We 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.
How dare doctors demand a voice in how medical care is organized?
Government contracts physicians to provide services that society approves, full stop.
Doctors disagree. They believe that, as professionals in medical care, they should have the biggest voice, on all medical issues. Doctors believe that they know best how to care for patients and run medical offices.
However, even if socialized medicine did not exist, most docs admit that they cannot provide care without government providing some structure.
Reality of Co-Management
Co-management has already been tried and found wanting.
Every contract in Ontario starts with an agreement between doctors and government. Both parties agree to work together and fix problems.
Co-management is enshrined in the Physician Services Committee (PSC): a powerful group co-chaired by the Ontario Medical Association and the Ministry of Health, for more than a decade.
The PSC always starts work enthusiastically on a new contract, implementing grand designs through gangs of sub-committees.
When government has money, politicians agree to all kinds of programs that benefit patients.
But every time, politicians spend all the money on other things. Then they stop spending on medical care. Eventually, bureaucrats abandon sub-committees and avoid meeting to talk about it.
The PSC process falters, and meaningful co-management ends.
Doctors have no way to keep government accountable to contract promises. Doctors can beg and whine. Too often, unpopular or costly bits in a contract get left untouched, swept up by the next contract.
Still, the dream of co-management survives. Doctors long for a ‘seat at the table’.
Surely, government will listen to our ideas? Maybe we just need to think more like bureaucrats and less like doctors?
Reality
At some point, babies grow up. Passion stops ruling their lives. They realize dreams do not always come true, yet real life can be fun, too.
One doc said recently, “My 6 year old has a seat at the table, but she does not have an equal voice.“
It’s fine for doctors to dream of equal power, in a government-run system. But at some point, doctors need to admit that true co-management is not reality.
Doctors must never lose passion for change, but they need to wake up. Government runs healthcare and has run out of money to pay for it.
Well said Shawn….the “sell” on how this tPSA was going to be about co-management was painful to see….really, the OMA brass were doing a bold-face lie because everyone who has been around (hence the students and residents falling for it hook, line and sinker) knows there has always been an attempt at co-management, for decades, which has never done much in the end. Pretending the last 2 years of “no contract”, and no “seat at the table” was somehow the norm was just ridiculous. Even Hoskins spun that one to the media and they (and the students and residents) bought it. The stark reality is the OMA has to stop trying to be 2 conflicting things: fighting for physicians salaries, while also trying to be on the other side of the table dictating health policy, a powerful feeling for those involved (I guess), but partnering with a bankrupt system. The conflict of interest is simply hard to understand, especially how tolerated it is by a passive physician group. Why Randed dues are allowed to pay for anti-smoking adds (as one of many examples), while laudable, is simply unacceptable, as it is the government who should be paying for this this, not me.
What a great comment, ksy11.
I think you said it best with, “…the OMA has to stop trying to be 2 conflicting things: fighting for physicians salaries, while also trying to be on the other side of the table dictating health policy…partnering with a bankrupt system.”
You and I are thinking very similar thoughts. How can we – the OMA – try to do both of these things (advocating for docs and partnering with cuts) at the same time without compromising both in the process?
As for RAND, I do not agree with forced dues for activities beyond negotiations. I even question whether we should have RAND for negotiations, but I do appreciate the problem of free-riders: those who do not pay dues but benefit from the effort.
Thanks so much for taking time to read and share a comment! Most people are on vacation at this time of year… 🙂
Best regards,
Shawn