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.

What does the OMA support? Insiders might say that the OMA believes in a strong healthcare system based on mutual respect.

How does that differ from anyone else? Doctors need an association that will fight for doctors so that doctors can care for patients.

Doctors and patients do not need the OMA to be popular.

The public, most doctors and even many inside the OMA think that the OMA negotiates raises for MDs. They are partly right but mostly wrong. Contracts are about patient care and only look like they are about money.

Raises mean almost nothing. A raise that fails to improve patient care all but guarantees a cut next time.

The OMA negotiates fees that fund necessary care. Without fees, very little care occurs. If fees are too low, then access to that service decreases. This is not greed; it’s basic economics.

Every economic decision creates behavioural incentives.

When the OMA accepts a cut, it does not really cut doctors. It cuts patient care. OMA leaders swell with moralistic pride about accepting cuts to fees. In the same way, Soviets bragged about the cheapest bread in Europe, but citizens had none to eat.

B. Speak Up

The OMA needs to critique healthcare on behalf of patients. Government and patients will respect the OMA for it.

The anemic response to Bill 41 will not earn respect. The OMA should have launched a strong public campaign as soon as it learned that government was redesigning healthcare based on the Price-Baker report, in 2015.

The OMA had documents from the Ministry showing how the LHINs were creating plans to implement the Price Report / Bill 210 / Bill 41.

Government needed labour peace with doctors, this summer, to implement its so-called Patients First Act, this fall.

Doctors had to beg the OMA to realize the danger. Even at roadshows this fall, the OMA argued with doctors that Bill 41 wasn’t really about doctors at all.

The OMA finally started fighting Bill 41. But only after rival groups, Concerned Ontario Doctors and the Coalition of Ontario Doctors, tabled a petition demanding the resignation of the OMA Board Executive Committee. Under threat, the OMA started to campaign, but Bill 41 had already been referred to committee.

The OMA must critique real problems to earn respect:

For example, it could tackle IT integration.

Digital images should be shared seamlessly across hospitals and clinics.

The OMA could use the news about 20-week wait times to write about the actual 2 years wait-times for joint replacement in many areas.

Talk about 1600 nurses being laid off. Highlight no raises for hospitals for 9 years.

The OMA must gird its loins and speak up about real problems, not just issues that threaten its own existence.

C. Shun patronage

Doctors are the only reason the OMA exists. It must forget about winning patients’ hearts; leave that to doctors.

And it must give stop lusting for friendship with government. Power befriends those who offer more power.

The OMA must win the respect and trust of doctors before it can dream of friendship with government. Sycophants offer nothing.

Everyone loves individual nurses or autoworkers, but no one truly loves the unions that represent them. The OMA must stop trying to win support that it can never keep.

The OMA must banish self-serving motions, ideas, policies and programs. It will never be loved, if it insists on serving itself. The OMA must serve others, protect others and stop trying to protect itself. Serving doctors offers the best protection for the OMA.

D. Change the business model

The OMA relies too much on Rand; the OMA Dues Act could be repealed. The OMA pays little attention to this.

Instead of creating ways to report its members to the college, it should focus on changing its business model. The OMA should make itself impervious to political whim or legislative change.

Rand makes OMA beholden to government. Like a feudal Lord, the OMA exists at the pleasure of its monarch.

Doctors will never get great service from an organization funded on patronage. The OMA must see Rand for what it is: a legislated monopoly that undermines the OMA mission to serve doctors so that doctors can care for patients.

Strength, not Power

The OMA does not need popularity or raw power. The OMA needs principled strength built on solid character.  Everyone needs a strong OMA: doctors, government and especially patients. The OMA will earn respect with concrete action, and respect must be given before it is received.

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28 thoughts on “How to Earn Respect – OMA”

  1. Hi Shawn

    Mostly agree EXCEPT for the part of the OMA earning the respect of the government. I don’t want the government to respect the OMA (or doctors). I want them to FEAR US. This applies no matter who’s in power. Until we establish ourselves as a political force that WILL cause them to lose an election if they cross us, we are going to be forever doomed. That fear can come with begrudging respect or even with hatred and loathing (I couldn’t care less). But it has to be a debilitating FEAR of what doctors and the OMA could do to their political careers.

    1. Brilliant comment, Sohail!

      You add a nuance that I failed to bring out, but you are correct. I was thinking of respect in the same sense as you respect a tame lion: It is still a lion and potentially dangerous. I was not thinking of respect in the sense that we ought to show respect by staying off the grass or wearing a poppy.

      Thanks for all you do, Sohail. Please keep writing, informing and leading doctors!

      Highest regards,

      Shawn

  2. Thanks you, Shawn.

    I think that the RAND is a huge problem. It’s probably a huge reason why the OMA cares more about being on the government’s good side than standing up for physicians. It needs to go.

    What would happen if, at the next council meeting, a motion were tabled to make the OMA request that the government repeal the RAND (for MDs?)?

    (I presume it would be fought tooth and nail. De-RANDing would lead to an exodus of dissatisfied members, causing dues to rise and more members to be dissatisfied.)

    1. Great question, Chris.

      I think it is worth a solid debate. I doubt the OMA would even allow such a debate. The dues do not have to be tied to legislation. The OMA could give the money back, even though the government collects it for the OMA.

      We could also ask that only the 30% of dues that gets spent directly on negotiations be mandatory.

      The ‘free rider’ debate can be solved. Just because a few doctors won’t pay dues for anything, if given a chance, does not mean that we must live with an organization that runs on taxation instead of service. The OMA must be responsive to the members it purports to serve. It must be held accountable.

      Thanks for taking time to read and share!

      Cheers

      Shawn

  3. Brilliant and topical though I fear will fall on deaf ears based on some of what I read about during the council meeting a couple of weeks ago. This pessimist sees little hope for the monster to slay itself, but Bravo as usual, Shawn!

    1. Thanks Mick!

      Council is a strange beast. Most of the time, council follows where the Board leads. The Board knows how to tell council what council wants to hear. For example, apologize profusely so that people feel bad about asking questions about performance. That will not do. When a company under performs, stock-holders do not give the Board a pass at the annual general meeting just because the CEO apologizes profusely.

      We need to talk with out colleagues. Get them involved at council. Hold the Board accountable. Hold the Chair of council accountable. Change governance. We have no other choice…

      Thanks again! Great comment.

      Best regards,

      Shawn

  4. Hi “former director”

    We used to have a motto at the the Board of the old COFP …. in the pre MRC days ….

    It was FEAR-> TRUST-> RESPECT

    Good to know it hasn’t gone out of style!

    1. Hey Mike! 😉

      What a great vision. I might put STRENGTH or POWER in place of FEAR, but fear seems to capture the sentiment best.

      Great to hear from you – Merry Christmas!

      Shawn

  5. Shawn, really none of my business re relationship of physicians and OMA- patients have zero impact except at general election. OMA aside, docs daily patient decisions are of paramount concern to every citizen in Ontario. Not to be dramatic, but our wellbeing and lives depend on access to all treatments recommended and implemented by our doctors. It’s at this juncture we have a govt (Wynne & Hoskins) problem. Again little we can do but ….take it and if we can afford to, seek care Out-of-country.

    I had a conversation with a specialist who pointed at passing docs in clinic & said they perform the exact services & skills as him, but some of them bill much higher for same treatment and live a much more extravagant lifestyle. As I see it, this inequity in billing is one of the key problems to managing billing, funding, services, doc perceptions and overall funding debates. Some are screwing many with their selfish business practices.

    Have to wonder why govt allows this, they see billings of all but allow the few to impact decisions that penalize majority and ultimately us patients.

    Keep up the great thought provoking articles and fight for patients.

    Don

    1. Thanks for maintaining an interest in this, Don. Your insights are excellent.

      I think we need to focus on patient benefit before billing. Were patients helped? How many were helped? What kind of help did they receive? No matter what speciality you work in, you must see a tonne of patients and work the hours required of TWO jobs to generate the salacious salaries that generate so much envy. I realize this is odd coming from someone in one of the lowest paid specialties. I just find too many people start this discussion on money, when we should start it with patient benefit. IMO.

      Thanks again for taking time to write!

      Best regards,

      Shawn

      1. Absolutely. Govts dialogue is ALL about money, not patient benefit. My point was simply to say if some are over billing then that’s a starting point to address & rectify to get govt off doc income. I would be happy to see every doctor taking home $400k after expenses. Then on equal basis as many govt employees. Docs train with entire focus on patient benefits, govt employees focus on personal income and personal benefits.
        Have a very Merry Christmas Shawn

  6. On another forum it was pointed out that the support of the OMA was recorded in Hansard as Bill 41 was passed.

    OMA discussions with the government were carried out in April and June 2015…February 2016…May 30 2016 the MOHLTC met with the OMA CEO and the OMA President giving advance notice of the tabling of the Patient’s First Act…June 30 a meeting was held between the government and the OMA staff and legal counsel to discuss Bill 210 ( that morphed into Bill 41) …June 8 the deputy minister and ministry officials met with the OMA primary care advisory group to further discuss Bill 210…on July 7 the ministry provided assistance to the OMA staff in answering Bill 210 questions….September 26 the ministry presented the Pstients First Act to the Coalition of Regulated Health Professionals Associations with the OMA present…on October 13 the ministry requested to consult on the clinical leadership components of the Act….there were 6 standing meetings between the OMA CEO and the deputy minister to discuss the Act.

    The OMA took part in consultations all along the line….it was involved in the process.

    It’s support of Bill 41 is recorded in Hansard .

    Physician contracts will be signed off by the LHINS and Mini LHINs, physician mobility will be controlled, no LHIN/ Mini LHIN contract…no income…physicians are to be reduced to demoralized leaderless box ticking widgets….we are to be displaced but not replaced…there will no longer be any leadership just a permanent state of disarray as the health care bureaucracy grows and grows.

    The medical profession lost its way with the RAND…the alliegance of the OMA switched from the membership to the government…since then it has been reduced into competing castrated elements fighting over a government shrunk pie.

    The OMA is fighting a phoney war against Bill 41…it will lead the membership into dark alleys where it will be mugged and remugged by the government, bringing the membership to its knees…the ultimate goal of the government.

    1. WOW!

      I must check this with the policy department ASAP. This is a strong allegation. If true, the OMA has some major explaining to do. This sort of thing could trigger another GMoM in days.

      If it is not true, then it needs to be corrected ASAP. I have written to the OMA asking for clarification.

      Thanks for sharing this, Andris. I will double check and report back….

      Shawn

    1. Thanks again for sharing this, Joe.

      I started scanning through the link. I could not find the spots where the OMA was part of the consultation. Does anyone have specific quotes? I know that the government insists OMA was consulted. I just have not seen evidence of it. And even if government spoke with the CEO, there was no usual consultation process, that is, OMA did not get a copy of the bill to share with members and sections for feedback.

      Looking forward to hearing how this resolves. I mentioned it to OMA central…

      Thanks again for raising the issue!!

      Shawn

      1. Nothing about this process has been ” usual”….there evidently has been a great deal of behind the scenes hankypanky going on between the OMA, it’s representatives, it’s agents , with the government….the surprise ” deal” sprung on the profession last summer was a reflection of such “not usual ” behaviour…happily the grassroots revolted….unhappily there is devious activity still going on behind the scenes as we speak…where is Wikileaks when we need it?

  7. At the last council I had a motion to ask for a referendum on the following question.

    The Ontario Medical Association conduct an electronic referendum by January 30, 2017 to following proposed change to the Mission Statement of the OMA:
    The Ontario Medical Association’s primary mission is; 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 collective political, social and legal rights of its membership at all times.

    The board opposed it on the grounds that a referendum would cost too much!. As if this were more complex than a thought lounge survey! Despite the negative recommendation, this won 47% support of council which is not exactly representative of the general membership. I think that if we could ask the membership, they probably would want an OMA as described above and not what we have now.

    1. I felt sick that the Executive Committee would oppose such a reasonable motion. Good for you for moving it, Ernest!

      Perhaps members could hold a referendum on social media?

      Great motion. Don’t give up on it.

      Thanks for sharing it!

      Shawn

  8. The remarks above are frightening.

    MDs are incredibly valuable members of the health care system and should be given respect, there is no question there.

    However the remark about becoming a tamed lion who should be feared and that politics should be decided by physicians is taking the sentiment too far. Remember that you are part of a system- not manning it alone. Comments like that lose the respect of your peers who otherwise support the amazing things you all do daily.

    Please remember you are not the top of the food chain, or king of the jungle. You are a team member of a system of players you could not do without.

    Sincerely,
    – the rest of the health care system trying to make things work through supporting and working with bill 41

    1. Thanks for sharing this, Anonymous.

      I assume you are a unionized employee? And you know how much administrators and politicians FEAR your union(s)?

      This has nothing to do with food chains. You are reading comments of DESPERATION after 30% cuts to net earnings, public slander and outright attacks on the medical profession for the last 5 years. Patients are already waiting almost 2 years for joint replacement in my area while surgeons cannot find work.

      I love my healthcare team members. You are 100% correct: I cannot survive without you. And if you were under relentless attack for 5 years, I would empathize with you and show great sympathy.

      Both of our jobs depend on each other. I hope we can depend on some support from you in the future.

      Kind regards,

      Shawn

      1. Hi Shawn,

        Actually I am not a unionized employee. I work in primary care and see first hand the currently flawed system that funds our MDs. A perfect example as seen in physician led FHTs where MDs are all members of the board and decide how a non-profit, government funded org should run to benefit their own bottom line. I see it daily. Diabetes days that other HCPs could do the work but MDs run 60-80 people per day through the line so they can bill an outrageous amount and only work three days per week while also collecting their monthly patient fee.

        No wonder the Gov wants more oversight into your practices.

        Everyone else is paid for their hard work, overtime and sacrifice of time with family/friends through salary or hourly wages… why shouldn’t MDs? What puts you above other health care professionals who are also essential to the system?

        As far as empathy goes, I find it hard to toe your party line when all I have read about in submissions to Legislature from MD groups is the ‘unavoidable need for privatizing care further’. The only person this benefits is those who benefit from the billings to insurance companies etc. Not the patient.

        In a time like now, our population really needs our publicly funded health care. We also need flexibility from all HCPs including MDs to understand that things need to change from current state. Your group isn’t the only ones targeted btw, although never in any communications do MD groups even make mention of other HCPs. Nurses have been laid off en masse, physiotherapists are hardly funded in the home care system and NPs, Pharmacists, Dieticians and Health promoters haven’t seen a raise since the dawn of time.

        Community pharmacists more recently went through a similar reform and outrage ensued from the removal of kick backs, reduced cost of generics etc. No one felt bad for them- why? Because after they protested at Queens Park they threw their signs into their Porch Cayenne and drove to the nearest wine bar for drinks. A community Pharmacist still doesn’t make near the income a family MD does and spends an equal amount of time in school/tuition. It is really hard to find empathy when the rest of us can barely afford a babysitter so we can actually go to work.

        1. Thanks again, Anonymous.

          You make some solid points. I would suggest that we focus on patient benefit as a starting point. Everyone wants to attack this or that doctor for the what they earn, but very few people want to talk about how many patients were helped, or how many hours the MD worked.

          I won’t get into a competition about who earns less. Since I started a small, rural family practice 2 years ago, I earn less than my secretary after paying overhead. And I LOVE IT! I am honoured to care for my patients in our tiny community. It just means I have to work outside the clinic to make ends meet.

          People often blame doctors for system failures. If the system encourages a certain kind of behaviour, we cannot sit and criticize individuals for providing what the system asks for.

          You suggest that all doctors should be on salary. Bring it on! I would LOVE to have a pension, benefits, time off, coffee breaks and everything else that goes with being salaried. The government could not afford to run such a system, even if they paid doctors the same as school principals or nurse practitioners. Doctors who pay for their own offices offer government the best deal in healthcare. And government knows it. They do not want doctors on salary, but many doctors would jump at the opportunity.

          In the end, we need to focus on patient benefit. What approach offers the best service? How can we get patients the best care possible? RNs cost more than RPNs. Pharmacists cost more than pharmacy techs. Doctors cost more than physician assistants. Nurse practitioner led clinics cost more than privately owned doctors’ offices.

          Thanks for writing. If we all focus on facts instead of impressions and myths, I think we could start to build a system worthy of the patients we serve.

          Best regards,

          Shawn

          PS Please share your real name and location/type of work, if you want me to post future comments. Thanks again!

  9. WOW Shawn,
    The truth speaks volumes…small wonder you resigned!
    Only wish we, as nurses could speak up with support from our colleagues.
    This is a great piece on behalf of your medical colleagues and I hope they will support you.
    Jean

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