Before armies figured out how to kill each other with explosives, they built castles.
A tiny army could lean from the tops of their stone fortress and taunt their enemy. Powerful armies stood helpless before much weaker forces.
Castles led to standoffs, and standoffs turned into siege warfare [historical paraphrase]. Armies found it more efficient to starve an enemy through siege than to attack a fortress head on.
Terms of surrender rejected by those inside the castle, at the start of a siege, might look very attractive after months of uncertainty. Resolve often ran out long before rations.
Strong positions held at the beginning of a siege become idealistic wishes at the end. Desperate people accept almost any terms of surrender.
Doctors Under Siege
Doctors in Ontario have been under siege by the government of Ontario since 2012.
Between 2012 and 2014, a momentary truce saw doctors agree to future cuts in return for reversal of some of the unilateral cuts Minister Deb Matthews hurled in 2012.
Doctors purchased peace by accepting the 5% (FIVE percent) cut from unilateral action, plus a negotiated 0.5% (zero point five %) annual cut going forward.
The government attacked again in 2015. After a full year of “negotiations” where the government just kept repeating “no more money”, the government launched unilateral action for the second time in 2 years.
It cut 2.65% (retroactively applied to 2014 fees). And government also cut 2.65% to 2015 and 2016 fees. These cuts added on top of the 0.5% fealty that started in 2012 and has not stopped.
Unbelievably, in October 2015, the government lobbed yet another attack by clawing back 1.3%.
This final claw back birthed a spontaneous activist group of 11,000 members on Facebook, the Concerned Ontario Doctors.
They have a massive rally planned, with patients and allied supporters, at Queen’s Park this Saturday (see poster below):
Will Doctors Surrender?
The siege leaves physicians with a 30% cut to net earnings, by 2017 (cuts + inflation + overhead increase).
Many doctors are desperate. They cannot run businesses with so much uncertainty. They cannot buy equipment, renovate offices, or hire staff without knowing whether the government will loot more of their fees.
Doctors have plenty of rations for a prolonged fight with government. But a siege uses psychology to attack resolve.
Desperation drowns idealism. Many physicians face tough questions from bankers. Loans risk recall, especially for those early in practice.
After 5 years of destroyed relationship with government, and the second full year of all-out siege warfare, doctors are tired. They want to get on with their lives.
Government knows this.
Eventually, the government will offer terms of surrender. Don’t be surprised if doctors cheer and jump at any offer, just to get out of the siege.
If it happens like the battles in the 1990s, doctors will accept the current evisceration of the physician services budget as a trade for peace and certainty.
It will leave doctors with another 15 years to climb back up to where they were in 2012, when fees had finally caught up to inflation from the 1970s.
Hopefully, the 1990s taught doctors to not accept peace for its own sake. Rebuilding medical services must start as soon as talks re-open, not 10 years later, like it did in the early 2000s with primary care reform.
With the aging tsunami closing in, doctors need to hang on to their idealism and not sell out for peace. How much will doctors surrender to end the siege?
Each compromise with government has just prolonged the war and agonies. The Oma should have taken the stand in 2012. Now the grassroots have to stand firm.
My mouth remains agape from what happened in 2012.
I remain aghast at what transpired and believe that the course of action the OMA set us on in 2012 will have repercussions for decades. It amazes me that the lawyers/economists/negotiators/OMA Board could not reasonably predict what was going to happen. Fellow physicians were led like sheeple by the OMA right off a cliff in exchange for a ‘side’ representation rights agreement (that was 8.5 years longer than the contract itself) that turned out to be a house of cards. What good is representation rights if (1) you’re going to agree to cuts and (2) you’re the only one at the table.
I will NEVER forget how the OMA promoted and sold the 2012 deal. I will never forget how the OMA crowed about ‘highest voter turnout ever’ and the 81% approval.
I will never forget the roadshow selling the deal where I asked “What kind of representative association recommends that it’s member accept cuts?” I was told that the government was in a bind and it was felt that we had to do ‘our part’. I said “Once we vote that cuts are OK, they will never stop”. Negotiations 101 says to never sympathize with your opponent’s position.
I asked “What happens when the government takes advantage of the right to impose their terms WHEN the dispute resolution mechanisms fail?” The exact response I got was “Quite frankly, we don’t believe that’s going to happen. Next questioner please” My parting shot as I left the microphone was “Talk to me in three years”. The OMA table of lawyers/economists/negotiators and reps were rolling their eyes and laughing at me. Well how’s that working out for you now?
The betrayal of the profession in 2012 when what was going to happen next was obvious is something that I will never forget and never forgive. The damage done was unbelievable and may be irreparable without the collapse of the system.
My lease ends in 4.5 months. At age 46, I am “this close” to walking away from this profession…
I hear your well deserved fury at the OMA for setting the stage in 2012 for what happened to physicians and patients in 2015… and maybe beyond.
I cannot blame the OMA. You and I are the OMA; it is our family name.
The OMA is only as smart, thoughtful, and effective as those of us who spend the time to get involved. If anything, I feel frustrated. Frustrated that we trusted the government to play fair and be reasonable. We all thought that offering a 0.5% cut for 2012 and 2013 would gain us favour going into the next ‘negotiations’ in 2014.
I write to encourage doctors to stay engaged, keep talking about this, and to not lose hope. We need stay unified in our fight.
Thanks again for writing!
Shawn
Oma should have taken a stand in 2012. Now the grassroots have to do the dirty work and stand firm.
I hear you, Gerry.
2012 was a very tough decision. We thought we were being reasonable by ‘doing our part’ to help in a struggling economy. Every negotiation requires compromises. When do we compromise too much?
I sure appreciate you taking time to comment!
Shawn
2012 was the equivalent of handing a lit bomb to the profession and then it explodes while it is in the OMA’s hands. The profession and OMA are both badly damaged/killed because of it.
I really wonder what the membership opinion of the OMA is given what has happened and how hard the OMA sold the ‘deal’.
I am stunned that the OMA Board recommendation was unanimous. Did no one really see what was going to happen? I know what I would personally do if I was on the OMA Board and had voted for and recommended a deal that blew up in everyone’s face. I would step down…that is what I would do…
Thanks for sharing your thoughts so clearly, Paul. I respect you for saying what you think.
As you know, I serve on the board. I was part of the discussion in 2012. It was new territory for all of us. Our decision seemed to be the right one at the time. It seemed to be the best of the other options. We had just got a 4.88% raise in Sept 2011. It seemed reasonable, given the dire state of provincial debt, to take a 0.5% cut per year for a short agreement.
Hindsight makes us more confident, more strident in our opinions. Given all that has happened since 2012, if we could go back in time, we would fight to the death to prevent all this. But we assumed this government would be reasonable. They were not. They are completely unreasonable and acted illegally, as is argued in the Charter Challenge. The events of the last 4 years are new territory for Medicare. Liberals campaign on building healthcare, not cutting it.
As for your call for resignation, I seriously considered that in early 2015. I believe many of us did. All the doctors I spoke to asked me to continue to serve. I stood for re-election in the fall of 2015. If everyone felt the way you do, they could have voted me out.
Government is the problem, not primarily the OMA. Without a massive change in governance at the OMA, we will continue to have an elected board of our peers. Perhaps an appointed board would perform better? Appointed board resign. Elected boards get thrown own at election.
As always, I really appreciate your thoughts, your passion. I look forward to seeing you at council. I’d love to see you get more involved in the OMA to help with all the work that needs to be done.
Highest regards,
Shawn
Shawn,
I did not call for anyone’s resignation…I simply said that this is what I would have done had I voted yes. However, if I was on the OMA Board in 2012, I would have been the lone NO vote…trust me, I would have.
As the months and YEARS pass since the unilateral imposition there must now be a deeper understanding of the mess that physicians are in.
Yet, I see and listen to these ads put out by the OMA and they continue to be vague, tepid and uninspiring. There is minimal or muted/ineffectual response to continued volleys from the MOH. Are we just too good to go down into the trenches and fight? It is hard to imagine wars in history that were won from the castle tower. Yet this is where it seems the OMA wants to fight from. Do we have any concrete evidence that the plan put forth by Navigator is working? The government seems unconcerned regarding what the OMA is doing…
You may or may not know…I was with the SGFP Exec from 2004-2010. I left because I saw a self serving corporation that could not see the forest for the trees. I saw a complacent burgeoning bureaucracy that was ineffective and lacked vision. Too many people happy to have conversations about their own stories while not looking after the best interests of the entire profession. We are too smug and think that we are too smart…that is used against us time and again.
So…I do blame the OMA. I was on the inside and was horrified by what I saw. That is why what has happened is not the least bit surprising…
The OMA major errors were not the 0.5% cut. The major errors were:
1. Accepting the government’s going into the fee schedule and lowering individual fees. The OMA should have made it its business to know the effects of the cuts on services within the hardest hit specialities.
The OMA allowed the government to continue with its divide and conquer strategy that has allowed it to be in a position of power in any disagreement with the doctors of Ontario.
The OMA may have quietly agreed with the cuts to individual sections as it fit with their longstanding love affair with fee for income. The quest for fee for equal income has been a major reason all the sections of Ontario physicians having seen their earning power eroded so badly over the past 30 years.
2. The major cause of the current disaster is the OMA’s pushing the 2012 agreement in which the government entrenched the OMA as the legal bargaining agent for Ontario doctors, ostensibly for NON-binding arbitration. As my lawyer friend told me, “Only an idiot lawyer would allow a client to agree to non-binding arbitration.”
The non-binding arbitration is the crux of the current disastrous cuts to physician incomes and because of this, a further decrease in the availability of physician care for patients.
I believe much of the blame falls upon the bureaucracy who work at the OMA. Just as in parliaments, it is the unelected administration and bureaucracy who feed and control the information that our elected officials use to make their decisions.
The 2012 agreement helped protect the security of the OMA bureaucracy and saved the government who had been in violation of the Canada Health Act after imposing their cuts without a negotiated agreement. All this was at the expense of hardworking frontline physicians and the quality of patient care in Ontario.
If the OMA fails again in its fiduciary duty to the physicians of Ontario, then the many doctors already calling for the formation of other associations or a union to take over bargaining will gather even more support.
If you can tolerate more from me, some of you may find my 2013 blog about the 2012 agreement interesting in hindsight. The comments after the blog piece are especially interesting,m. They include Paul Conte’s April, 2015 comment three years later. http://healthydebate.ca/opinions/is-the-oma-an-appropriate-vehicle-for-negotiating-doctors-fees
Thanks again for sharing this Gerry!
I will quibble with one point. The board must be held responsible for OMA performance. That means ME. I am responsible. That’s what makes this job so painful…when we get bad outcomes, I cannot help asking whether I could have done something else. We cannot blame those who work for the OMA. The CEO, and the staff, delivers what the board ask for. It takes a strong board with a clear vision to shape strategy and keep the organization aligned with the strategy.
Again, thanks for taking time to share!!
Highest regards,
Shawn
Thanks for this, Paul. I thought you suggested we all resign…my mistake!!
When you mentioned the SGFP, it reminded me of you having said that before…again, sorry for forgetting that important service!!
Given that you have a unique and experienced view from inside the organization, what do you suggest that we can do to make things better? And even with an ‘ideal’ organization, could it withstand a tyrannical government?
I really like your comment: “We are too smug and think that we are too smart…” Well said!
Regarding the ad campaign, Dr. Walley posted a long comment on COD 1 hour ago about the evidence-based approach Navigator uses. She describes it better than I could.
Looking forward to hear your suggestions for an alternative…
Thanks again for taking time to write, engage, and share your passion on this. If only all of us had the same passion….
Highest regards,
Shawn
Physicians have definitely been beaten up in recent years. The likelihood of seeing any increase to compensation before the next election is very slim. Your largest expense is income tax and if physicians are to survive they should be looking to trim as much of that expense as possible. There are a couple little known strategies that can go a long way in reducing the taxes payable especially for those professionals who have accumulated earnings in their corporation
Physicians should be talking to their advisors getting some guidance. (if they offer you an investment with a tax sheltered number on it find a new advisor.)
Thanks Vernon!