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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Understand the Implications of the "Framework"

It is shocking to me that Ontario physicians would be encouraged by the OMA or any other group to be supporting a deal with so many MAJOR pitfalls for the profession and for Ontario patients as this one.

It is WORSE than the tPSA that was voted down not so long ago with such extraordinary upheaval.

Let me be more accurate, the pitfalls are not just potholes, they are huge sharp cliffs in this case. There is a trap being set for Ontario physicians and apparently not even our own leadership can see it. The Wynne government is using Ontario physicians as part of its campaign, offering them an election goodie right before the potential of a snap summer election which may come sooner than you think...The Wynne government, after cuts to care and causing so much upheaval, is trying to deliver Ontario MDs on a silver platter and the OMA is complicit.

I will post some of the information put out by Concerned Ontario Doctors and from DoctorsOntario after this plea to think critically about the serious and dangerous ramifications of this potential "framework" not only to physicians but to Ontario's patients.

There are really four areas of concern that jump out from this contract which are more than unsettling:

1. One of the Ontario Medical Association's own negotiators is linked through family to a very vocal activist group. This in itself should have been recognized as a potential conflict of interest. This is extremely relevant since this conflict of interest puts into question the motivation for at least several contentious aspects of this potential agreement.

2. Tying arbitration to economic conditions in Ontario is murky. Although the government will say that Ontario is doing better than most other provinces in Canada with its GDP growth, this is a relative comparison and in no way indicates an overall positive econonomic picture here.

Ontario has a huge debt burden that threatens credit ratings and as it sells off revenue generating entities like Hydro One, drives up energy costs, and makes it harder for businesses to thrive, the current government is creating greater challenges for the economy for years to come. In addition, an aging population will have an effect on productivity. This too will have an impact just as need for care begins to surge. Make no mistake, tying binding arbitration to the economy is a major flaw in this agreement.

3. "Perpetuity"--any contract that requires those involved to be bound in "perpetuity" should be looked at with a special lens. Physicians must be aware that binding arbitration that is flawed by being tied to the economy, which is a problem in itself, will now be linked to other requirements that will be in "perpetuity"....items that because of this deal cannot be renegotiated.This is a major downfall and should outweigh any positive in this agreement.

4. After four years without a contract and major cuts to patient services, and being treated disrespectfully, physicians must not accept the Wynne government's newest election ploy. The Wynne government is luring physicians and the OMA with promises of  binding arbitration but the binding arbitration described  is so badly flawed that it will result in serious ramifications for doctors and patients now and in the future.

It will result in an agreement silencing physicians without any recourse. Legal counsel has confirmed that No Strike and No Job Action becomes effective immediately upon ratification, not later. The Liberal government and the OMA negotiating team with Steven Barrett will have silenced physician voices forever thereafter.

Ontario physicians and the OMA are being duped.



Reader Comments (584)

A ‘no’ vote for binding interest arbitration

Written by Dr. Douglas Mark on June 6, 2017 for CanadianHealthcareNetwork.ca
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Dr. Douglas Mark
Hard though it may be to believe, Ontario’s doctors have been without a contract for 38 months and counting. Small wonder the Ontario Medical Association and the Ministry of Health and Long-Term Care are feeling the heat to “get a deal done” as soon as possible. While I’m not a defender of the status quo—certainly not when it comes to healthcare and how it’s funded or administered—an argument could be made that sometimes it’s better to deal with the world as we know it rather than taking a chance on something risky and unproven.
Take, for instance, binding interest arbitration . . .
My colleagues and I overwhelmingly rejected the tentative Physician Services Agreement (tPSA) that was hastily foisted upon the medical profession last summer by the previous leadership of the OMA. Not surprisingly, after the tPSA went down rather spectacularly in flames, grassroots physician leaders made it clear that heads needed to roll—including those at the very top. The eventual resignation of the entire executive committee and subsequent board elections have gone a long way toward breathing new life into the Ontario Medical Association.
That said, DoctorsOntario does have serious misgivings about the tentative binding interest arbitration (tBIA) agreement that the new OMA Board has placed in front of its members for consideration. For one thing, why the rush to get this ratified? We’ve been clamouring for our representative association to negotiate some form of binding arbitration on our behalf for more than two decades. Is there some reason why we can’t have more than a couple of weeks to make up our minds on such an important piece of the puzzle?
Then there is the question of whose “interests” are being looked after here—ours or the government’s. Let’s face it, Ontario premier Kathleen Wynne and health minister Dr. Eric Hoskins need this agreement a lot worse than the province’s doctors do. In fact, I’d be willing to wager that the ink will barely be dry on this agreement should we ratify the tBIA on July 17 before the two sides hunker down somewhere and begin negotiating a new physician services agreement. I mean, why not? We are only 12 months away from the next provincial election. The clock is ticking for the premier and our health minister.
They need to “kiss and make up” with the province’s 30,000-plus doctors pronto. Ontario’s doctors need no such thing. What we do require—ever so badly—is an outside, independent analysis of what’s in the tentative binding interest arbitration agreement and what it all means. That’s why DoctorsOntario, along with others, asked a leading labour lawyer, Richard Charney, to take a look at the document and give us his thoughts via a legal opinion.
Here, briefly, is a summary of Mr. Charney’s concerns:
1. The Framework Appendix does not provide for the recovery of clawbacks nor does it prohibit it. The OMA may hope to achieve this result through a Charter challenge, but this is at best speculative.
2. The Appendix appears to be enforceable through the Arbitration Act. It would always be possible for the legislature to repeal and override the Appendix, although that can be subject to another Charter challenge.
3 The Appendix provides for a duty to bargain in good faith, although the enforcement mechanism, while present, is not as expeditious as may be preferred by the OMA and its members.
4. The scope of interest arbitration is broad but is subject to exceptions and ambiguous criteria.
5. Under the Appendix, physicians are at risk that starting in 2024, payments to subsidize physicians for a portion of their fees to the CMPA may be curtailed.
6. Section 23 of the Appendix excludes from interest arbitration certain matters, such as decisions to add or de-list fee codes and pensions.
7. The interest arbitration provisions contain criteria. Some of the criteria are open to different interpretations. Clauses (a) and (d) together may invite a cap on the Physician Services Budget.
8. The Appendix contains a broad prohibition on strikes. Furthermore, the total ban on job action applies even to matters not subject to arbitration, a troublesome situation.
9. With respect to rights arbitration through a Referee, access to such a process is granted to the “Parties,” but there is ambiguity as to what that entails.
10. The Appendix indefinitely entrenches the role of the OMA as the sole legal representative and bargaining agent for all physicians in Ontario.
11. The Appendix ousts the right of appeal from a decision of an interest or rights arbitrator.
12. The Appendix deprives an arbitrator of the power to order legal cost or interest.
13. The perpetual nature of the Appendix is a concern. Even physicians who see a benefit to the Appendix should consider the fact that things are bound to change in the long run, yet the OMA appears to be committing itself indefinitely.
Sobering thoughts, indeed.
Bottom line, no matter how we try, we just can’t trust a government that has unilaterally clawed back $3 billion from Ontario’s doctors over the past three years to do what they say they’ll do. Which is why DoctorsOntario is recommending our colleagues all across the province reject the tBIA. We’re frankly tired of playing Charlie Brown to Kathleen Wynne’s Lucy. Let’s not give the premier yet another opportunity to yank the football away from us just as we’re about to kick it.
Dr. Douglas Mark is the Interim President of DoctorsOntario. Follow him on Twitter @DocsOntario.
June 7, 2017 | Unregistered CommenterStephen Skyvington

Educate, motivate, activate

by Stephen Skyvington

I hope the newly-reconstituted OMA board won’t take this the wrong way, but Ontario’s doctors deserve better than this. I’m talking, of course, about the tentative Binding Interest Arbitration (tBIA) agreement that was recently negotiated between the Ontario Medical Association and the Ministry of Health and Long-Term Care. The province’s doctors will have an opportunity to pass judgment on the new agreement between June 7-17, 2017.

Now, I’m not going to spend time listing all the things that are worrisome about the tBIA. The province’s doctors will have at least two independent legal opinions to help make sense of the agreement. Instead, I’d rather focus on something I believe is sorely missing in all this—namely, a strategy.

Many people—doctors included—confuse strategy with tactics. So, let me help clear up some misconceptions. Job actions, legal opinions, rallies at Queen’s Park—those are all tactics. A strategy, on the other hand, is the plan you come up with to help you find the path to victory. Tactics are the things you may or may not choose to use to implement that strategy.

With me so far? Good. The other thing I’d like to point out is that in order to run a successful campaign of any kind—be it a public relations campaign, an election campaign, or a campaign to convince someone to support something (or not) that’s been negotiated on their behalf—you need to do the following three things: educate, motivate, activate.

With this in mind, here is a five-point strategic plan that Ontario’s doctors and the OMA should seriously consider using as their road map when dealing with the Wynne government over the next 12 months:

1. Reject the tentative Binding Interest Arbitration agreement. The authors of the seminal book on negotiations, Getting to Yes, speak frequently of a concept known in the business as BATNA. Best Alternative to a Negotiated Agreement. For the province’s doctors, voting down the tentative BIA would be the first step toward implementing their own BATNA.

2. Inform Kathleen Wynne and Eric Hoskins that you will not be returning to the negotiating table until after the next provincial election. Simple rule of thumb. You can’t negotiate with bullies, nor should you. Just because the Liberals are desperate to reach a deal with the OMA doesn’t mean we should accept whatever table scraps the government is willing to throw our way.

3. Begin reaching out to the leadership of both the New Democratic Party and the Progressive Conservatives. It doesn’t take a rocket scientist to figure out that someone other than the Liberals are going to form the next government. With this in mind, it’s essential for the leadership of the Ontario Medical Association to begin building bridges now—before next year’s election—with both Andrea Horwath and Patrick Brown.

4. Implement Operation “Take the Wind Out of Wynne’s Sails.” Fact: Ontario’s doctors have the power to bring any government to its knees. Clearly, the best use of the next 12 months would be to actively campaign against Kathleen Wynne and other Liberal candidates in every riding across the province. Forget job action. Political action is a much more powerful weapon.

5. Launch an aggressive public relations campaign to explain all this to both your membership and the people of Ontario. Here’s where the educate, motivate, activate part of the strategic plan comes into play. In order to get the province’s doctors and their patients onside, the OMA needs to hire someone with the courage to create an advertising campaign that tells it like it is. No more confusing messages. No more playing nice. The Wynne government has screwed up health care and needs to be brought to account for its actions.

Sounds simple, doesn’t it? That’s because it is. If we band together and help those at the Ontario Medical Association who’ve been charged with the duty of getting it right, then there’s nothing we can’t accomplish on behalf of Ontario’s doctors and their patients.

But in order to win, one must first find the path to victory and then find a way to get on that path as soon as possible. One thing you can’t afford to do is waste anymore time playing “footsie” with those who have already shown by their actions that they’d chop off an arm or a leg without so much as a second thought.

Premier Wynne and her band of bullies and charlatans don’t deserve our cooperation or respect. The reborn Ontario Medical Association, however, does. Which is why the best thing we can do to help the OMA is reject the tentative Binding Interest Arbitration agreement and move forward with Plan B before it’s too late.

Stephen Skyvington is president of PoliTrain Inc., former manager of government relations for the Ontario Medical Association, and currently an adviser to DoctorsOntario, a grassroots physicians’ organization. Twitter @SSkyvington.
June 7, 2017 | Unregistered CommenterStephen Skyvington
If the OMA would committ to making relativity or pay equity the issue in this matter, I would vote "yes". I have not heard it yet. Until I do I vote "no".

Your other points are important. They are not as important to me.
June 7, 2017 | Unregistered Commentereklimek
I understand. You may have more reasons to vote No.
June 7, 2017 | Unregistered CommenterMerrilee Fullerton
Some points to consider from COD:

"Some of the most basic flaws and omissions:

NO recovery of unilateral clawbacks: the tBIAF provides no mechanism for the recovery of the illegal government clawbacks from 2014 to 2017. This is an ENTIRE PSA period and represents almost $3Billion. OMA has seen fit to agree to have this EXCLUDED from arbitration. Meanwhile other provinces have had clawbacks returned retroactively with interest.

Strike Definition EXPANDED: while it is common to agree not to strike in return for Binding Arbitration, OMA has consented to EXPAND the definition of No Strike such that you will not be able to engage in ANY Job Action including a work to rule campaign if it involves patients at all. This is NOT the norm. Most collective bargaining agreements are not this restrictive and even other provincial medical associations have not given up the right to engage in job action for items not being arbitrated on (ex. government health policy, legislation and regulatory changes).

Government to have TOTAL control over health policy, legislation and CPSO regulatory changes: this tBAIF explicitly gives total control over health policy to the government. Consider Bills 41, 84 and 87. These bills alone include provisions to control when and where you work, how many patients you see, your reporting responsibilities; they take away your rights to object to participating in certain medical acts; they remove our profession’s self-regulation; they disclose your personal medical information to the CPSO and your right to a fair due process may be lost in the case of a complaint. As written, the tBAIF does not allow for Arbitration OR Strike on ANY of these issues. This will render all physicians forever powerless against ALL present and future health care policies and legislation.

Establishment of the concept of a Physician Services Budget (PSB): despite the denials of the OMA, the tBAIF indisputably establishes that there IS in fact a PSB and that the OMA shares JOINT responsibility for this. This was why the 2016 tPSA was defeated in the summer. Once again we are being asked to be responsible for increased healthcare utilization.

Risk of Reduction or Elimination of CMPA Reimbursements: it is troublesome that starting in 2024, the door would be opened to potentially detrimental changes to CMPA reimbursements, including a potential reduction or complete elimination of CMPA reimbursements.

Arbitration Criteria: the Arbitrator is to both take into account a “high quality, patient centred sustainable publicly funded health care system” AND the “economic situation in Ontario”. These will virtually guarantee that it will be impossible for the arbitrator to provide a fair decision and risks the imposition of a cap on the PSB.

Perpetual Agreement: if you vote this tBAIF in, ALL of these disadvantageous criteria will be in effect “in perpetuity.”

Ontario physicians have been mistreated and denied fair compensation for at least the last 4 years. We are all desperate for a resolution and for Binding Arbitration BUT this binding arbitration agreement is clearly a bad deal for Ontario’s doctors and patients. Rejecting this tBIAF means both the OMA and the MOHLTC must return to the table to negotiate a new tBIAF. If it precipitates unilateral actions, then this tBIAF was not the result of genuine labour negotiations.

Get Informed. Vote Between June 7-17, 2017.

*Legal Analysis by Richard J. Charney, LLB (Western) 1980, LLM (Cambridge) 1982, is a Toronto-based partner in the international law firm of Norton Rose Fulbright and Global Head of its Employment and Labour practice. Called to the Ontario Bar in 1983, he practises labour, employment and administrative law, and is an Ontario Certified Specialist in Labour Law. Mr. Charney regularly appears before labour boards, arbitrators, tribunals and courts including the Supreme Court of Canada. He provides strategic and policy advice to clients, and engages in collective bargaining. He lectures regularly, having taught collective bargaining law for the LLM program at Osgoode Hall Law School and, more latterly, as an Adjunct Professor in Advanced Labour Law, University of Toronto Faculty of Law. Amongst his writing is Judicial Review in Labour Law, a text which he co-authored and was the recipient of the Walter Owen Book Prize; and a chapter in the text Collective Agreement Arbitration in Canada.

Mr. Charney has served a range of clients such as universities, transportation undertakings, municipalities, energy utilities, and employers and employers' organizations active in sectors such as manufacturing, construction, media and long-term care.

Mr. Charney is recognized in a variety of legal publications, such as Chambers, International Who’s Who and Lexpert. He is listed in Chambers Canada 2017 at Band 1 in Employment and Labour for both Ontario and Canada, and was recently named in The 2017 Lexpert/American Lawyer Guide to the Leading 500 Lawyers in Canada."
June 7, 2017 | Unregistered CommenterMerrilee Fullerton
eklimek, relativity is part of the framework.
June 7, 2017 | Unregistered Commentersteve

Maybe we are reading the same thing, albeit differenty. This is the OMA's take, which I understand means it is not a mandatory consideration.

"No doubt, as in any interest arbitration process (including in Manitoba to which Mr. Charney refers), the criteria are somewhat general or ambiguous. This is hardly a disadvantage for the OMA, however, since it ensures the arbitration board is independent and can apply and give weight to whatever criteria it determines to be appropriate, which may or may not include the specified criteria. It also leaves it open to the OMA to shape its argument in reliance on any one or more of the criterion and to argue how the board or arbitration is to consider and apply those criteria. In this sense, section 25 of the BAF provides for both arbitral independence, and flexibility, in both the framing and presenting of any submissions to the board of arbitration. "


It is "general or ambiguous", to use their own description. Relativity "may or may not" be included.

Where is that "enshrined"?
June 7, 2017 | Unregistered Commentereklimek
Be cautious about rejecting the deal you wanted, central still has a majority,and lots of time to pass legislation "enshrining" income reductions. "Deincorporation "would be interesting.
June 8, 2017 | Unregistered CommenterMovingforwardOntario
We will end with the wise words of our fellow colleague, Dr. Plabon Ishmael:

Friends and colleagues, I am not a lawyer. The most negotiation I have ever done is haggle at the farmer's market. I don't pretend to understand labour laws. What I am about to say can be applied to any contract you might be asked to sign over your life time:

1. Never sign a contract that says "forever"
2. Never sign a contract where the other party can pull out whenever they want, but you can't
3. Never sign a contract where the other party can void part of the contract, and you are stuck with the rest
4. Never sign a contract that starts with you giving up 3 billion dollars
5. Finally never sign a contract where the favourable outcome depends on the best case scenario
Now let's get out there and VOTE NO!!
MDs wanted binding arbitration. What they got with this "framework" was the term "binding". They'll live it.
June 8, 2017 | Unregistered CommenterMerrilee Fullerton
From Hepburn at the TStar:

"UPDATE: In a column on May 10, I wrote about Kevin Smith, the health-care CEO who was holding two major jobs at the same time. Smith is the ninth highest-paid public servant in Ontario and receives $726,000 a year as chief executive officer of Hamilton-based St. Joseph’s Health System and Niagara Health System. He also had enough time on his hands to be the chairman of Home Capital Group Inc., the embattled private lending company, for which he received $357,000 a year.

On June 1, Home Capital announced that Smith, who stepped down as chair in early May, will not stand for re-election as a board member at the company’s annual meeting on June 29.

Bob Hepburn's column "
June 8, 2017 | Unregistered CommenterMerrilee Fullerton

Binding arbitration: the desperate last hope of a profession

Written by Dr. Sharad Rai on June 8, 2017 for CanadianHealthcareNetwork.ca
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Dr. Rai Sharad
That’s not a word that we usually use to describe physicians. But for Ontario doctors, after three years without a contract, after a proposed contract with government was overwhelmingly voted down last year, with a provincial government that has either passed or is in the process of passing healthcare legislation that effectively rearranges the healthcare system—without physician input, and after billions of dollars in unilateral cuts to the physician services budget, the reality is that the word “desperate” is the best description of what it’s like to be a physician practising in the province today.
Consider for a moment some of the most important decisions that you have ever made in your life: buying a house, choosing a career, choosing a spouse. Consider the time and effort that went into these decisions. Now consider, from your own experience, what happens to your decision-making skills when you throw desperation into the mix: It isn’t pretty is it? Yet, after three years of abuse at the hands of the government of Ontario, that is precisely where a desperate profession stands.
Now consider what happens when you offer a desperate profession something it hasn’t had in more than 20 years: binding arbitration. It’s like offering water to someone dying of thirst. But in this case, that glass of water is coming with some fairly strict stipulations, and the hand that’s offering it to us is one that many in the profession trust the least of all: the government of Ontario.
The government is going to legislate whatever policies regarding healthcare it wishes, and we are going to give up the right to substantively protest those policies forever.
The initial reaction on social media to criticism of the proposed binding arbitration framework agreement, released to Ontario’s physicians on May 25, was dumbfound disbelief. How could anyone challenge the offering of something so sacrosanct? Yet a closer examination of the proposed framework reveals its many flaws.
Arbitration criteria are skewed in favour of government
There’s been a lot of debate about whether “the achievement of a high-quality, patient-centred sustainable publicly funded healthcare system” (section 25(a) of the framework) is a fair criterion. No one can argue with having a high-quality, patient-centred healthcare system, but why is such emphasis placed on sustainability? This is the same government that has said the healthcare system is not sustainable, yet when it comes to negotiating matters of physician compensation, it insists that the arbitration board take sustainability into account. Does that sound fair to you?
And then there are the pro-physician criteria that got left out of the binding arbitration framework agreement. How about: “The principle that any historical power imbalance between the parties, or penalties which one party has imposed on the other, be cured;” or “The principle that adequate CMPA funding is a pillar of a sustainable healthcare system.”
We’re giving up the right to strike/engage in substantive job action – forever
From section 42 of the agreement, “’Strike Action’ is defined as any withdrawal, restriction or limitation of physician services to patients by two or more physicians… .” Section 22 of the agreement states that “subject to those matters that are arbitrable under s. 21, the parties agree that the government of Ontario has the right to make decisions about healthcare policy, which elements of the healthcare system will be funded on behalf of the people of Ontario, and how that system is organized, funded and delivers healthcare.”
In other words, the government is going to legislate whatever policies regarding healthcare it wishes, and we are going to give up the right to substantively protest those policies forever.
Many in the profession have argued that physicians would never strike or engage in substantive job action anyway, so we shouldn’t be concerned about this provision. When we’re referring to “substantive” job action, we’re referring to the kind that inconveniences patients (not handing out buttons or flyers)—the type of action that is expressly forbidden in section 41 of the agreement.
In Ontario, we are dealing with a government that has unilaterally rearranged the healthcare system (Bill 41, the Patients First Act); forced mandatory disclosure of physicians’ health information; undermined due process for physicians facing regulatory complaints of a sexual nature; and shifted the burden of reporting vaccinations from parents to physicians (Bill 87, the Protecting Patients Act); forced “effective” referrals for medical assistance in death, notwithstanding the conscientious objections of physicians (Bill 84, Medical Assistance in Dying Statute Law Amendment). Against this backdrop, OMA leadership has decided that it is OK to give up the right to engage in job action to protest the provincial government’s policy—forever.
To give an example: Bill 87 proposes to download the responsibility of reporting vaccinations to physicians. If the OMA asks members to refrain from providing vaccinations to patients to protest Bill 87 (for whatever period of time), this will meet the definition of “strike action” in section 42 of the arbitration framework, and this OMA-endorsed action would likely be deemed illegal in the courts.
After what Ontario’s medical profession has endured at the hands of its provincial government for the past four years, we have absolutely no reason to trust it. We should all be really worried about what the government might do when we give up the right to substantively countervail their actions in perpetuity. How much are your rights worth to you?
Every physician in Ontario wants binding arbitration. But we shouldn’t be desperate for it, particularly when the criteria the arbitration board will use to make an award are skewed in the government’s favour. We shouldn’t be desperate for it when dealing with a government that has demonstrated, over and over again, that it will make healthcare policy that runs counter to the interests of the profession and our patients. And we especially shouldn’t be desperate for binding arbitration when we’re giving up the right to strike action that will substantively protest the government’s policies forever.
Yes, this is where the medical profession stands in 2017: We are absolutely desperate for binding arbitration. We should all be very worried that the profession is about to make a colossal mistake.
Dr. Sharad Rai is a family physician in London, Ont., president of Doctors for Justice, and a proud member of Concerned Ontario Doctors. He is also president of the London and District Academy of Medicine and OMA District 2 alternate.
June 9, 2017 | Unregistered CommenterStephen Skyvington

The principles are valid objections.

It is unacceptable to allow the OMA to negotiate away pay equity.

Someone needs to say "stop" to this lack of representation to a problem all agree needs correction. Yet no one seems to wan to actually do it.
June 9, 2017 | Unregistered Commentereklimek
Great article by Dr Rai.

"After what Ontario’s medical profession has endured at the hands of its provincial government for the past four years, we have absolutely no reason to trust it."
June 9, 2017 | Unregistered CommenterMerrilee Fullerton
Just unionize, and accept the master-servant relationship.
June 9, 2017 | Unregistered CommenterMovingforwardOntario
From my naive, "outside-looking-in" perspective, what surprises me most about this seriously flawed ongoing issue is how little attention is being paid to it in the mainstream media.

More airtime has been allocated to coverage of former FBI Director Comey's Senate testimony, terror attacks in England, and the (disastrous for Elizabeth May) UK election.

Provincially, the government has been plastering Ontario with promised increases to minimum wage, new and enhanced services for autistic children and a complete re-vamp of the Ambulance Act.

Regretfully, I don't have any suggestions for Ontario physicians to effectively and elegantly elevate their messaging in this battle. I'll leave that for brighter minds...but something has to be done quickly - otherwise the residents of this province will find themselves in a hole so deep that it will take at least a generation from which to recover!

For the record, I am not against raising the minimum wage (however I would have preferred seeing more emphasis place on a guaranteed annual income project).

Nor am I against enhanced services for autistic children. This should (and could have) been done a heck of a lot earlier in the Liberal government's 14 year reign of error.

As for re-vamping of the Ambulance Act, it didn't take the industry too long to recognize the announcement for what it was worth...a big "thank you" to the firefighter's financial contribution to the party in power.
" but something has to be done quickly - otherwise the residents of this province will find themselves in a hole so deep ... "

Nothing needs to be done You largely get the government you vote for. I am grateful there is currently no serious external threat this group has to address.

It has always puzzled me that they are capable of organizing a political machine. This suggests the implementation of policy is capably handled but the overarching strategy is unable to see beyond reelection.
June 9, 2017 | Unregistered Commentereklimek
<<I am grateful there is currently no serious external threat this group has to address.>> - DrK

I'm right with you, Dr. Klimek.

That being said, we both know that given the Ontario government's propensity towards ignorance, should even the mildest of threats come to pass, we risk suffering commensurately greater consequences.

Spreading around tax money is much easier to do, than coming up with fiscally wise policy.
June 9, 2017 | Unregistered CommenterMovingforwardOntario
The government has promised free prescription drugs for anyone under 25...4400 drugs covered on January 2018 ( 6 months before the provincial election. ) ....the mind boggles at the potential for abuse as relatives above age 25 and below 65 ask their under 25's to go to the walk in clinic and ask for, let's say an expensive psoriasis medication..." my psoriasis is quiescent today but could you give me x amount of grams with repeats?"
June 9, 2017 | Unregistered CommenterAndris
"the Liberal government's 14 year reign of error."- ELB

That's a good line. It might get used again!
June 9, 2017 | Unregistered CommenterMerrilee Fullerton
Dr. F,

Please note that I "borrowed" the line from Diane Ravitch's book "The Reign of Error: The Hoax of the Privatization Movement and the Danger to America's Public Schools".

But of the shoe fits...
*if the show fits.
I have taken note ELB!

Also of note is that another conflict that Barrett has is that he is ALSO the legal for PARO, including for their negotiations...past AND currently. Notice that there was no mention about medical residency or medical training spots in the tBIAF.

More conflict of interest for Danielle Martin's husband as he negotiates a most conflicted "framework" for the OMA and physicians....
June 9, 2017 | Unregistered CommenterMerrilee Fullerton
Come on...Barrett would appear to be in conflict of interest with his wife Danielle Martin and her connections to Doctors for Responsible Healthcare created by the people of Canadian Doctors for Medicare recently as an Ontario chapter to counter COD. They are officially endorsing a yes vote on the tPSA. Barrett's wife is the founder and past chair of Canadian Doctors for Medicare.

And not to mention Barrett's role with PARO.

Hmmmm. Certainly doesn't look too good.
June 10, 2017 | Unregistered CommenterMerrilee Fullerton
Funny how the OMA is silent on this glaring COI with Mr. Barrett, wife of Danielle Martin, negotiating on behalf of the OMA.

In Sean Whatley's latest blog post or possibly in the comments he states that his main goal is to regain the trust of the profession, however when I read about this egregious COI under his watch any flicker of trust in the OMA is lost.

In fact one really wonders if he has now swallowed the Kool-aid and is yet just another in a long list of OMA presidents looking out for the corporation's rather than the profession's best interests.

I'll be voting NO.
June 10, 2017 | Unregistered CommenterCanary in a Coal Mine

I do not think much can be gained by critiquing the lawyers. The OMA purposely went to a known union Labour law firm for support and advice. The intent of the OMA was to get "union" advice.

The overall goal is to unionize the MDS under the OMA structure.
June 10, 2017 | Unregistered CommenterMovingforwardOntario
With the passage of the BAA, next step is the realignment of the MDs with the LHINs and regional slots. Where will central allow MDs to practice, and under what resource restrictions?

If you are under 50, better move to your spot where you wish to be, withing 5 years, central will determine this.
June 10, 2017 | Unregistered CommenterMovingforwardOntario
Looks like the unions and Ontario Health Coalition are on the offensive again to keep Canadians queued up waiting for Soviet level service in our public hospitals, but claiming we are world class.

Talk to any nurse working in the GTA and more and more they will say they would not attend the institution they are working at due to overcrowding, lack of equipment, dirty rooms, and poor morale.

Private clinics and boutique medical services are becoming more common as a result of the public system to provide timely, high quality care.

At some point the public is going to have to decide what kind of health care system them want. But it can't be free, fast, and high quality.


"The Globe found the reality to be quite different. As health-care costs and wait lists grow, regulators are doing little to stop doctor-owned clinics from quietly and increasingly making patients pay for quicker access – for everything from appointments to surgery. Patients and doctors on all sides of the health-care debate agree on one thing: This is happening in part because the system is in what many call a “mess,” where some people suffering in pain aren’t seen and treated quickly in public facilities. "

June 10, 2017 | Unregistered CommenterCanary in a Coal Mine
Realist could you download the G& M article on Venezuela ' Brutal times for the once thriving state'...a really sad article demonstrating how socialism is the most efficient poverty creating ideology known to mankind....having the world's largest oil reserves, rich in minerals and agricultural potential is no protection , no cushion...its President taking credit for his country's free universal health care system ( guaranteed by the constitution ) .

Venezuela today....Ontario ( the world's most indebted sub sovereign entity) tomorrow.

I voted NO.
June 10, 2017 | Unregistered CommenterAndris .
Mfo....the OMA should remain as an Association....a medical Union should be a seperate entity.
June 10, 2017 | Unregistered CommenterAndris .
" Carmen Tovar remembers the apologies. The doctors who stood around the body of her 17-year-old daughter Nakarid told her they were so very sorry, but the girl had died, and so had the baby she was trying to deliver. We did all we could, the doctors told Ms. Tovar – we’re terribly sorry.

Nakarid had high blood pressure all through her pregnancy, but the free clinic in their hillside slum on the edge of Caracas had no drugs to treat it, and her mother could not afford the wildly inflated prices in the private pharmacies. When Nakarid’s contractions started, on the night of Dec. 7, Ms. Tovar took her to a nearby maternity clinic, but they were turned away: no beds available there. Same thing at the next clinic. By the time they reached the third, Ms. Tovar, 49, was out of money to pay another taxi, and her daughter was disoriented, dizzy with a shattering headache. Ms. Tovar demanded a bed, and that clinic reluctantly took Nakarid. But she died a few hours after they reached the hospital. The doctors said she had pre-eclampsia; they lacked even a basic intravenous line to treat her. "

June 10, 2017 | Unregistered CommenterCanary in a Coal Mine
...the Venezuelan socialist dictator has the chutzpah for giving credit to the free universal health care system policies for the decreased obesity rate in his country.

Odd how our "poor" gain weight ....there must be a bell curve where the rate of obesity increases with poverty and then reverses and crashes.

The answer to the obesity epidemic affecting North America is socialism....then more socialism....then more until it reverses.

My late father when he visited Canada just prior to the collapse of the USSR could not believe that we actually " treated" obesity in the west , an unknown phenomenon under true socialism ...North Korea has only one case of obesity.
June 10, 2017 | Unregistered CommenterAndris
Same observation in Cuba. It is very rare to see anyone overweight.

When the social safety allows the purchase of excessive Twinkies, cigarettes, alcohol, and now pot and watch the rates of obesity rise.
June 10, 2017 | Unregistered CommenterCanary in a Coal Mine
"As the nation’s opioid crisis worsens, the authorities are confronting a resurgent, unruly player in the illicit trade of the deadly drugs, one that threatens to be even more formidable than the cartels.

The internet."

June 10, 2017 | Unregistered CommenterCanary in a Coal Mine
As for BA, take the deal. At least it assures you get to accept the terms of the servitude. Servitude is going to occur. Help set the terms.
June 11, 2017 | Unregistered CommenterMovingforwardOntario

According to your vision, join the dark side and benefit from the servitude. Fair enough if ones aspirations are alignment with strength.

Acceptance of this binding agreement will bring a Roman peace as you suggest. Rejection means more money and time in pushing the governmnt to the edge and perhaps over.
June 11, 2017 | Unregistered Commentereklimek
A slave does not set the terms...even with consensual slavery...one is the slave, one is the owner, master or mistress who perceives the slave to be nothing but chattel, widgets to be moved about at will.

The slave makes a commitment to obedience....the only difference in this situation is that the owner does not take ultimate responsibility for the well being of the voluntary slave , if he or she burns out or jumps off a bridge, so be it...,the owner makes all the decisions and the slave has to take responsibility for their outcomes and pay for any losses.
June 11, 2017 | Unregistered CommenterAndris .

Yes. Widgets. Just try to get the best terms. Widgets you areally.

Now go get those advanced directives, so at the first signs of dementia, you'll know centrals needs.
June 11, 2017 | Unregistered CommenterMovingforwardOntario
So with a deal on the table,the media manipulation by central will be starting soon. the MOHLTC has put on the table,the solutions, to peace in our time. Rejection won't be an option. All to be rolled out before the 17th. Deal gets rejected, OMA loses the public, deal gets accepted, central has done a great job. OMA better get ahead of central.
June 11, 2017 | Unregistered CommenterMovingforwardOntario
So...let me see....
June 18 the deal is announced as accepted after trusting Ontario MDs want to believe in the new OMA leadership.
Wynne has what she needs to complete her pre-election booty...
Ontario election announced for middle of August....just before the OPP investigations into the Liberal bribery scandal and the gas plant email deletions hit the media...

Ontario physicians, you are the masters of your own destinies. Your patients are depending on you. This is not the time to agree to a treacherous "framework" with such an untrustworthy government...not even with the new OMA guard.
June 11, 2017 | Unregistered CommenterMerrilee Fullerton
"OMA better get ahead of central."-mfO

If this deal goes through, expect more rationing, expect longer wait times, expect more suffering even if MDs get some form of "arbitration".

It's tough to watch.
June 11, 2017 | Unregistered CommenterMerrilee Fullerton

Completely agree.More rationing, more MAiD. MDs are just widgets doing centrals culling of the population. You own it. You own it. You own it.

You've made the moral decision .Money, over providing health care to your patients. Own it.
June 11, 2017 | Unregistered CommenterMovingforwardOntario
"You've made the moral decision .Money, over providing health care to your patients. Own it."

Let's not over simplify this shall we.

First, if the agreement passes it results in no increase in services to patients. But if it fails it results in no increased services either.

Second, if it fails we get nothing, If it passes we get nothing.

Morality is not the issue here, working environment and wages are. If individuals wish to offer good samaritan services "gratis", it also presumes no liability for the service rendered.

Government does not wish to fund the structure and is seeking wage concessions in order to maintain the status quo. That may be a morality question. It is a societal determination that on balance the suffering incurred is acceptable.
June 12, 2017 | Unregistered Commentereklimek

The individual's wants, versus, society's need for equity. Currently, individual's morbidity and mortality,loses to the societal wants.

Central, in its authouritarian role, knows what is best for "social good".

Next housing fairness. If you have empty rooms in your home,the state has people you need to house.

The new world of social justice.
June 12, 2017 | Unregistered CommenterMovingforwardOntario
Back to opioids


More naloxone and public health workers.

Yep that will do it.

Not a word about why the 25-34 are succombing to substance abuse. No mention of co-morbid depression, anxiety or severe mental illness.
June 12, 2017 | Unregistered Commentereklimek
Mfo....one more reason to downsize into a bungalow....to solve its housing problems the Soviets introduced communal apartments with a half dozen families sharing each communal appartment with a communal kitchen and communal bathroom.

The calculation is 9 square meters per person....that's 29.5276 square feet....the average new condo size in Toronto is around 739 square feet enough for 25 people...with an average household size of 2.9 in TO thats 8-9 families in each....cozy.

With the collapse of the USSR I had the opportunity to ' enjoy' staying in such a communal appartment which was dominated by the Russian families with the native population having to give way...the shower was in a bathtub in the kitchen, so I had my cold shower around 4 am when no one was about.

My lingering memory of these communal apartments was the omnipresent smell of urine in the stairways ( elevators are so bourgeois) and eating ones breakfast in a small pantry style room off the kitchen as the Russian families dominated the main kitchen...one ate cold sprats from a can on rye bread in silence.
June 12, 2017 | Unregistered CommenterAndris

And in the heels of this 7.5% raise for OPSEU workers,
MDs will bite on "binding arbitration" frought with pitfalls and the possibility of some wobbly kneed Charter Challenge.

June 12, 2017 | Unregistered CommenterMerrilee Fullerton

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