Relax, the OMA Will Never Strike

Doctors believe patient stories. We think we catch liars. But we can’t. How could we?

If someone cries about final exams and talks about death, I believe her. If someone describes excruciating pain and grimaces when no one is looking, I believe him.

Doctors, for the most part, believe patients.

Wired for credulity, doctors want to believe. When the Ontario Medical Association talks about possible job action and strikes a working group to explore job action, doctors believe the OMA is thinking about job action. But is it? Continue reading “Relax, the OMA Will Never Strike”

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How to Earn Respect – OMA

a-little-r-e-s-p-e-c-t-09-17-2012Doctors received renewal notices from their ersatz union this week. The OMA collects almost $60 million in dues.

Doctors who refuse to pay lose their membership and have dues deducted from their OHIP billings: taxation without citizenship.

The OMA negotiated the last, successful contract in 2008. The biggest gains, roughly 4%, were set for 2011. Government asked the OMA to forgo the raise. The OMA said no. Government took it all back with unilateral action and has attacked, slandered and cut doctors ever since.

This summer, the Liberal Government of Ontario eviscerated their negotiating partner, and the OMA played along.

Government really wanted labor peace with doctors before September. Government pushed too hard with the OMA, and the OMA pushed even harder with doctors.

Doctors voted 63% No against the OMA Board’s new deal. Many saw the unprecedented rebellion as a vote of non-confidence.

Now the OMA must find a way to prove to doctors that it deserves the right to exist.

How to Earn Respect

Respect takes years to earn and moments to lose. Here are 4 essentials to earn it back:

A. Stand For Something

Support for fads never wins respect. Popular opinion only shields from abuse until the topic changes. Continue reading “How to Earn Respect – OMA”

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Manage Doctors for Patient Benefit

knead-breadParents can try to control everything their children do, or let them run completely wild. Neither extreme works well.

Politicians can try to control everything in medicine, or let doctors run wild.

Just like parents, politicians tend towards one extreme or another. If we listen closely, most pundits assume doctors should be controlled.

How to Manage Doctors

I spend hours listening to healthcare opinionists: politicians, candidates running for office, administrators, consultants, bureaucrats, journalists, talk show hosts and concerned citizens. They all have different ideas on how to manage doctors. But none of them questions the need for management. Continue reading “Manage Doctors for Patient Benefit”

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Doctors Need a Champion

superhero-kidMost people are too polite to tell you what they think. Even when it feels like someone was courageously honest, they still held back their strongest opinions.

This week, several dozen doctors met just west of Toronto to tell the OMA what they thought. It was one of many meetings booked across the province. Dr. Virginia Walley, OMA President, handled the questions and feedback.

Most docs pulled their punches and were polite. Even so, they offered bitter medicine. Continue reading “Doctors Need a Champion”

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Healthcare System vs Patients – Stewardship Part II

fork_in_the_road_-_geograph-org-uk_-_1355424Canadian healthcare stands paralyzed in a Robert Frost poem:

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveller, long I stood

And looked down one as far as I could

To where it bent in the undergrowth; 

– The Road Not Taken

Wooly-minded people pretend binary choices do not exist. They think we can choose both roads. Or they think one road will always be clearly wrong, as long as we use logic, facts and good will in choosing.

Doctors face two roads every day:

Do we do what’s best for the patient and prescribe an expensive treatment, or do we do what’s best for society and save the money for something else?

Until recently, doctors just prescribed what patients needed. Continue reading “Healthcare System vs Patients – Stewardship Part II”

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Not About the Money

Hand holding fanned out Canadian money.The Canadian Press Images-Mario Beauregard
The Canadian Press Images-Mario Beauregar

Almost 50% of couples divorce, but 90% never fight about money, according to a new study.

Government has fought with doctors for almost 50 years now, and it looks like all they do is argue over money. This assumption is reasonable, and wrong.

Money is a Distraction

Most grownups pay attention to their accounts. They limit debt and make payments on time. They know that money runs out.

Government takes a different approach. In part, government does not need to worry; it can always raise taxes. But voters will not tolerate anything. Taxes run out, too.

When doctors and government fight about money, observers often miss an important point: Government does not really need to worry about the money it spends on doctors. Continue reading “Not About the Money”

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Distract Doctors, Gain Control

distracted-parentSmart kids learn to distract and stay out of trouble. They know Mom won’t bother about overdue homework, as long as she stays stressed about something else.

Politicians do the same. They distract voters with new handouts, or even better, stoke anxiety about Zika, Global Warming or some other ominous event.

Just do not let voters ask about things that government can impact, like patient wait times.

How to Gain Control

If government wants to shape society, instead of just serving it, politicians need the power to tell people what to do. Continue reading “Distract Doctors, Gain Control”

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Doctors Need a Common Enemy

common-enemyMy son’s hockey team kept losing, even though they had one outstanding player. They got an early win when their superstar was away. The team started passing, worked together and won.

Team unity beats divided talent every time.

The OMA presented a contract to the doctors of Ontario in July. Even at first glance, people could see that it would divide doctors.

We should not fear dangerous ideas. But ideas must come out at the right time, in the right place.

Tackling divisive issues in a tentative contract is like starting a team brawl in the locker room, just before a game. You will lose.

Divide and Conquer works well. Politicians know that.

Government is Not the Enemy

Doctors need government. Teams cannot play without goal posts and referees. Doctors cannot provide care without government to enforce contracts and maintain order.

As much as many of us hate to admit it, we need a little government bureaucracy.

But sometimes, government is the enemy.  Continue reading “Doctors Need a Common Enemy”

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Dreams of Co-Management

Blond Boy CryingWe start life ruled by passion. We clench our fists, howling at hunger pains and wet diapers. We swing from elation to rage, driven by desire.

Eventually, we grow up. We learn to control emotion. But passion continues to fuel our dreams throughout life. Life absent passion is death.

Dreams of Co-Management

Doctors have audacious dreams. They want a say in how patients receive medical care. They want an equal voice in decisions about medicine.

Some call these dreams arrogance. Continue reading “Dreams of Co-Management”

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Crisis of Trust – Doctors Vote No

harry-potter-philosophers-stoneOrphans make great fiction. Harry Potter leads a long list with Tom Sawyer, Anne of Green Gables and Oliver Twist.

Children need someone to trust. They cannot be children and fight the world at the same time. Abandonment is held with universal disdain.

Doctors feel abandoned. Over 61% voted No to a tentative deal that promised cuts and underfunding for 4 years.

The Wynne government has squandered money for medical services, by gambling on windmills and pension plans. Health Minister Hoskins makes a point of belittling doctors for working hard in the system his government created, while every other public union gets contracts, with raises.

Doctors feel abandoned by government.

Many doctors feel the same about the Ontario Medical Association (OMA).

No one can accuse the OMA of bargaining in bad faith. The OMA was determined to promote the 2016 Tentative Physician Services Agreement and spared no expense in advertising.

Robocalls, personal phone contact on the weekends, slick campaign ads by email, video interviews, dozens of roadshows, tele-townhalls, local medical meetings, letters to the editor and a massive social media campaign pushed doctors to vote Yes.

No one knows, but people guess it cost between $1 million to $3 million. This ignores hours of OMA staff time, as other work got put on hold.

The OMA has never tried so hard to convince their members to ratify a contract.

And that’s the problem.

The board endorsed the New Deal. It was wise to share it with members. But endorsement morphed into promotion and desperate advocacy.

Desperation creates blindness and drives odd behaviour. Superior Court Justice Perell ruled that the OMA Board’s Executive Committee had “abused the authority provided to it” and created an “unhelpful, unclear,  unbalanced, and unfair” voting process.

Perell called the Exec “sneaky”.

Addendum: One physician leader insisted that Perell called the “OMA” sneaky. Legal opinion did not back up that statement, although it is not 100% clear. Regardless, whether Purell referred to the Exec, the whole Board or the OMA writ large, his comments are damning. We must get on and face the fact that the comments exist and stop blaming people for drawing attention to them. 

We must not judge too quickly. Passionate beliefs make people double down and pour in more energy, precisely when they should step back. Double or nothing seems logical at the worst time.

A wise friend said that, People with weak arguments hold the bitterest resentment for those who do not support them. People with strong arguments do not need endorsement. Their case stands on its own merit.

The OMA bet everything on promoting a Yes vote and lost doctors’ trust in the process. Many of us might have made the same mistake.

Crisis of Trust

Warren Buffett said, “It takes 20 years to build a reputation, and 5 minutes to ruin it.” It takes years of effort, sacrifice and principled behaviour to earn the trust that creates lasting change.

Doctors need someone to watch their back, so that they can focus on patients. Doctors cannot provide care with one hand on their sword.

Many believe that the massive No vote is a vote of non-confidence in the OMA.

How to Rebuild Trust

Healing starts with taking other people’s beliefs seriously, regardless of our opinions about those beliefs.  Denying a crisis of trust guarantees more failure.

For leaders, staff opinion must trump leadership ‘facts’. When staff members firmly believe that leadership betrayed them, leaders cannot fix it by proving their staff has no right to feel that way. Leaders win trust with behaviours and outcomes, not arguments and facts.

Doctors know this. When grieving parents attack us, it does not help to debate the best way to resuscitate a dying toddler. We want to run away when lawyers show up, but that is exactly the time to engage with compassion.

Leaders must deal with beliefs and emotions before process and projects. We must take the accusations of our most passionate critics with utmost seriousness.

If government is a reckless, absent parent, then the OMA must be the dependable one. The OMA must win the right to be trusted. It can be done. But it will be costly, in many ways. We need the courage and humility to start.

The OMA must prove to doctors that it values its members before anything else; that it will never abandon them. That might require painful sacrifice. But it’s essential. Orphaned doctors do not provide great care.

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