Healthcare Mismanagement – Ontario

wynne and hoskinsNo one writes articles criticizing close friends. Who publishes critiques about office associates? We share some responsibility for the behaviour of those around us. For these reasons and many more, the Ontario Medical Association almost never prints meaty criticism about healthcare mismanagement.

But times have changed.

The Wynne Liberals slander and lie about doctors. Notable doctor-bashing bureaucrats now hold prominent positions of power and lash out with impunity. The OMA-MOH relationship is in tatters.  Even talk about engagement, a nauseating pretence for partnership, has disappeared.

OMA as Health Critic

Doctors have a rare opportunity to speak frankly about waste and mismanagement. Physicians work around it every day. We apologize for it continually. Most of the time, we own some of the system’s performance. Not anymore.

Doctors of Ontario need to speak up, soon. In a few months, politicians will realize they risk even bigger mistakes in completely ignoring doctors. By then, doctors will be back into some sort of working agreement, and we’ll have lost our chance.

Healthcare Mismanagement

We need to educate voters on the rot inside healthcare. We should share examples. We don’t have to expose our own hospitals. But at least we can talk about global problems.

Let’s avoid asking for more beds, more MRIs, more drugs, etc. Asking for more just empowers government to take more control.  We need to show how centralized control created mismanagement in the first place.

For example:

  • The ministry of health got public hospitals to spend millions on their own information technology systems but never cared if hospital IT communicated with any other system. This leaves patient records fragmented and in many cases almost useless. Any real business knows its first priority must be to communicate with its business partners, like other hospitals and providers. But hospitals don’t need to worry about pleasing partners like a real business.
  • Diagnostic imaging results are not available for many days. Scans get reviewed within hours. But results often drag along days to weeks later with many still arriving by fax.
  • Archiving systems for digital images (PACS) are not shared and available to all hospitals in the province only small groups of select hospitals.
  • Family doctors make referrals only to find out weeks later that that particular specialist cannot accept any more referrals for months. Other provinces track referrals to consultants so that patients and primary care providers can follow referrals along in the process. Providers know which specialists are accepting new referrals.
  • Specialty services have long wait lists or are unavailable in many communities. For example pediatric psychiatry, neurology, and neurosurgery are notoriously difficult to consult.
  • Government massively increased the number of physicians 15 years ago. Now the government refuses to provide an opportunity for trained specialists to work despite long wait lists of patients needing care.

These are just a few examples of healthcare mismanagement that government could have prevented or could fix now.

Politicians dread talking about healthcare. They know it’s impossible to control a complex system from the top down. But they insist on trying anyways. Politicians want nothing more than to keep media distracted, even scandals are better than having to show their ineptitude at healthcare mismanagement.

Government cannot run healthcare all alone. It needs help. It needs doctors intimately involved with managing the system in the best interest of patients. I hope doctors take the opportunity to speak up. Please feel free to share more examples in the comments!

 photo credit: thestar.com

Access to Health Care | CBC National

For different resolution, try this link: Angelina Jolie’s Cancer Surgery | Access to Health Care | Sunday Panel – The National – CBC Player.

Highlights:

  • How dare Angelina Jolie have access to better care than everyone else.
  • Private healthcare is like closing 1 lane of a highway.
  • Private healthcare is like adding 1 lane to a highway.
  • Every country in the world allows people to purchase care, to treat their own bodies as they see fit (except Canada and N. Korea. Cuba changed recently).
  • Everyone gets decent care in Canada. Stop whining!
  • People suffer on wait lists. Some are paralyzed for life.
  • We need a government sponsored, universal system as a base.

Let me know what I missed. I found it rare to have the CBC allow Medicare doubters any airtime. Is the CBC sensing the inevitable?

I’d love to hear what you think!

Ontario Medical Union

Diving-boardUnions formed to fight bosses who demanded more work for less pay in unsafe conditions. Majority support allowed ruthless employers to dictate wages without negotiation. Labourers built unions to force entitled elites to listen, to back down.

Premier Wynne and Minister Hoskins swagger through parliament. They attack new physician graduates with impunity and slander established doctors without shame. Then they lie about it (see We Expect Honesty from Our Government). Many physicians cry out for a union to fight back.

Union versus Association

Unions bargain collectively. Union bosses fight every instance of oppression. But they also shield low performers, promote incompetence in the name of seniority and willingly kill their young to get higher wages for senior dues-payers. Unionists lust after bigger membership lists, more dues, more power.

Associations work to promote an industry and ideals supported by trade professionals. Associations acknowledge excellence and kick out members who underperform. Individual workers get help only if their case shows potential to harm other members; unique cases get ignored. Unions and associations usually share features; they overlap.

Ontario Medical Union

The government legislates all physicians to be dues paying members of the Ontario Medical Association. The Rand formula makes collective bargaining doable. Even libertarians have no appetite for negotiating separately with over 60 physician specialty groups.

Forced dues and collective bargaining feel like unionism. But government carries the clubs and demands collectivism.

Design

The OMA acts like a union in collective bargaining but was never designed to fight for individual physician rights. There’s no dispute resolution when collective bargaining fails, and no work grievance process. The government can cut as much as voters will allow during ‘negotiations’. And it can treat individual doctors however it likes in between. There are no union bosses around to help.

Over time, the OMA has increased representation for individual physicians and beefed up its legal department. It offers contract review and advice for individual compensation issues. However, it does not show up for every grievance in the way a union boss does for his members.

Even without a 25-30% cut to net income, MDs fume that politicians can mistreat doctors with no legal reprisal. It enrages doctors and fuels cries for unionism. But the current OMA does not have the legislative authority, constitutional structure or mandate to behave like a union. This frustrates physicians even more.

Medical Union = Demise of Medicare

A union of 27,000 physicians would crush Medicare. The Ontario physician services agreement is the largest labor contract in North America. If MDs were fully unionized with dispute resolution and job action, the economy could not produce enough taxes to support such a beast.

The only reason Medicare hobbles along is because politicians can deal unfairly with physicians when times get tough. They make unilateral cuts or massively curb access, like they did all through the 1990s and from 2012 – present.

Patients and physicians face uncertain and troubling times in Ontario. But crisis creates opportunity. Let’s hope physicians and patients get a meaningful voice in the change that follows. When money runs out, governments tend to increase control. Politicians could decide to become even more regressive – more totalitarian – in their management of nationalised industry.

Our toes grip the end of the healthcare diving board this spring. A splash will follow. Let’s hope it’s not a flop.

photo credit: theguardian.com