and quality of life improving immeasurably.

I've mentioned before the importance of spouses in an MD's decision making---when marital pressures increase ( as Canary pointed to) because of the financial pressures and the desire of the spouse to purchase a family home, the move to more amenable environments become inevitable.

Visiting my daughter and her family in Houston I hear of the good reputation of Canadian MD's---she, herself, sees a physician from Mississauga.

Ed is right , the "system" is rapidly forcing us to practice poor quality medicine via the delays and barriers built into it --- evidence based when cheaper, evidence ignored when more inconveniently expensive---with medical practitioners left hanging exposed to the dangers of malpractice suits--- the new layers of managers and social justice overseers from the LHINs, and their demands, will aggravate matters , not help.

Then we have the increasing urban/ rural split which aggravates the various dangers for both patients and practitioners in rural areas.
February 11, 2017 | Unregistered CommenterAndris
"Some people hate doctors.

No doubt, doctor-haters have deep reasons for feeling so. Perhaps they had a bad experience with a scary doctor.

Now, they write nasty columns in the Toronto Star about doctors. All the inspiration they need is a tweet, by a famously unpopular Premier from the 1990s."

http://shawnwhatley.com/doctor-derangement-syndrome/
February 11, 2017 | Unregistered CommenterCanary is a Coal Mine

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