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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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Wednesday
Jun072017

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 (587)

Dr. F.

CICM asked the associate medical officers of health question, not me. Don't mean to steal their thunder.

That being said, people who keep an eye on the MOHLTC org chart will comment that these positions have been vacant for a very long time...I'm guestimating more than 12 months!

20 positions from Deputy Minister, Associate Deputy, Assistant Deputy, Chief Medical and Chief Health Innovation Strategist.

And out of the 68 boxes "under the fold" 18 (26.5%) are acting or vacant. Is that healthy?

<<There are so many managers at Central, we need managers to manage the management.>> -MfO

Yup.
July 14, 2017 | Unregistered CommenterExecutive Lead Blogger
Apologies for the confusion ELB. Give credit where credit is due.

It's curious regarding the 27% of vacancies in well paid positions in the MOHLTC.

Is it that we are seeing an unsettled bureaucracy suspicious of the Wynne government's next move.
Or
Is it evidence of the MOHLTC efforts to control its own budget...just for political optics?

Other?
July 15, 2017 | Unregistered CommenterMerrilee Fullerton
From the Red Star no less.

"How bad do things have to get before we make the right changes? What about the death of a baby or the near-death of a young woman?"

http://www.thestar.com/opinion/commentary/2017/07/14/health-care-in-northwestern-ontario-beyond-becoming-a-crisis.html
July 16, 2017 | Unregistered CommenterCanary in a Coal Mine
From the Red Star no less.

"How bad do things have to get before we make the right changes? What about the death of a baby or the near-death of a young woman?"

http://www.thestar.com/opinion/commentary/2017/07/14/health-care-in-northwestern-ontario-beyond-becoming-a-crisis.html
July 16, 2017 | Unregistered CommenterCanary in a Coal Mine
"The MUHC board said it cannot function effectively with a health minister who threatens trusteeship and refuses to speak to them directly.

“Instead of putting the emphasis on productivity and performance of those managing and producing services, on innovation, on initiatives … when you centralize all the decision-making, people have no incentive whatsoever, and the result is quite clear,” Castonguay said. “Not only has there not been any real improvement to access, but costs haven’t really decreased with better productivity.”
July 16, 2017 | Unregistered CommenterMerrilee Fullerton
The Red Star states , in this article, that doctors are irreplaceable...yet it has also published that NP's can do 90% of what MDs can do...
July 17, 2017 | Unregistered CommenterAndris
http://www.canadianhealthcarenetwork.ca/physicians/discussions/opinion/why-healthcare-has-become-taboo-cocktail-conversation-50440


Why healthcare has become taboo cocktail conversation

Written by Stephen Skyvington on July 17, 2017 for CanadianHealthcareNetwork.ca

Sex, politics and religion. These are the three things I’m told you should never talk about in mixed company. In addition to this troika of taboo topics, I’ve recently discovered a fourth. Healthcare. Honestly, tossing a grenade into a room full of pacifists couldn’t create more chaos than announcing publicly you’re in favour of a hybrid healthcare system, and that it’s high time Canada embraced the future instead of clinging pathetically to the past.

I made this surprising discovery while chatting with some people—strangers mostly—at a friend’s place. We’d gathered to celebrate his wife’s birthday, and were doing so in style, roasting a pig and eating corn on the cob. My friend mentioned I’m a rather vocal advocate for private healthcare when he introduced me upon my arrival. One of those in attendance—an American who’d become a Canadian citizen, after having spent the past 40-plus years living in Toronto—wanted to know what I had against our free healthcare system.

“For one thing,” I replied, “it’s not free. For another, it’s not much of a system.”

The man took umbrage with my comments, and began telling me about his experience with Canada’s “jewel” of a healthcare system. “I had a heart attack last year,” he said. “Would’ve died if it hadn’t been for the doctors and nurses on duty in the emergency department that day. They saved my life. And it didn’t cost me a nickel!”

I smiled and said I was glad to hear that. He clearly was one of the lucky ones. So much luckier than the 63,000 Canadians who had to leave the country last year and go elsewhere because they couldn’t afford to wait any longer for medical treatment.

The man scoffed at this, called it “right-wing propaganda,” and said I was just like all the others, running down the best healthcare system in the world just because my rich friends and I wanted to push people like him out of the way and jump the queue.

“Not so,” I said. “First of all, I’m not rich. I’m middle class—just like you. And secondly, if I was rich, I wouldn’t need another, private tier of healthcare. I’d just jump on a plane and fly to the States.”

I then took the opportunity to point out that Canada, while it once did have the best healthcare system in the world, can no longer make that boast. Study after study shows our system is in decline, that waiting lists for procedures are growing, and people are dying because governments of all stripes have been forced to take an axe to medicare, cutting funding and programs in an insane attempt to prove our very unsustainable system is somehow sustainable, that the status quo is just fine.

“Take British Columbia, for instance,” I said. “Dr. Brian Day has so far spent $2 million on a charter challenge out there, in hopes of convincing a judge that our system is broken and causing real harm to patients. Guess how much the B.C. government has spent trying to defend the indefensible?”

The man shook his head.

“Twenty million dollars,” I replied. “And they’re not even halfway through. That’s $20 million the good people of British Columbia have had taken from them by their government in taxes, just so that same government can hire a flotilla of lawyers to deny regular Canadians like you and me the right to choose when and where we access medical treatment.”

The Supreme Court of Quebec was pretty clear in 2005, when it rendered a decision in the Chaoulli case, I added. Access to a waiting list is not access to healthcare.

The man took a sip of his drink and said, “All I know is I’m glad I don’t live in America any more. The last thing I’d want is to have to deal with their messed-up system.”

I told him I agreed, but that unfortunately unless our elected officials stop trying to distract us with fairy tales and finally come clean, I’m afraid we’re going to end up with the very thing everyone says they don’t want—a healthcare system that looks a whole lot like the one in the States. That’s what defending the status quo will lead to.

“So, what’s your solution?” the man asked.

“We need a made-in-Canada hybrid healthcare system,” I replied. “One that takes the best elements of other healthcare systems throughout the world and blends them together—in creative and courageous ways—so that we might ultimately come out the other end with a real healthcare system, one that treats the whole person and not just the illness. A system that isn’t simply an insurance scheme but one that allows patients to take charge of their own medical care, paying for what they want when they want, without being forced to travel abroad to receive medical treatment. This is my dream.”

Sadly, I told the man, neither you nor I are likely to live long enough to see the day when that dream becomes a reality. So long as politicians continue to wrap themselves in the flag of medicare and declare they’ll defend Canada’s publicly funded healthcare system to the bitter end, I’m afraid we’re doomed to stand hopelessly by and watch more of our fellow citizens suffer and yes, even die on waiting lists, while our elected officials ration healthcare and deny us our rights and freedoms.

“We’re being played,” I sighed. “This madness has to stop … and soon.”

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.
July 17, 2017 | Unregistered CommenterStephen Skyvington
"Politicians will do the right thing only after having exhausted every other alternative"...there are so many more dead end blind alleys that the political class have not explored , that their ivory towered advisors have not contemplated ....opportunity after opportunity of doing the right thing have been squandered ...look to our south...Obama built a blundering ineffective, hyperexpensive , non functioning monstrosity...
July 17, 2017 | Unregistered CommenterAndris
<<For one thing,” I replied, “it’s not free. For another, it’s not much of a system.>> - SS

And yet, even after being so patient and eloquent with the expatriate American, he probably still thinks that health care is free.

Sweet Lord. We do not only pay taxes to exclusively support government boondoggles, right?
July 17, 2017 | Unregistered CommenterExecutive Lead Blogger
Dr. F:

In Quebec, the Minister of Health and Social Services has final say in appointing hospital leadership.

The MUHC has had an interim leader for over seven months since its previous director general retired (which was a well-planned and predictable event).

Yet, the Minister criticizes the MUHC board for ineffective leadership at the senior management level.

We can only surmise that the Minister is a level-7 "suck and blow" Jedi master.
July 17, 2017 | Unregistered CommenterExecutive Lead Blogger
To 70% or more of the population, health care is free. This ship is not turning. It is going to get worse, as we develop more and more policies that divide us back into tribes.
July 17, 2017 | Unregistered CommenterMovingforwardOntario
USA statistics

https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2015_SHS_Table_A-18.pdf

Does the same apply to Ontario?

http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14177-eng.htm
July 17, 2017 | Unregistered CommenterEklimek
New agenda for the election,which likely will succeed. Anti Trump.Everything Trumpis wrong, all parties supporting anti-Trump +,will succeed. Just promise anti Trump, and more. You will succeed. Debt is not an issue.
If the current party can get that message accepted, they will win.

Free drugs for all.
July 17, 2017 | Unregistered CommenterMovingforwardOntario
Look for big hits in 2018 on incorporation. Lots of support to get the "high earners" even from the OMA. Most family based corporations will be gone within 5 years.

Central has huge support to go after high income earners. The debt exists because the high earners don't share enough. It will be taken from them.
July 18, 2017 | Unregistered CommenterMovingforwardOntario
Back to opioids

"Middletown EMS reported to a total of eight overdose calls the day we were there. At this point, the idea to withhold the response is just that -- an idea, not a formal proposal. It's unclear whether it would ever withstand a legal challenge."

http://www.cbsnews.com/news/opioid-crisis-ohio-lawmakers-first-responders-overdose-calls/
July 18, 2017 | Unregistered CommenterEklimek


Specific conditions or activities such as maladaptive dangerous, if not lethal, behaviour is not normally covered by an insurance policy.
July 18, 2017 | Unregistered Commentereklimek
We are moving from insurance based support, to societal responsibly for well being. Basic guaranteed income, happy spaces, no negatives.

All will be fine in utopia.
July 18, 2017 | Unregistered CommenterMovingforwardOntario
mfo

Corporate responsibility for the health of the employee is well established.

Extending this to government responsibility for all is wonderful concept. It should also consider the responsibility of the stakeholder(s) to society as well. Let's see the evidence that this is a bilateral arrangement.
July 18, 2017 | Unregistered Commentereklimek
Seriously? It's 2017 why are we still "studying" this?

Geographic Variation in the Supply and Distribution of Comprehensive Primary Care Physicians in Ontario, 2014/15
https://www.ices.on.ca/Publications/Atlases-and-Reports/2017/Geographic-variation-in-physician-supply

<<A new study has found gaps in which many rural residents - including those in local areas - face long drives and barriers to service.>>

SNIP

<<The study’s authors noted more work must be done to gain a more complete understanding of the issues involved. But Glazier said the report could help Local Health Integration Networks, which now have a greater role in planning for primary care.>>

Holy crap on a cracker. If we are still only at the "study" phase of this issue and those "studies" recommend - in part - further studies, we are truly screwed. And if LHINs didn't know this already, then we might as well pack it in and go home.

I am sorry to state this, but this kind of well-funded ****-FOR-BRAINS research annoys me to the fibre of my being. Instead of working to develop solutions, all we have here are a bunch of sanitized "senior ICES scientists" pointing at the same slow-motion car crash that happens every day and showing us new ways to count them.

Put your education to some freakin' use boys and girls! Be bold and propose solutions. I hope you are as tired as I am looking at new infographics telling us nothing but the same old story:

Urban = lots, probably too much ... rural = not much, needs more

Apologies if I offended some - but it had to be said.
July 18, 2017 | Unregistered CommenterExecutive Lead Blogger
ELB

Everyone knows the solution but can't implement it yet. More top down authouritarian action from a central authourity, telling providers where and how to practice.
July 18, 2017 | Unregistered CommenterMovingforwardOntario
Building unforeseen consequences.

With the removal of incorporation by 2019, we will see further disincentive to leave the urban areas. One can only hope the young ones are paying attention. It is going to get very tough.
July 18, 2017 | Unregistered CommenterMovingforwardOntario
Hmmmm
A modicum of sense:


https://beta.theglobeandmail.com/opinion/poor-health-care-ranking-a-sign-our-system-needs-fixing/article35709352/?ref=https://www.theglobeandmail.com&service=mobile
July 18, 2017 | Unregistered CommenterMerrilee Fullerton
M"ore top down authouritarian action from a central authourity, telling providers where and how to practice"-mfO

Won't work. Been tried.
July 18, 2017 | Unregistered CommenterMerrilee Fullerton
<<Won't work. Been tried>> - Dr. F

Agreed. But that was then and this is now. Perhaps if you incent the right behaviour, the right result will occur.

It worked with the NHS ("Stuffed their mouths with gold" (Bevan)), FHNOTs - "wrestled to the ceiling with cash" (Unknown)) - why not with relocation?

Taking a possible example from MfO, you get to keep the benefits of your incorporation status if you relocate your practice to (fill in name of underserved/rural area). If you choose to stay put, there will be some modifications.

Continue underserviced area funding, northern retention bonuses and voilà, it could be a workable solution.

At least it is a trial balloon - which I am certain some will shoot down. Others, however, may think twice!
July 18, 2017 | Unregistered CommenterExecutive Lead Blogger
ELB

That is what the NOMS was to address. What happened?
July 18, 2017 | Unregistered Commentereklimek
It is going to get really weird in health. With the struggle to have a national system, managed by provinces and territories, over a population that is being further and further being broken apart into tribal clusters, this has the makings of chaos.
July 18, 2017 | Unregistered CommenterMovingforwardOntario
<<That is what the NOMS was to address.>> Dr. K

Excellent point, Dr. K. NOMS has done a better than good job over the last dozen years. Take a look at their most recent Achievement Report:

https://www.nosm.ca/uploadedFiles/About_Us/Media_Room_2/NOSM%20Achievement%20Report%202016.pdf

Alas, we all know that:

• The number of physicians retiring from practice in the North continues to grow
• The retiring physicians practiced very differently than current graduating GP/FPs
• It takes AT LEAST 2.5 new GP/FP graduates to replace a retiring GP/FP

Therefore, despite NOSM's best efforts - which continue - Northern and rural communities will still be short for the forseeable future and will still have to rely on recruitment from other Ontario medical schools, provinces and international medical graduates to fill the gap.
July 18, 2017 | Unregistered CommenterExecutive Lead Blogger
Mfo
Disincentive to leave urban area if no incorporation?
I see incentive perrsonally, in order to survive financially.
What am I missing?
July 18, 2017 | Unregistered CommenterMid 50's doc
Gees. The NOSM is not exactly transparent about outcomes.

FROM YOUR LINK ABOVE

"94% of NOSM MD graduates who
have also completed their
residency with NOSM are now
practising in Northern Ontario."

94% Is not a number. It is a proportion of those completing their residency with NOSM now practicing.
July 18, 2017 | Unregistered Commentereklimek
ELB,
There was some improvement with incentives to work in the North.
The problem that I see is the lack of back up. In an era of high expectations for every eventuality, the idea of managing the most serious medical scenarios that do occur and will occur becomes a nightmare for many primary care physicians without experienced specialist back up and modern diagnostics.
July 19, 2017 | Unregistered CommenterMerrilee Fullerton
ELB,
There was some improvement with incentives to work in the North.
The problem that I see is the lack of back up. In an era of high expectations for every eventuality, the idea of managing the most serious medical scenarios that do occur and will occur becomes a nightmare for many primary care physicians without experienced specialist back up and modern diagnostics.
July 19, 2017 | Unregistered CommenterMerrilee Fullerton
not to mention hardship for patients
July 19, 2017 | Unregistered CommenterMerrilee Fullerton
Please correct me if I'm wrong but the daily fee to work in the north that Health Force Ontario provides for the rural family medicine locum program has been fixed at $750 per day for 20 years. Out of that one pays for accommodation, food, and transportation to the job site although I know there are sites where the town (Geraldton) provided accommodation for free.

A new grad might be enticed up north by that fee and the opportunity to practice with little to no back up to gain experience and confidence, but not too many others are going to drop their life elsewhere for that amount.
July 19, 2017 | Unregistered CommenterCanary in a Coal Mine
Please correct me if I'm wrong but the daily fee to work in the north that Health Force Ontario provides for the rural family medicine locum program has been fixed at $750 per day for 20 years. Out of that one pays for accommodation, food, and transportation to the job site although I know there are sites where the town (Geraldton) provided accommodation for free.

A new grad might be enticed up north by that fee and the opportunity to practice with little to no back up to gain experience and confidence, but not too many others are going to drop their life elsewhere for that amount.
July 19, 2017 | Unregistered CommenterCanary in a Coal Mine
Back to opioids

"More than half of the methadone distributed in Ontario is prescribed by just 57 doctors, most of whom work in high-volume clinics that provide assembly-line medical care to the burgeoning number of patients struggling with opioid addictions, a new study says."

https://www.theglobeandmail.com/news/national/ontario-study-raises-red-flags-over-methadone-distribution/article35727909/
July 19, 2017 | Unregistered CommenterCanary in a Coal Mine
So it is clear: At both the federal and provincial and municipal levels, central is after MDs. Too rich, to arrogant. They will be the first brought under control by social justice. Central is advised,constantly by the salaried academics, and the locum MDs, make the fee billers more accountable and control and dictate hours of service. Look at Quebec,where most in province trained MDs can not leave.

Ontario incorporation gone within 3 years. No compensatory fee increases.

The backroom discussions are very targeted to "get" the MDs.The public loves it. Over a 75% polling support to get the MDs.

Second group on central's list -old wealthy people. Need to tax their active, current, estates.

Third, inheritance. No further transfer of wealth across family. It first must flow through central.

A changing social blueprint. Wealth will NOT be transferable within families. Not socially just.
July 19, 2017 | Unregistered CommenterMovingforwardOntario
One would think that those who want to inherit from their parents and grandparents would vote against the social justice warrior politicians who would deny them their inheritances.

53% of Canadians have inheritance expectations...in 2014 the average expectation was $100,000 ( the average for Ontario was $113,509.10)....79% hope to pay off their debts with their windfalls...the working class tend to be very conservative where money is concerned and will vote according to their interests, more so than will the more prosperous young from middle and upper classes more vulnerable to the social justice meme...who believe that money grows on trees and who will be the most horrified when their rich uncles' monies are transferred to the state and they themselves won't be able to afford to visit Koh Phangan or Barcelona.

Perhaps the opposition should be beating the drums on this topic.
July 19, 2017 | Unregistered CommenterAndris
DrL:

Too late. Too many changes already in place.
July 20, 2017 | Unregistered CommenterMovingforwardOntario
DrL:

You need to carefully review the demographics of the over 40,and under 40 groups. dramatically different social structure.
July 20, 2017 | Unregistered CommenterMovingforwardOntario
Mfo care to elaborate. Are you referring to family and support structures or to financial health by generation?
July 20, 2017 | Unregistered CommenterCanary in a Coal Mine
Family and support structure.
July 20, 2017 | Unregistered CommenterMovingforwardOntario
''In an era of high expectations for every eventuality, the idea of managing the most serious medical scenarios that do occur and will occur becomes a nightmare (...)>> - Dr. F.

Not even with serious medical scenarios...just wondering what kind of punishment the patient's mother was really looking for? An eye for an eye - a burn for a burn?

'Inadequate and insulting': Sask. family unhappy doctor not disciplined after boy burned during cast removal
http://www.cbc.ca/news/canada/saskatoon/burns-cast-removal-saskatoon-saw-1.4211672
July 20, 2017 | Unregistered CommenterExecutive Lead Blogger
<<Central is advised,constantly by the salaried academics, and the locum MDs, make the fee billers more accountable and control and dictate hours of service.>> - MfO

If Central is going to do this, then why doesn't it make ALL doctors more accountable? Why disfavour the fee billers?
July 20, 2017 | Unregistered CommenterExecutive Lead Blogger
ELB

Because ffs hasn't had budget control until recently. Now in the sight of central is removed of unneeded fee codes that are overused.
July 20, 2017 | Unregistered CommenterMovingforwardOntario
So if I get this straight, MfO, Central has gone completely "nose blind" to results and outcomes and is only interested in budget predictability?

Where does that fit with the "innovation" agenda?
July 20, 2017 | Unregistered CommenterExecutive Lead Blogger
Innovation only works if it saves money. The money pressure are huge, but central is looking everywhere for "new revenue" tools. Wait til you see the tax on housing appreciation. Central needs to redistribute wealth faster.
July 20, 2017 | Unregistered CommenterMovingforwardOntario
R:

Do get central is ending capitalism, for the average citizen,and shifting capitalism to central. Moving tax dollars to influence the future. Central must spend even more.
July 20, 2017 | Unregistered CommenterMovingforwardOntario
<<Innovation only works if it saves money.>>- MfO

Is there an understanding at Central that sometimes to save a lot of money you have to invest a small amount for a brief period of time?
July 21, 2017 | Unregistered CommenterExecutive Lead Blogger

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