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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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 (788)

February 12, 2017 | Unregistered CommenterCanary is a Coal Mine
Canary: one expects that the next Presidential Order regarding immigration will cover such individuals---the danger for such individuals ,if they come to Canada, is that they will be locked into a particular LHIN for life---also, they will have to go through hoops and be supervised by a colleague for a period.

I'm involved with supervising a returning immigrant FP at present---at least I will when she finally gets through the prolonged process with its hurdles and hiccoughs.

The USA will fix these immigration vetting problems and continue to suck in the best brains in the world , including those from Canada---the unvetted and those who fail vetting will come to Canada.
February 12, 2017 | Unregistered CommenterAndris
I think the immigrant issue warrants comment, not because of FMGs (foreign medical gradustes).

Immigration integration and citizenship are facets that are rarely addressed cplored simltaneously. How easy is it to have a group of sponsors bring in a family warranting support for the first year? Answer, thats the wrong question.

Do you want to help a refugee from poverty, illness and persecution? Everyone does.

Do you want to import potential citizens? Now think about that.

I am myself a product of a refugee immigrant influx. When the Cuba missile crisis occurred my father said, son if this becomes a war , you will fight. Maybe that is revealing to you. Maybe you just want to help refugees?
February 12, 2017 | Unregistered Commentereklimek
Wait times for cataracts have been lowered because of manipulation of the stats. FIrst eye gets measured in years, second eye measured in weeks because done soon after the first. Tricky eh?

Also wait times for cataracts have been improved because of the $ spent on services...not only from the government but also from ophthalmologists investing in equiipment and space to service growing numbers of patients.

Now the government says they are costing too much....


Please tell me how much it would cost to educate doublt the number of ophthalmologists to distribute the income over twice as many.....and would this make any difference to costs? No. It simply waters down what each specialist can make. It could even cost more.

So government takes to the TStar to lament overpaid specialists when the reality is they work hard, invest in their equipment and then serve the public only to find they become the scapegoats.

It's all so backward, distorted and wrong.
February 12, 2017 | Unregistered CommenterMerrilee Fullerton

Just politics. Find the minority. Blame them. Ignore evidence or facts.
February 12, 2017 | Unregistered CommenterMovingforwardOntario
MDS are greedy, capilists pigs, who have oppressed the poor for personal gain. They have not contributed to improving health, extending life span, innovating treatments and therapies. Albert Switzer was a colonist abusing Africans for personal capitalist agendas!
February 12, 2017 | Unregistered CommenterMovingforwardOntario
Government toils seeking justice and equality for all, while their wages are found in the afterlife.

I think we get it. There is no redemption but through Liberal grace. Until we can see the angels dancing on the head of a pin held by Prince Hoskins, we must be instructed in the righteous ways.
February 12, 2017 | Unregistered Commentereklimek

MDS---acronym for myelodysplastic syndrome? MDS labs? Mennonite Disaster service?

Albert Schweitzer?
February 12, 2017 | Unregistered CommenterAndris

Albert sweitzer. I apologize. My spellchecker also misbehaved.

MDs. Not lifeless. Just regular greedy physicians, whom, according to central, constantly lie and overcharge.
February 12, 2017 | Unregistered CommenterMovingforwardOntario
Sorry, I didn't realize that the MDS was MD's , so my thought process went along a different and bizarre path.

Merkel's over compassionate globalist instincts encouraged the violation of all the borders of sovereign countries between Greece and Germany....Macedonia, Bulgaria, Serbia, Croatia,Bosnia- Herzegovina, Hungary , Slovenia, Slovakia Austria and the Czech Republic------it is not a coincidence that these countries are experiencing a populist backlash--- Brexit--- Trump.

As Mfo points out , we are regarded as greedy , venal creatures who lie and cheat---every month I look at my OHIP statements at the government claw back of fees that would be laughable in relation to that of the other professions and of medical professions in the more effective and efficient health care systems of the world and wonder at what %age of claw backs the victims decide to exit.

April 2017 looms, The Federal budget looms---populist USA will look increasingly attractive.
February 12, 2017 | Unregistered CommenterAndris
Despite the negatives ,but here are more positives. Life expediency had grown, caliber of experience has improved, ove4 life quality is better. Despite those whom attack, in North America, most of us can enjoy a better known
Life style than thev1800s.
February 12, 2017 | Unregistered CommenterMovingforwardOntario
"The B.C. Health Coalition consulted economist and former automotive union spokesman Jim Stanford as an expert in the trial.

He sees public healthcare as a major Canadian asset that both attracts business and ensures healthier people.

It saves automakers about $10,000 a year per employee, he said."

A wee bit of bias.
February 12, 2017 | Unregistered CommenterMerrilee Fullerton
Suppressing health care spending to save $10,000 per employee in the car industry while jacking up electrical / energy costs---sounds logical to the government's way of thinking---how many $'s is that per employee in the car industry?
February 12, 2017 | Unregistered CommenterAndris
From the Medical Post:
VANCOUVER | “The nature of waiting for surgery in orthopedics is different from waiting for cardiac surgery,” for predicting deterioration in patients, said Dr. Murray Penner, head of the regional department of orthopedics at Vancouver Coastal Health Authority and Providence Health Care.

Dr. Penner was testifying at the B.C. medicare challenge trial on February 9. Under cross-examination by the plaintiff’s lawyer, Andrea Zwack, he testified that “in orthopedic surgery it is much more difficult to achieve a line in the sand. There is no expected outcome with this mark versus this mark,” he said, referring to wait time targets. “They massively oversimplify the situation.”

Timelines spanning four to six weeks, for example, represent a “meaningless distinction” in orthopedic cases, Dr. Penner said. And category cutoffs are sharp: a patient who was treated one day after the target time is placed in the same category as one who was 26 weeks beyond the target date."
February 13, 2017 | Unregistered CommenterMerrilee Fullerton
Time for women to step up to the plate and start shoveling the snow. Much lower risk for death by MI.
February 13, 2017 | Unregistered CommenterCanary is a Coal Mine
Lots of money flowing as the Minister does his northern handout tour.
February 13, 2017 | Unregistered CommenterMovingforwardOntario
In the Globe today:

Kills the old and take their money. It is under discussion. The young are getting antsy.
February 13, 2017 | Unregistered CommenterMovingforwardOntario
Rumor pretty strong at Central that selected additional cuts start April 1. Interesting how much some of the consultants despise their fellow MDs.
February 14, 2017 | Unregistered CommenterMovingforwardOntario
The silver spooned ivory towered , ideologically driven , types most likely--- also, those power hungry activists , climbing the greasy political pole in the hope of gaining lucrative posts in the collectivist health care system of the near future , where they could oppress their more successful betters.
February 14, 2017 | Unregistered CommenterAndris
All this doctor bashing by the media (and Hoskins who enables it) is having real effects on the front line. Last night I learned that three physicians in our area, probably in their seventies, have made plans to retire early. That will cast at minimum 6000 older patients onto the ice flows because there is no one to take on these patients locally.

And I'm sure the decision process that led these doctors to retire earlier than planned is occurring all across the province. Remember for each of these older male physicians you'll need two to three of the younger docs to replace them especially they are working on capitation.
February 14, 2017 | Unregistered CommenterCanary is a Coal Mine
I will be turning 75 in September and my lease expires in December. Whatever altruism that was left in soul has been destroyed by Hoskins. Two years ago I was making plans to continue in a limited capacity for another 5 years. However in the last 2 year 2 neurologists doing EMG have have left or retired and one busy neurologist in the region with a large EMG practice passed away. I am overwhelmed with referrals and with rigorous triaging I am keeping the waiting period down to 3 months. With Hoskins vendetta on technological test and neglect of EMG technical fees by the OMA for decades no new neurologists are willing to do the volume of EMG studies that some of us older neurologist did in our office.. When I quit many doctors including plastic surgeons and family doctors and neurologists will be clamouring for EMG services in Scarberia. I just saw an early case of ALS and very severe CTS. MRI and Ultrasound cannot be substitute for and adequate EMG study. EMG is a procedure and a test in the true sense of the word.
February 14, 2017 | Unregistered CommenterFarouk

If the government has a duty of care to maintain culture, as the courts have ruled over indigenous rights, does it not have a duty of care to provide immediate and reasonable responsibility to reduce morbidity and mortality?

One thinks central has lost its way.
February 14, 2017 | Unregistered CommenterMovingforwardOntario
Hi there Farouk, long time no hear.
February 14, 2017 | Unregistered CommenterAndris
"As reported by the Toronto Sun’s Sue-Ann Levy, documents obtained by the Sun indicate the model, two-year contract extension Wynne is offering teachers to ensure labour peace safely beyond the spring, 2018 Ontario election, include a 4% pay hike, a 4% annual hike in benefits and a 0.5% lump sum payment for “supplies”.

Levy reported specifically on the hush hush, tentative deal reached between the Liberals and the Ontario English Catholic Teachers Association, in which teachers appear to be getting a 1.5% pay hike this September, a 0.5% lump sum payment for “supplies” in November, a 1% pay hike in September, 2018, a 1% pay hike in February 2019, a 0.5% pay hike in August, 2019 and a 4% annual increase in benefits."
February 14, 2017 | Unregistered CommenterCanary in a Coal Mine
"Under the Liberals, Ontario today has one of the world’s most expensive health care systems, costing taxpayers $51.8 billion annually — 42.4% of all government program spending — that delivers mediocre health care outcomes compared to international norms.

We have fewer doctors, nurses and hospital beds per capita than countries with less expensive health care systems that produce better medical results."
February 14, 2017 | Unregistered CommenterCanary in a Coal Mine

We have created a political health care system. With no restrictions on access. Those in the middle are being ground down, quickly.
February 15, 2017 | Unregistered CommenterMovingforwardOntario
And to afford the health care we have I received the following message today.

"The OMA takes the legal position that under the existing OMA Representation
Rights and Joint Negotiation and Dispute Resolution Agreement, government cannot take unilateral action to adjust fees for the period beginning April 1, 2017.
Rather, it is obligated to negotiate with the OMA under the procedures set out in
that Agreement."

This means mfo is onto something. Further cuts enroute.
February 15, 2017 | Unregistered Commentereklimek

Do not understatement centrals agenda in Ontario. It wishes to redistribute wealth, and the MDs are the biggest wealthy group. Central WILL control that. It does not concern itself with long-term consequences. It has short term goals, to satisfy its vested interest voting groups. Daily, the vested interest groups are lobbying central to force MDs to be centrals widgets. Centrals OMA consultants support that. Central will win this, before the next election.

This has nothing to do with health care. It is politics, solely, politics. If the OMA doesn't get that, its members will be sacrificed to the "noble" causes of equity, on their backs. Central will control its widgets.
February 15, 2017 | Unregistered CommenterMovingforwardOntario
Central will control its widgets in Ontario but not in other provinces.

Lots of old timers are bailing early and young ones heading west. Others will just leave medicine altogether in order to stay in Ontario with friends and family.

The profession may be down but don't count us out yet. Hoskins last unilateral attempt to slash and dash next month may be just what the profession needs to stiffen its spine further.
February 15, 2017 | Unregistered CommenterCanary in a Coal Mine
I just realized a bunch of recruiter emails were in the spam folder. Problem corrected. And I was pleasantly surprised to see the attractive offers out there.

Medscape publishes an annual income survey for MD's by specialty. Again very pleasantly surprised.
February 15, 2017 | Unregistered CommenterErdoc

The widgets will evolve and adapt. Society will get the change it supports. It is unlikely there will be a broad fee for service base in primary care. Primay care will be distributed among the groups all presenting themselves as providers. The buzz words are many....

"A culturally responsive approach to service delivery, driven and respectful of the voice of the client, and guided by the determinants of health. "

See for you xample.
February 15, 2017 | Unregistered Commentereklimek
"Some ideas are so stupid that only intellectuals believe them".( Good old George Orwell).

If it gains short term electoral traction in Ontario , then other political geniuses in other provinces are sure to mimic them.

Politicians are rather ordinary self serving souls , lacking moral fibre they are more concerned, as Mfo constantly points out , of gathering power, thinking of short term gains in order to get themselves elected and reelected.

Their gods are public opinion polls and focus groups.

Statesmen possessing moral fibre, wisely think in realistically terms of the long term oblivious to public opinion polls and focus groups---any one think that the Churchill's , Gandhi's, Lincoln's, Mandela's, Ben Franklin's, Thomas Jefferson's, and Canada's own Sir John A MacDonald used polls and focus groups?

Bad ideas can often be very politically sexy and can spread much like a contagious disease--- look at Marxism, the disease is still with us.

My fear is that this particular health care 'kick the medical doctors into submission' will spread across Canada , with the social justice warriors fanning the flames.

To our South that particular flame looks as if it is fluttering out.

In Canada do we have any budding statesmen waiting in the wings that may save the country and its health care system?
February 15, 2017 | Unregistered CommenterAndris
Ed , I liked that link to the LHIN--- enough to make one gag.
February 15, 2017 | Unregistered CommenterAndris
I know a budding future stateswoman who might save the system,.....Realist.
February 15, 2017 | Unregistered CommenterCanary in a Coal Mine
Do not underestimate the intent of central. DO NOT UNDERESTIMATE THE INTENT.

Widgets whom belong to central.
February 15, 2017 | Unregistered CommenterMovingforwardOntario
However one plans one's life, do not underestimate centrals goal.

A widget whose life is dictated by central.

This is an "envy" derived agenda.There are serious psychological issues behind this.
February 15, 2017 | Unregistered CommenterMovingforwardOntario
Is there some concrete report, plan that you are aware of or are you just trying to fan the flames here?
I know there are trends but you used all caps! You are digitally shouting! This is new for you,
Ten years here and no shouting before. Why do you think this time is different or do you believe Wynne et al just think they can solve health care costs by manipulating physicians?
The challenges in health care are vast. The system needs agility. It does not have it. How do we create an adaptive, resilient, responsive system?
February 16, 2017 | Unregistered CommenterMerrilee Fullerton

No report, no new rumours. Just years of experience. We are at a point I've not seen before, in arrogance. This government believes in its right to "lead". If the MDs don't get they are targets, they can't say they haven't been warned.
February 16, 2017 | Unregistered CommenterMovingforwardOntario

I apologize for my digital shouting. I am concerned the MDs don't get they are a target. I had hoped to enjoy my retirement years in Ontario. I'm beginning to rethink that.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
Thanks for the warning Mfo.

It has been quite obvious that there were serious psychological issues with this government, particularly the health minister.
February 16, 2017 | Unregistered CommenterCanary in a Coal Mine
I notice "out of catchment" issues more and more, especially in mental health. In our city where everyone wants a referral to the prestigious tertiary care centres, you could be on the townline and geographically closer to the metro's hospital yet get turned away. Oddly if you send the referral again and again it sometimes gets accepted perhaps if a box ticker/gatekeeper was distracted or doesn't do their job properly. A glimpse into the future of this socialist utopia:

"A letter from McMaster said she should consider an "alternate referral" because she was "out of catchment" and they suggested she try Holland-Bloorview.

Holland-Bloorview said her referral had been "cancelled" because "this client lives outside of our catchment area.""
February 16, 2017 | Unregistered Commenterdocinthepark
We were noticing the same with MRI referrals into the neighbouring region whose wait list is two months shorter than ours. Delays in responding to referrals and other inappropriate comments such as "this MRI is only for patients in our catchment area" were common.

After bringing up the issue with the chief radiologist it seems to have improved for now.
February 16, 2017 | Unregistered CommenterCanary in a Coal Mine
Didn't posters predict this " out of our catchment" phenomenon morphing to " out of our LHIN"?
February 16, 2017 | Unregistered CommenterAndris
Balkanizing Ontario through the LHIN. Your OHIP card is geographically acceptable.
February 16, 2017 | Unregistered Commentereklimek
There will be a per capita funding formula for the LHINS. They will need to accommodate their residents from that money. Health will be run exactly like schools.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
My thoughts on specialty paediatric service catchments areas...although no one asked me. They are simply a honking big pile of doggy doo behind which organizational bureaucrats attempt to hide and avoid work and Central bureaucrats claim ignorance.

Eventually, everyone is exposed because of the stink.

Of course, it doesn't stop paediatric specialty centres from fundraising in communities across the province. Funny how there is that double standard. We'll take your charitable donations from wherever you live, but if you need to need service, we will micro-scrutinize your residential address in relation to the LHIN boundary.

Most communities and LHINs in this province do not have any specialized paediatric services - try to reconcile that (moron).

Way back in 2005 I seem to remember a senior Ministry 'Dream Health Results Team' member (the fab five, right?) hand-selected by the Honourable George Smitherman stand in front of many a crowded room filled with senior executives, this one clad in an uncomfortable combination of neon, chains and leather declare that patient referrals would NEVER be determined by location of residence.

Time to call bullshit.
February 16, 2017 | Unregistered CommenterExecutive Lead Blogger
As DrK. Has put it, Ontario is formally Balkanized. It is going to get worse.
February 16, 2017 | Unregistered CommenterMovingforwardOntario
Typical MoHLTC. The announcements are made. The Photo op is produced. Next , ...

"The province should develop clear milestones; concrete objectives that
each LHIN is expected to achieve by the end of 2006 and at designated later
dates. "

But we never see follow up.
February 16, 2017 | Unregistered Commentereklimek

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