Toronto taxi licenses peaked at $360,000 in 2012. Three years later, licenses sold for $118,235.
Today, taxi plates go for less than $100,000.
Uber found a way to lower rates, offer better access and collect customer feedback with each ride.
Uber disrupted the taxi industry. Netflix did the same with movie rentals.
Airbnb entered the ‘hotel’ business without owning a single hotel room. It now has a larger market cap than Hilton and Marriott. Luxurious monopolies create irresistible targets for disruptive takeover.
Disruptive Takeover
Ontario doctors founded the Ontario Medical Association, in 1880, to represent doctors’ interests. In many ways, the OMA runs like it did 100 years ago. Socialized medicine added a twist in the 1960s, but the OMA stayed true.
Some say the OMA changed direction after the OMA dues act, in 1991. This law gave the OMA mandatory dues from every MD in Ontario (see debate). Today, annual dues generate around $55 million.
In good times, the monopoly benefits doctors and government. Government negotiates with only one group, and doctors gain political power from unity. But all that changes when doctors reject a tentative contract.
Why should politicians lose votes to support a doctors’ monopoly that embarrasses politicians?
Political support for monopolies grows thin when monopolies fail to deliver on political interests. Even though politicians prefer fighting with only one physician group, they will not protect a monopoly forever.
Value for Dues
Doctors need strong associations. They need powerful, sophisticated organizations to advocate for all medical concerns, not just negotiations, so that regular doctors can focus on patients.
Doctors usually ignore medical politics. But after 5 years of cuts, totalling over 30% of their net income, doctors have started to pay close attention to their medical association, in Ontario.
Doctors have not had a good contract since 2008, and government has cut medical fees every year, since the 2008 contract ran out in 2012. Physicians are asking about the value they get for the dues they pay.
The Coalition of Family Practice attacked the OMA in the 1990s after years of bad contracts and a number of self-serving decisions by the OMA. Coalition members ran for election and took over the Board around 2000. The renewed OMA delivered solid value for members for a decade.
Today, new groups challenge the OMA: Concerned Ontario Doctors, a new Coalition of Ontario Doctors, and Doctors for Justice.
These groups have launched sophisticated traditional and social media campaigns.
They’ve organized rallies.
Many people give them credit for defeating the tentative contract this summer.
These disruptive groups accomplished all this with a few thousand dollars.
Prepare Now
Great organizations operate knowing that competitors would love to crush them. They prepare for disruption. They plan for takeover.
They imagine their biggest risk and change their businesses to protect themselves. They plan for the worst and then relax knowing that they are prepared.
Relentless attacks from government plus a huge budget of mandatory dues makes the OMA an irresistible target for disruption. Are we ready?
Photo credit: newsroom.uber.com
PS – Thanks to the CMA for sharing these ideas in an educational session.
PPS – I wrote this piece during the week before and finished it on Tues, Oct 25th.
Shawn,
What type of OMA related disruption do you forecast?
Hey Del,
All great organizations prepare for disruption in a competitive environment. Even with the OMA dues act, the OMA exists in a competitive space. Look at Toronto taxis: Uber moved in despite a highly regulated environment.
So, I’m calling for preparation. How might we do business differently, if we had to? How might someone else do exactly what we do now, at the OMA, but do it with only 5% of the budget? In every competitive environment, we can be sure that someone is thinking about how to steal our lunch.
As to a forecast: I don’t have an answer. But I think we need a team of creative people to work through possible scenarios. We can use the scenarios to improve operations, if they seem like workable solutions.
Thanks for reading and asking!
Cheers
Shawn
We need cultural change at the OMA, starting with a refocusing of the mandate for OMA. It cant simultaneously be the bargaining agent for Doctors which qualifies for the Rand Formula and simultaneously work to protect the mess of a government program like OHIP. Its a fundamental conflict of interest. Advocating for patients and defense of the government program does not qualify the OMA for Randed dues. We need to refocus OMA and therefore strengthen it. We would swing much more clout for change for our patients if we were a respected and feared advocate for doctors. As it is now, the government knows the OMA is conflicted and ineffectual and possibly dishonest (see todays supposed cost of the general meeting complete with inflated legal fees and a completely unnecessary and controversial ad campaign to convince doctors to accept the unacceptable).
We need change and unfortunately it looks like the old guard are trying to dig in and fight in a business as usual attitude. It isn’t business as usual and the old guard has to go since they aren’t doing the wise thing which is to facilitate change which is inevitable. Ultimately trying to do business as usual is going to cost the OMA much more than dollars. I initially thought that we shouldn’t clean house as that would be de-stabilizing, but the last couple of weeks has convinced me that they aren’t actually “listening” they are preaching the old guard mantra and hoping for a different result. Einstein said that if you do something the same way over and over again without succcess – you are insane.
Thanks for this, Ernest!
I really like what you said about conflicted aims. Can an association advocate for doctors and patient at the same time as they are advocating for a government that works to cut healthcare? We have come to a Maginot line: on one side, we find patients; on the other, we find the system. Doctors must choose – more often than we want – between the patient in front of us and the greater good of the system at large. Co-management is a myth in austere times with long wait lists.
I truly believe that the OMA offers doctors’ best bet. But it needs to refocus. It needs to prepare. It needs to think and act like RAND might disappear at any moment. It needs to ‘Uber-ize’ as Andre Picard tweeted.
Thanks so much for reading and sharing a comment! I always appreciate hearing what you think.
Best regards,
Shawn
I have said it for years, we must withdraw our funding of this useless organization and place it in a trust en mass until we either have a union or we are satisfied with new OMA leadership. If we all do it then what are they going to do? if they try to sue us, that would be a contravention of their mandate to act on our behalf.
Thanks for this, Sam!
I wrote this as a challenge for us all. I wrote it in hopes that we could improve the OMA. Doctors end up with the OMA we elect. It is not hard to get elected to council. Too many of us ignore medical politics until things get terrible. Then it takes a few years to recover.
I hear your passion. You speak for many doctors in my district. For me, this comes as encouraging news. It means that doctors care enough to have opinions about the OMA! As you know, the OMA dues act allows the MOH to hold back billings on docs who refuse to pay their membership dues. Every year, a few hundred docs refuse to pay. The problem with not paying is that you also do not get to be a member and vote.
Thanks so much for sharing your thoughts! I truly believe that we can improve our association. Every membership association dreams of having engaged, passionate members. The OMA has tonnes of them lately. Now it has to figure out how to use all that energy.
Best regards,
Shawn
The rationale for Randing is that all members get the benefit of the organization’s bargaining and so should pay dues. Following from this, at a minimum, the Randing of dues should only apply to ~20% of dues. The rest would be optional.
Great point, Gerry.
I would rather see different levels of dues: bronze, silver, gold, platinum. Doctors could choose which level of dues they wished to pay based on the services offered at each level. An entrepreneurial mindset could build revenue by offering platinum services for much higher dues than what we pay now. At the same time, members who did not find value in the higher offerings could choose to pay only the basic level of dues. I see this as a way to increase revenue, choice and accountability, all at the same time.
Thanks for taking time to share!
Warm regards,
Shawn
Factually, Gerry’s point (compelling the differentiation of compulsory dues into bargaining and other costs) has already been considered and rejected by the Supreme Court of Canada in Levigne v OPSEU, I think.
More importantly, members don’t just get the benefits of bargaining in a Union scenario …. they also get protection from many of the unacceptable tactics regularly used by employers, exactly like the insulting behaviours which the Liberal government is currently using against doctors.
Most important of all was that Justice Ivan Rand’s groundbreaking decision also required that the Union act in a democratic and responsible way. So, compulsory dues checkoff is not granted to a Union in perpetuity, unlike what happens as the effect of OMA Dues Act. Unions MUST from time to time reconfirm members support by means of a referendum …. which allows for the members to get rid of, or change the Union if a majority is dissatisfied.
Since Minister Hoskins has recently offered to discuss Union status, perhaps it’s time for the OMA to have that particular conversation with its membership?
And for anyone interested in Ivan Rands momentous decision, which has now withstood legal challenge for more than 50 years, I suggest mlj.robsonhall.com/mlj/content/rand-formula-revisited-union-security-charter-era.
or
https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0ahUKEwiUvdKEvYLQAhUI6YMKHV3uBZwQFggiMAE&url=http%3A%2F%2Fmlj.robsonhall.com%2Fmlj%2Fcontent%2Frand-formula-revisited-union-security-charter-era&usg=AFQjCNETvcrLgxud0blVtoJep1rTkQmflA&sig2=A-_DLXN-aRTXj9Vff5wvYA&bvm=bv.136811127,d.amc
Thats right Mike, that is in part why I want to change the OMA mission Statement to;
The Ontario Medical Association will take it as its primary mission, to protect
and promote the financial, physical and professional welfare of the members
of the organization through all phases of professional life. The organization
will focus on obtaining and maintaining the best possible benefits of having a
career in medicine. It will defend the political, social and legal rights of its
membership at all costs and at all times.
I plan to bring this as a motion but may frame it as a motion to have an electronic referendum with a built in time limit. Are you with me?
Ernest
I agree with you, but will not be at Council in November.
You should try to enlist support from the SGFP Exec, and get the motion submitted within the allowed timeframe.
An electronic referendum is a good idea, but a motion endorsed by Council also has teeth.
Best
Thank you, Mike!
As always, you add nuance that most of us did not know or understand. Excellent!
Shawn