Morneau’s proposed tax changes negatively impact patients

Minister Morneau the Millionaire

I was excited. The Globe and Mail had agreed to publish my op ed. It would ‘go live’ at 10 am.

I checked my phone every 15 seconds.

What did they edit?

What did they cut?

Did it still make sense?

At 10:01, my heart sank.

The editors had added one lethal sentence. Their edit left the reader thinking about doctors’ incomes instead of patient care.  Precisely what the government wanted, and exactly what I wanted to avoid.

The whole point was to show how Morneau’s tax would hurt patients.

I asked them to remove their sentence. They refused.

Here’s the full piece, with their sentence in italics. Let me know what you think: Did their edit ruin the message?

 

OPINION

Morneau’s proposed tax changes attack doctors – and negatively impact patients

SHAWN WHATLEY

CONTRIBUTED TO THE GLOBE AND MAIL

SEPTEMBER 15, 2017

Dr. Shawn Whatley is the president of the Ontario Medical Association.

Finance Minister Bill Morneau wants people to think that his new taxes will only mean a little less champagne for small-business owners; no one else will notice any difference. But Mr. Morneau’s tax proposal will decrease access to medical care and make Canada an undesirable place to practice.

Government cannot attack doctors without harming patient care. Patients will first notice the change in doctors’ offices. The tax that Mr. Morneau plans to grab from doctors would otherwise stay as retained capital in medical corporations. Doctors use retained capital to upgrade offices, purchase equipment and hire staff. If the capital goes to taxes, patients will be seen in older clinical facilities, have less access to medical technology and have fewer staff caring for them.

When doctors cut spending on clinics, the community feels the impact, too. My rural clinic supports the tiny pharmacy in town. Without it, seniors would have to take a 2 1/2-hour round trip bus ride into a larger town to get their medications.

When doctors cannot buy technology – such as ECG machines – patients have to bear the cost of travelling to a lab or hospital for simple tests. Hospitals or public labs have to fund the staff and equipment that doctors would have otherwise funded, in their own clinics. Government-run clinics cost more than private offices. So, patients will have less access and the access that remains will cost the system more overall.

The second impact of Mr. Morneau’s taxes on medical care will take longer for patients to feel but causes more damage. In Ontario, the 1990s provide a 10-year test case about what happens to patient care when governments attack doctors. The Ontario government made deep cuts to medical funding and human resources, as politicians pursued their “social contract” agenda. Lower-paid doctors, such as those in family practice, struggled to pay office overhead. Medical students avoided training in family practice and residency spots went unfilled.

Family doctors chose focused practices in emergency medicine, sports medicine or as hospitalists. New doctors avoided the risk of starting a private practice. Doctors scrambled for salaried positions in community health centres, workers’ compensation or with the coroner’s office. Some doctors took extra training in non-medicare work, such as cosmetics and spa medicine.

Tax hikes and fee cuts have similar effects: They encourage doctors to adjust the care they provide. Years ago, I lamented about fee cuts to an older orthopedic surgeon. He shrugged and said, “I’ve got long wait lists for worker’s compensation and military work. I will just spend more time there. OHIP patients will have to wait longer.”

The 1990s left 1.2 million patients without a family doctor. Communities mounted massive recruitment campaigns. A former municipal politician from Belleville, Ont., said recently, “We were able to sign 15 docs. We paid them a bundle. I felt sorry for the smaller communities. There was no way they could compete.”

Orphaned patients ended up in emergency departments and walk-in clinics. Diagnosing diabetes in the emergency department became commonplace. Our hospital set up diabetes clinics because orphaned patients had no family practice to see for follow-up. The same happened for patients with dangerously high blood pressure, low functioning thyroid glands, angina and other conditions.

Finally, Mr. Morneau’s tax hike will force doctors to change career plans. Attacking doctors doesn’t make them work harder. We should encourage doctors to jump out of bed to see more sick patients in the middle of the night. Mr. Morneau’s plan will make some doctors retire or semi-retire. They will slow down and spend time with family. They will retrain, downsize their homes or find a paying hobby.

Paying 53 per cent of every dollar earned to government does not make sense. [Editor inserted the following in brackets, italics added] (Under the new proposal, Ontario residents earning more than $220,000 would be subject to income tax at a rate of 53 per cent.) As a last resort, doctors will move away. Although brain drain is the first thing people fear when governments attack doctors, it takes years to see the impact.

One writer suggested that doctors might work harder, to maintain their income. This should make patients worry. If doctors have to work harder because of tax hikes and fee cuts, it’s not the kind of work patients want.

Patients need doctors at the top of their game. More than 50 per cent of doctors are already burned out. We don’t need doctors who work more than they should or neglect self-care and work-life balance. No one wants to see a tired, burned out, disgruntled doctor, who may have been forced out of retirement because they cannot survive on the retirement plan they built for 20 years. Changing the rules for doctors at mid to late career is bad for doctors and patients.

Mr. Morneau’s tax changes will have a drastic impact on patient care. Doctors will change how they run their offices, adjust the kinds of care they offer and alter career paths. These changes will impact local communities and businesses that rely on medical clinics. But most importantly, Mr. Morneau’s tax proposals will negatively impact access to medical care. It will make Canada an undesirable place to practise medicine. Let’s hope Mr. Morneau changes his mind before he does something we will all regret.

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42 Replies to “Morneau’s proposed tax changes negatively impact patients”

  1. Shawn,

    Regardless of the edit, you produced a great article. Sure, people will argue, “that is the same tax rate as any other salaried person!” However, that is certainly not a new argument for the Morneau supporters.

    I came away with your argument that services will decrease as a result removing this tax incentive.

    The editor note did not disrupt your article.

    In fact, it appeared to say the preferred tax incentive is what drives better care such as reinvestment of that money back to the economy and patient care, with office equipment and staff.

    As Churchill said, “I contend that for a nation to try to tax itself into prosperity is like a man standing in a bucket and trying to lift himself up by the handle.”

    –D.L.

  2. Shawn,

    Thank you for writing this. It is clear and compelling.

    I would even go beyond stating that these negative effects “will happen”. In fact, I have first-hand knowledge that they ARE HAPPENING ALREADY.

    I’m a Southern Ontario emerg doc and I have MANY MD colleagues who are now actively seeking income sources other than the standard Ministry-of-Health ones (I’m one of them).

    Even more alarming is that several other MD colleagues of mine have actually taken the steps to set up job interviews south of the border. (And after how we’ve been treated by the government over the past several years, I’m finding it pretty hard to blame them.)

    To be clear, both of these consequences come as a direct result of these proposed tax changes. And both will result in less doctors available to treat our fellow Canadian loved ones at the worst times of their lives.

    All of us are going to suffer as a result.

    The message that I want to send to Mr. Morneau, Mr. Trudeau, and all others who support these tax changes is that IT DOESN’T MATTER ONE BIT WHY they are doing this – the consequences of these tax changes will be the same regardless of how they are justified.

    And, with these proposed tax changes, the consequences that I’m already seeing are unacceptable.

    1. Great points, Crispen. I’ve seen the same moves already, too. People are blind if they don’t think this will happen again.

      Thanks for commenting!

    2. I’m a few steps away from acquiring an American practice license.

      It’s not the tax-rate that bothers me, it’s the rhetoric that is being used to paint all small business owners including doctors as tax cheats. Meanwhile Morneau has most of his money in offshore accounts and has backpedaled on planned stock option tax hikes for 0.1%er corporate CEOs with whom he is on a first name basis. The hypocrisy is almost parodic.

      I am concerned that things will get worse for doctors in Canada before they get better. Mobility is our biggest strength.

      1. Thank you, Secret Doctor, for commenting!

        I have heard from a number of docs who say the same thing. They are mobilized to find different streams of income, even if that means moving outside Canada. No doubt, businesses are doing the same. We cannot blame people for fleeing so much uncertainty.

        I wish you the best in your endeavours! Please share an update as things progress. Perhaps you could write a guest blog from your new job, when you get settled.

        Thanks again,

  3. Aahh….Welcome to the world of “The Grope and Fail”, Canada’s national newspaper.

    Haven’t read it in years.

  4. A good piece Shawn. I do not think the additional line changed the message. Government policy adheres to the rule that every action spans unintended consequences and you have reminded us of this.

  5. Unfortunately, I would have liked to riposte their editorial line with one of my own. I would love to make $220 k instead I make half of that.

    1. Exactly!

      The whole point of changes to medical practice focusses on those at the lower margins of income distribution. To throw in $220 paints a different scenario, I thought. Having said that, many people seem to think it was fine.

      Thanks for commenting!

  6. It is a very clear explanation of how patients will be impacted. When I read the article I didn’t even make note of the edit. It had zero impact on me. It did not detract one iota from your point. Don’t give that edit another thought, Shawn

    Thanks for the best explanation so far of how patient care will be affected.

  7. I am sorry Shawn. Do you really think that the average , socially correct, Liberal reader of the ‘Glib and Frail’ reads with the same analytic intensity and desire for the truth that you do, in the ‘not-that-busy’ Emergency Department at 3 o’clock in the morning, seeking the real implications of another physician’s note in the EMR? Half of them will not even notice it, and the other half have something more like $400,000 fixed in their tiny brains anyway. The OMA is so lucky that you have ‘great hair’ anyway.

    1. I can see the huge smile on your face as you wrote that comment, Roger!

      Thanks so much for taking time to share!

      Cheers

  8. Hi Dr. Watley,
    Great article. Congratulations.
    I’m confused as to why the OMA is allowing the government to slander physicians, turning people against people? Why is the OMA not arguing that the government should be focusing on Bay Street and CEOs who have an 840million stock option tax break every year. The tax haven loophole has not been spoken about and it is estimated to cost billions every year. They said that they would put a 100 000 cap on the stock option loophole in their platform. Why is the government saying that they are in consultation yet saying that they are not changing their minds? This show of disrespect and arrogance from people of such privilege is enraging hardworking physicians. They listened to a few letters from CEO friends yet are not listening to us. Why is the OMA allowing this message to convince the public? The OMA needs to aggressively fight for our reputations and FAIR tax change for the 0.1 percent as well as everyone else. The message needs to be that they are actually targeting the upper middle class and the middle class but leaving the upper class alone. People do not know this. The message needs to begin with the OMA. Why are we being polite and subservient to a government who treats us with no respect? What are we gaining? It seems that certain very rich people with large companies are the winners in this ridiculous game. They must be laughing at us, trying to argue logic when it’s not about logic it’s about preserving the wealth of a very few Canadians. We are being played and the change in your column is proof.
    An NDP MP named Richard Cummings from BC summed it up in an article today. Please read and share on social media.

    1. Solid comments, Mad Doc.

      The first weeks of our response focussed on raising awareness and forming a coalition. Doctors only represent 12% of incorporated businesses. We need to keep farmers, landscapers and shop keepers at the front. Having said that, we also need to plan for next steps. How best to push back if this approach does not work? So far, there has been an overwhelming media response and grassroots outcry over these proposals…far bigger than I ever could have imagined.

      Thanks so much for sharing your thoughts. I agree. We need to prepare to get more aggressive if government refuses to listen.

      Cheers

      1. I am sickened by the thought of farmers being too busy harvesting their crops to be able to launch any sort of response, so I’m happy that we can help them in anyway. It is very insensitive for the government to have given a 75 day consulting period during Canadian harvest (although both Morneau and Trudeau say that they will not change their minds so the consulting is likely for show like everything they seem to do). The last major tax overhaul gave citizens the respect of a Royal Commission. Is the OMA asking for or suggesting this? A Royal Commission studying all taxation issues and their economic ramifications would show respect to everyone as well as guaranteeing that no unwanted negative economic or societal consequences occur.

        1. Me too, Mad Doc.

          Farmers will face a massive tax hit if they pass their farms on to their children. Farmers will be better off selling to a stranger under Morneau’s new taxes.

          The Carter Commission started in 1962. Tax law changed in 1972, the last change of the magnitude facing us now. In 1972, government started taxing capital gains and investment income.

          I addressed this personally with Morneau. He said that things are different today. If they take years to consider things, voters will have time to rearrange their affairs(!). [Seriously, he actually said that.]

          This tax grab comes from a desperate government. It’s a sign of how bad things are in federal finance.

          1. “If they take years to consider things, voters will have time to rearrange their affairs(!). [Seriously, he actually said that.]”

            Aarrgh!!!

          2. Wow, wouldn’t want people who pay the government salaries and trips for the PM to be able to organize their finances.
            I realized today when I read a story by a global news reporter that the government is clearly directing the story. She outlined all the loopholes but missed the 3 biggest tax havens, stock options, and entertainment/meal allowance. The public reads this and believes that the problems with the tax system are only what the reporter outlined. She wrote about income sprinkling, capital gains, and passive income. I think that she was given this info or alternatively, she is unable to use google. We need to direct the message and educate the public. We are dealing with a sophisticated well oiled machine.

          3. Also,
            Why is Ottawa bailing out the failing Bombardier? It is a family business still and its executives gave themselves huge pay raises despite a failing business. The bailout is large enough to cover four years of so-called tax loopholes for small businesses. Doesn’t Morneau have time to give the small businesses a few years to sort themselves out and to plan for the future? I guess the Liberal government only cares about Big Business and Bay Street and not small business. We need to talk about this. The only winners in this game are big businesses, still, no stock option loophole change or tax haven change and no one is writing about this.

            1. I am for a flat tax or a few tiers at much lower rates. Get rid of most deductions and subsidies. No sports tax credit. No charity deduction. Tax churches, synagogues, mosques etc. Why do I say this? Because I don’t think another taxpayer should have to support the charity or synagogue of MY choice. Just lower the tax rate for everyone.

              Also, no subsidies for business: nada. No subsidies for Bombardier, GM, Amazon, Green Industries or any other company. If a business can’t make it on its own then it must fail on its own. If Bombardier is subsidized to save its employees’ jobs then the folks working three jobs to pay for their own mortgage and kids are subsidizing the jobs of the Bombardier workers.

              When GM was bailed out, it did not save any autoworker jobs but it did save the jobs of those who already worked at GM. Had GM gone bust and stopped building cars then Ford, Chrysler, Toyota etc would have built those cars and hired people to work in their factories. Maybe the jobs would have paid less but the same number of cars would have been built and the same number of jobs would have existed. Again, there are lots of poor slobs working their guts out without a pension or drug plan paying to keep others with better jobs than their own.

  9. I would assume that most of the business owners hurt by the proposed changes did not vote for the party in power and won’t next round either. They do make ready scapegoats for why the gov can’t balance the budget and cash cows to fund “Progressive” election promises. The party’s support base will likely think this is benefitting them and will not connect it to why they cannot get a family doctor or timely specialist referral. Thanks for speaking out.

    1. Wise comments, as always, Phil.

      Trudeau uses fantasies of radical material equality with voters inflamed by envy. The fantasy rides on the assumption that abundance is a common good. People assume that the only reason they do not have more is that the “1%” stole it from them. Politicians want us to believe that our material condition has nothing to do with hard work, prudence and thrift. Those values are out of date. Only the government can save us from the evil capitalists who steal what’s rightfully ours. And so the country goes further into debt to pay the price of its populism.

      Thanks for taking time to share a comment!

      1. In my experience, when someone is successful, the general mindset in the US is to congratulate them, while in Canada we think, “Who did they cheat?”

  10. Good article, Shawn, I agree with other comments that the edit did not significantly affect it. This message should be a great template for all our colleagues presenting the subject in media, as unfortunately, some of them often sound confused/not clear.

    Still, I will repeat my point: apparently the Lib’s will go with their plan for political reasons anyway, so we’ll have to plan a step ahead & think what we can do to ensure the opposition’s win at the next elections & then the legislation will be reversed. With this in mind, the worse = the better, so let them pay more millions to terrorists, give out billions to foreign nations & enjoy their endless vacations..

    During the last Ontario elections, the Unions officially advertised, INVESTED & pressured their members to vote against the Conservatives, justifying it by “anti-labor/union” politics of the party.
    Now can we use the same strategy & turn our offices/waiting rooms into the anti-Liberals/pro-opposition agitation for-posts, using the same argument that the current governments, provincial & federal, are ANTI-MEDICAL ones?
    It would be great to get some lead from OMA to orchestrate the resistance, and the current BA-talks should not prevent us from this type of actions – ?

    1. Thanks Alexey!

      We are fighting back with everything we have. A strong coalition thinks that this is a really bad idea. More to come….

  11. Thank you for writing Shawn. It is a great article and the edit did not change the message for the reader. Your writing and that of a few other physician voices make me optimistic about the potential that change may be for the better, for us as physicians, for our patients, and for Canada.

    I wanted to comment on a ‘big picture’ issue regarding this CCPC taxation issue – and a revelation that I had today as to what potentially is behind all of this.

    I think the main political risk to the fed libs is the runaway deficits and that the public begins to see the ‘tax and spend/budget will balance itself’ rhetoric as a genuine concern to their future – particularly as the economy heads into a recession soon to be initiated by the housing bubble correction. Knowing that the federal budget is at about a $30B deficit this year – and with no indication that this is changing over the next few years towards the next election – it is difficult to see how the estimated $250mil the CCPC tax issue is to raise has anything to do with finances. This is clearly political.

    The question is why they are doing this and the potential answers are:

    1) The fed libs (caveat: the decision makers of the fed libs) believe this is the right thing to do – anyone think this is the case? – moving on…

    2) The fed libs believe that the attack on the ‘1%ers’, ‘those in the middle class and those working hard to join it’ etc. shtick will lose some voting support from a ‘vocal angry group’ but win overall at the polls. Current polls show that about 55% do support the approach. I am not sure this is it however – as they are already seeing substantial risk to this strategy. Many of the 55% are not that informed – but they will be more informed over the next few months as the house returns to session. The advocacy that the OMA, small business coalition etc are doing (and hopefully a good PR campaign from the fed conservatives) could change the popular support for them and this issue. Main point being #2 reason is too high a risk for them for the minimal ($250 mil gain).

    3) There is a bigger strategy at play with a timeline over the next 2 years towards the next federal election. I started to have this thought when I asked our local MP (Karina Gould) about why they were doing this for a minimal $ gain and a potential significant political risk when she had a local town hall on CCPCs a few weeks ago. I asked her if there was a bigger strategy discussed in Kelowna and that behind closed doors MPs must know what the bigger strategy is. She was silent of course but it was almost as though she was agreeing with my suspicion. And then – today – Globe and Mail – ‘If proposed tax rules are about fairness, federal servants should be next’ – Frederick Vettese. Main point being that change of Public Service Pension Plan (PSPP) from defined-benefit to target-benefit is a revenue generator of $2.5B/year. This is just for the PSPP – add in other public service pensions and the balance sheet impact is significant. Smoking gun – wait for it – look at the author – chief actuary at Morneau Shepell. I think bigger strategy is accept the political loss with CCPC – move on to PSPP (and others) towards the next election as a strategy. This would be a populist strategy for certain (as > 80% voters do not have public pensions) – and I have to think that some of Gerald Butts convs with his right wing populist/divisive strategist equivalent Steve Bannon have generated this idea. I think the CCPC ‘attack the rich’ is step 1 – softening up the electorate for step 2. Morneau et al know where the money is.

    If you know anyone with public service pensions who is silent or smug about what is going on with CCPC I would suggest that they watch their back – as they may be coming for them next.

    Our fed lib government have the arrogance to think that this strategy is going to work for them. What they are overlooking is that right now they are creating dissension in a group of hardworking, high-achieving, respected people (farmers, small business owners, professionals) who have in the past been fairly apathetic politically. Personally, I have never been to a political town hall (until recently), never put a pol lawn sign on my lawn in the past. Now however given my concern not just for what the impact of this CCPC will be on us/me – but to Canada – I will spend hundreds of hours knocking on doors, being vocal at town pol meetings towards the next election. I know that many are like me.

    I am optimistic that great good will come from these struggles we have been involved in (provincial negotiations, CCPC tax).

    I think those in government are underestimating the influence we have on the public.

    1. Great comments, Richard. Very wise of you to be thinking of this as part of a larger strategy. Usually, I don’t give government that much credit; it seems they attack whatever’s in front of them. But in this case, you might be right.

      Thanks for sharing!

  12. Dr. Whatley, you are the head of the OMA. I’m not very interested in your article. You write a passionate article. ONE THAT WILL BE SUMMARILY IGNORED. As long as the government knows that YOU, DR. WHATLEY will do NOTHING The fact is that you have performed completely ineffectively in representing doctors. I am an emergency doc in the busiest ER in Canada. I worked 8 or 10 hours straight without one calorie of food, without one instant of break. Yet YOU allow this government to kick sand in our faces day after day. No pension, no health benefits, no vacations, no sick days, no educational allowances for the thousands most of us spend to improve our skills each year; but instead you give us serial pay cuts, removal of what tax benefits there may have been and mandatory payments to any number of organizations with their fingers in our pockets — and the OMA is at the TOP of the list. Get serious about changing things for the doctors you represent. It’s time to get serious about REAL job action — not a bunch of play. We don’t need more silly surveys. We need YOU take ACTION, and NOW. You would have the support – try exercising it — or get out the way and let someone take over who will get results.

    1. Shawn is too self-effacing to come to his own defence so I have taken it on myself to do so.

      Brian, I understand your frustration. It is obvious that you work incredibly long hours and may not have had the time and energy to follow Ontario politics as I have over the last two years . Shawn Whatley just became OMA President in May 2017. He was elected along with a strong grassroots-oriented group of physicians that are now in power at the OMA. I call this group the New OMA. I agree with you about the woeful representation that the Old OMA and other medical organizations have given us over the years. Your complaints, however, should be directed at the Old OMA and not the New OMA that Shawn currently leads.

      Among others, the President, Shawn and President-Elect, Nadia Alam, of the New OMA have been vociferous publicly in advocating for physicians since they took over. As they have more time to settle into their positions I expect them to be even more pugnacious when necessary. Specifically, they have been very active in putting pressure on the Ontario government in getting us binding arbitration, something that we have been trying to put in place for years.

      Many doctors like you have gotten involved in the struggle to save ourselves and the health care system itself. Ask your colleagues that are involved in medical politics through the OMA or otherwise how you can help.

      Shawn and Nadia Alam have both been on the radio and on television again and again, most recently on the tax change issue. They are fierce advocates for physicians. Brian, don’t worry, we are in good hands now.

  13. Shawn, as I brought up with your last column (you didn’t reply, but I don’t know how you have time to even write these articles!), I remain confused as to why the OMA , and yourself, have not brought this public battle to the Wynne government. We are here because of a promised right to incorporate in lieu of some fee increases. Trudeau is not backing down- his deplorable behaviour in parliament recently just reinforces it. So is the OMA going to make the BA a more obvious place to regain our corporate losses? It would seem a beleaguered Wynne would have more pull with the Fed Libs then endless twittering, etc. As we move to the election, Wynne and Hoskins have had a free ride on this issue, one the Ontario government was significant in creating. Brian’s anger above is regularly repeated by my colleagues every day, for a long time now. From an optics point of view, it appears the OMA is just (frankly) doing the usual cosying up to it’s paymasters at Queen’s Park. I would like to be proven wrong…

    1. Ksy11, the bargaining for a new agreement between the OMA and Ontario was supposed to start in September so I assume that it is going on already or will be started soon. As incorporation was given to Ontario physicians in lieu of a raise then the incorporation factor should be brought in those negotiations. I would not be surprised that the government will resist and then it would be up to the OMA to present this issue to the Arbitrator.

      1. The Ontario Liberal negotiators will, likely, have a heads up regarding the fate of professional incorporation and are in a position to completely wrong foot the OMA negotiation team at the table.

        When will the Feds introduce their decision in Ottawa….October?

        Surely we , in Ontario, should delay until the cards are on the table…face up.

        1. Good point, Andris. Our negotiators will need to know the implications of the tax changes before a final agreement is reached.

  14. Gerald,
    The plan can not be to assume an arbitrator will rule in our favor. The plan cannot be to assume doctors will out- negotiate and out -media manipulate professional government teams which managed to still get Liberals elected despite horrible scandals. The only thing Wynnes crew respond to is public opinion and polls. They need to be dragged into the wrestling match they actually started. That will change the BA negotiations big time. Or just more leadership from the middle? More “no tax cuts because we only care for patients and nothing else” garbage. The gloves are off. See Trudeaus speech in Parliament. Best weapon against Trudeau and Wynne? Actually force her into the public ring. With an election looming. That will help both the BA and the tax fight with upwards pressure on Ottawa from TO. But NO mention from the OMA about the fee losses because of ONTARIO tax loopholing. Nothing. Id be happy if someone would convince me another strategy would work and why.

    1. The OMA, through its president, president-elect and others, are pushing back hard in the media. You may not be seeing it but I am. The fact that the tax changes are and will affect patient care is getting out there. The consequences of the tax changes is being exposed in several ways. You may not see it but it is out there.

      With regard to the bargaining, I think that the OMA will be tougher than it has been for decades. My feeling is that the arbitrator will be called upon for at least some of the issues. If things do not turn out as well as you like then pragmatically the options will be; retire, leave, change your practice style, lower your standard of living. That is the reality of where I believe we are now. Let’s hope for the best for doctors and patients as our interests are deeply intertwined.

  15. Gerald, I disagree…it is only people who are active online, like anyone reading this, who are seeing it. The other 99% of Ontario who never check twitter, etc, are getting the usual spin: greedy doctors. There needs to be articles in all the major papers, as those are read online on a much bigger scale. There needs to be regular radio, etc. Wynne has not felt ANY heat about this. Even on social media, 99% has been about Morneau and Trudeau, etc. Wynne will not be scared of an arbitrator; they will just legislate away (or try, anyway) any ruling they dont like. But they are scared of bad publicity near an election, WAY more scared. An OMA completely giving Queens Park a free ride on this critical issue, given its horrible history of partnership, looks like (in the least) bad optics, but the odds are much higher it is much more, i.e. the usual Rand driven pressures. Again, I’d like to be proven wrong. At least send out a message to members that the issue of Queens Park playing a part in lower fees due to incorporation IS being discussed. Give us something! It doesn’t matter who is in charge- the optics to members who have been following the Old OMA for decades are , right now, looking awfully familiar.

    1. There HAVE BEEN many articles over the last year in major and small town newspapers. I have seen them myself. Here is Nadia Alam in the Toronto Star this week: https://www.thestar.com/opinion/commentary/2017/09/20/trudeaus-sinister-stand-against-doctors.html

      When you say,“Wynne has not felt ANY heat about this,.” I am now not sure what you mean by “this”. The provincial government has taken considerable heat about health care in Ontario but not so much since the proposed tax changes hit the news. Nadia has been on the radio several times recently and so has Shawn. At this point their media interactions are with regard to the federal tax changes but up until recently the interactions were directed at provincial health care issues.

      There are many others too but Shawn and Nadia have been dynamos of action that the physicians of Ontario have on their side: I see and hear them in the media several times per week. I don’t see how we can expect any more of them; in fact, I find it much too easy to exercise my ego and narcissism by grabbing the limelight from Shawn and commenting here before he even gets a chance to look at HIS blog, let alone write a response. Sorry, Shawn.

      70% of Canadian physicians are incorporated and although I am not one of them, it appears to me that the tax changes are a much bigger hit for them than any fee cuts have been. That is why attention has turned to the federal government instead of at he provincial government. That is what has happened all over the country and this issue must be dealt with urgently. The situation with Ontario negotiations is backroom dealing for now and until this has had time to proceed there is no urgency for publicity. It makes perfect sense to me that the bulk of OMA public resources right now should be directed at Trudeau and Morneau. There will be a more appropriate time to go after the provincial government as the election draws near.

      With respect to your comment about legislation against a fee agreement:
      1. If the government legislates away a signed agreement, then we must deal with it then.
      2. If the negotiations go to arbitration, then the process is the process and must take its course.
      3. If the government legislates away an arbitrator’s decision, then we must deal with it then.
      4. If the government makes a deal and then legislates the agreement away after the election, then we have to deal with it then.

      I am not an elected official of the OMA but I have personally seen discussions of the impact of the tax changes on Ontario fee negotiations. I have lived through many frustrating and demoralizing times as a physician in Ontario but the current fight with two governments at once must be the worst. It is very draining to go into work with all this floating around in your mind. I feel badly for you and all my colleagues. I see that many have given up are starting to leave and retire. I hope things don’t have to get even worse before they get better.

      If you want to be part of discussions with other doctors, then you should ask your colleagues how you can get involved. I have no official capacity in any organization so I do not want to be giving out contact information. Maybe someone else can make a suggestion here. Otherwise, ask some colleagues.

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