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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19 Replies to “Crisis of Trust – Doctors Vote No”

  1. Well said. I think the book “Mistakes were made; But not by me” would offer an insight into the powers of cognitive dissonance to affect rational decision making, for those interested. Since reading the book, when I can’t explain someone’s behaviour as logical, it often offers a good explanation of the reasons. Conflicts of interest need to be examined and dealt with as well.

    1. Thanks for suggesting that, Leslie. I will definitely check it out.

      I hope readers will pause and let your comments soak in. You offer more advice than people might see at first glance.

      Thanks for taking time to read and share a comment!

      Warm regards,


    2. Fantastic book and certainly relevant to dynamics between docs and the OMA.

      And Shawn, another thoughtful piece of writing, thx.

    3. I second that recommendation. The book was quite an eye opener. It helps explain some of the behaviors observed recently.

      1. Thanks Rob and Matt!

        It really helps readers to see that others endorse the title, too.



  2. Shawn:
    “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.

    How true it is. Exactly how I feel about Dr. Wooder. I used to admire and respect him for his work in OMA and for the profession until he started on hard selling this tPSA in the last 2 weeks. You are right OMA central has a lot of soul searching to do on winning back trust from the membership. Good luck


  3. Thank you for this, Shawn. I hope the people who need to read this can allow themselves to see the wisdom you have communicated so well.

  4. I don’t think this has ever happened. I don’t think the OMA rank-and-file membership has ever rejected an OMA Board recommended agreement. We are in uncharted waters.

    And it’s not because the OMA didn’t try. Indeed, it was a Herculean effort, with no expense or endeavour spared to achieve the ‘yes’ vote.

    It didn’t happen. And the OMA needs to own the outcome because they were trounced at the polls. The OMA wants to rebuild trust at a time when it has scraped rock bottom. Dr. Wooder and Dr. Bonin have showed that they are honourable people. They have owned the outcome and have done the right thing in stepping down.

    There were numerous members of the OMA Board who were out there in videos/e-mails and tweets promoting the deal to the hilt. There are others who did not. The ultimate step of beginning to rebuild trust is for the leadership of the OMA to own the outcome. Those that voted at the Board level to recommend this ‘deal’ to the membership should stand down and resign from the OMA Board. I know that’s what I would do if membership rejected a deal that I approved for ratification as a Board member…

    1. Thanks Paul!

      I agree. The OMA owns this outcome. We need to explore all options for rebuilding trust. As you know, the negotiations committee would most likely have been sunset anyways. It was wise of the co-chairs to publicly resign, regardless. Very honourable.

      I sure appreciate you sharing a comment!



      1. There is so much wrong with OMA leadership on so many levels.

        1) There is a 10 year term limit on being on the OMA Board of Directors. This is consecutive years. After a 2 year break, you can run again and get another 10+ years.

        2) The 10 year term does not apply if one is to be privileged to curry enough favour with fellow board members and gain access to the Board Executive and climb the ladder to the presidency. That can gain a Board member and extra 6 years where they are immune to being voted out. So one can be on the Board for up to 16 consecutive years…

        3) 5 members of the OMA Board are selected by Council. This is utterly ridiculous and is nothing but a popularity contest. Why do we need Board members appointed by Council. Indeed, three of the current six Board Executive are those appointed by Council. They are immune to the wishes of the general membership.

        4) There is an academic representative on the OMA Board. Why?

        The structure of the OMA leadership needs a complete overhaul. There should be no Board members appointed by Council. And those that gain access to the rungs of the ladder should be allowed to be voted out by membership. There should be no academic representative.

        The current structure lends itself to OMA Board members being insulated from the general membership. Up to 12 of 25 Board members at a time are immune from being voted out by members. What is the incentive of such a structure to serve the needs of membership…especially when guaranteed 100% membership by the Rand Formula.

        This has come to a head. The Board Executive is untouchable. They should do the right thing and resign. As for the rest of the Board who promoted this with tweets/videos/e-mails/speeches, they should also step down. It is well known who they are. Right now, they have targets on their back and elections are in the spring.

        Spring 2017 OMA elections will be unlike any other. There will be other candidates to oppose them…guaranteed. And their promotion of a failed agreement will be front and centre on why they should be voted out…expect much turnover…

        1. Thanks again, Paul.

          Many still call for more governance renewal despite all the time that was just spent on it. You ask good questions. It seems that when similar questions get put to the membership, most vote for continuing more of the same. It’s possible that many are not as familiar as you are with the structure.

          We can make things better. Even just a major re-focus on serving members would help a tonne.

          Many of us, who have tried to support change from the inside, are getting tired. It feels we all have targets on our backs these days…

          Here’s hoping for better days to come along soon! (with lots of effort…)

          Best regards,


  5. We need more information from the membership at large to inform whoever or whatever takes over our bargaining in the future. We could start with unbiased surveys. OMA has been doing surveys with things like thought lounge for a while, but they are always biased to favour the answers OMA wanted to hear. More radical or original alternatives are never on the list of check boxes. We need an honest an open debate on what we want and what we deserve. Dr’s have been taking one for the team for far too long and now our futures are compromised by compromise. Why shouldn’t a doctor be able to earn enough to retire comfortably? Why shouldn’t we have a pension plan possibly run by ourselves or teachers? Why should we accept $34 for an office visit when the same thing costs 160 euro in Spain? Lets ask honest questions and then listen to the responses.

    1. Brilliant comments, Ernest!

      Agree entirely. We need to hear what working doctors think. We need to revisit whether everyone thinks we should let FFS die at $34 per visit before overhead.

      Ask and listen: Who could argue with that?

      Thanks again,


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