Author: Shawn Whatley

Kids want to stay up late, eat whatever they want, and do homework when they feel like it.

Little bohemians let Mom and Dad pay the bills, repair the car, and keep the house running.

Government wants it both ways, too. Politicians tell doctors how to practice, how many hours to work, and which tests should not be ordered.

Politicians are happy to let doctors pay for medical offices and do everything else to keep clinics running.

Government Wants It Both Ways

If government wants self-motivated, entrepreneurial knowledge workers, who take responsibility for private practices, they cannot control doctors’ professional lives and treat them like employees.

If government wants employees, who follow rules and deliver ‘high quality’ care dictated by government, then politicians cannot expect doctors to assume the cost and responsibility of managing care.

Please Premier Wynne, make up your mind. Do you want employees or professionals?

New Medicine

Centrally controlled healthcare systems often have outstanding prevention and screening. The Soviet system had advanced public health for its time. Soviets solved gender inequality in medicine 40 years ago: 73% of family doctors were women in the 1970s.

Maybe doctors should support the radical, Liberal healthcare reform? Let’s see where it leads.

If politicians want bureaucrats running healthcare, let them have it. Put doctors on salary.

Salaried doctors could see a set number of patients.

Government could fund private clinics and hire the staff.

Government could pay for all the management work doctors now do for free.

Many docs would love to show up at 9, punch a clock, take coffee and lunch breaks, and then punch out again at 5.

Public Employees

After years working with police officers, I grew to envy their lack of freedom and the inherent inefficiency of their jobs.

They were forced to sit for hours waiting for a coroner to show up. They drank coffee after coffee just because a silly rule said they could not leave the emergency department until one detail was signed off.

Did they complain? Sure.

But were they stressed? Not really. They were bored to death.

Faced with a choice between bored-to-death with a great pension and early retirement, versus stressed-and-burned-out with no pension or retirement, many doctors would choose the salary.

Negotiations

Doctors in Ontario want to get back to negotiations with government. It’s the same old thing: negotiators will try to get as much money as possible out of government, while compromising as much freedom and autonomy as doctors will ratify.

Maybe the days of doctors, as independent contractors, have ended in Ontario?

Maybe doctors should consider a salaried and government-runs-everything model?

What could doctors lose, at this point? Even the Soviets had some great healthcare until their money ran out.

Government wants it both ways. Politicians want to control doctors and, at the same time, let doctors finance and manage clinics.

Doctors should not keep fighting to work as independent contractors, if government insists on managed care. Many doctors would be much better off, not just financially.

Private clinics currently offer the most efficient part of Canadian Medicare. But why should doctors be the only ones fighting to keep them?

The only thing doctors would lose, if they gave in to government, is their professionalism. But no one sees much value in professionalism anymore, besides doctors.

Social leaders, like the Toronto Star and the Ontario Human Rights Commission, want medical technicians, not professionals, with personal opinions and clinical judgment.

If government wants it both ways, doctors should stop supporting the current, dysfunctional relationship.

No one wins when spoiled kids sponge off weak parents. Let the kids own the consequences of their actions.

Doctors should let politicians own their own mess. I wonder how patients would like the outcome?

photo credit: today.com

Pick an analogy: a frog slowly boiling, a camel’s nose inside the tent, a slippery slope. Too often, we accept small changes and wake up with disaster, a camel in our tepee.

Canadians hate rigid thinking. We avoid fights and love compromise. This makes us pions to activist governments.

Medicine faces an existential threat in Ontario.

Do not listen to the wise, old doctors who say,

“Relax. The pendulum swings. Seven fat years followed by seven lean. Don’t get your knickers in a knot. All good things come to those who wait….”

People who spew such nonsense, in light of the current Ontario government, are, with great respect, deluded.

Premier Wynne is no pendulum; she’s a juggernaut.

The Wynne Liberals propose changes faster than anyone can respond. The Liberals want a revolution in healthcare; a completely different way for patients to access care.

And they want the government at the centre of their new world order.

The examples of this government’s abuse of power would run pages long. Consider just the following:

Bill 210 completely revolutionizes primary care. The government wrote this with no input from working physicians. Bill 210 turns doctors into civil servants beholden to local bureaucrats.

Doctors will be paid to do what bureaucrats tell them to do, not what patients want. Every schedule change, every hour of patient care, must be reported, and approved by, local bureaucrats.

The government will hire an army of bureaucrats to staff the new ‘sub-LHINs’ and manage all the doctors under their care.

Bill 119 gives government broad access to patient records. Defenders of this bill insist that the government always could come to a doctor’s office and look at charts, but this is not clear (or even true apparently).

Even so, in the days of paper charts, sensitive bits of data, for example, an HIV test, might not be handed to the bureaucrat demanding a chart. With electronic medical records, it’s all available to government with a mouse click.

As with Bill 210, the government ignored input from physicians.

On top of this, the Liberals have cut hospital funding 9 years in a row and have cut 1400 nursing positions despite a growing and aging population.

Will Medicine Survive?

The Ontario Liberal government is attacking medicine. They want voters to believe it’s all about doctor and nurse incomes, but it’s not about money.

It’s about control.

Of course money is involved. It always is.

But politicians and social reformers love power more than money. They want command: absolute jurisdiction over how and when doctors work.

They believe that they know best whether a doctor should stay late in the office, or go on a house call. They want to control when doctors take breaks and how they pay clinic staff.

Government wants to make doctors accountable to government. They want to force doctors to order fewer tests, and do more preventive care, in return for little bonuses.

Patients’ needs do not matter; government knows what patients need.

Honest Politicians

Coercive Utopians won a majority in 2014. Voters gave most of the seats in parliament to an activist government. Honest politicians are humbled that only a minority of citizens vote. They know that a ‘majority’ government gets control of parliament from the support of a minority of citizens.

Honest politicians believe that forming government means serving and listening to all the people.

But not the Wynne Liberals. They act like any other democratically elected dictatorship.

Premier Kathleen Wynne is not a centrist. She’s a woman on a mission with a long list of things she wants to get done. She does not believe that representative democracy carries the duty to represent all voters.

She thinks that a ‘majority’ gives her the right to trample on anyone who does not agree with her. She steamrolls her bills through parliament without any adjustments or feedback from others.

Fair and Reasonable

Doctors need to assess how ‘fair and reasonable’ is working with this government. They need to look beyond negotiations and consider what’s crumbling around them.

• Who should lead medicine?
• How should decisions be made?
• Have unilateral actions, sham ‘consultations’, and cowboy legislation ever worked well, outside of totalitarian regimes?

Canadian doctors hate fighting. I get it. I am Canadian. I thrive on diplomacy. But, how’s that working for you, doctors?

I’m at my wits end. I am tired of making excuses for doctors being ‘fair and reasonable’ in the face of tyranny.

Things will change irreversibly in Ontario, over the next 12 months. Doctors could make a difference. But I suspect they won’t.

Will medicine survive, as we know it, in Ontario? Will patients appreciate the doctors they find in their tent when Premier Wynne gets done with her revolution?

photo credit: bbc.com

 

Calm, thoughtful advocacy works with reasonable people. The Wynne Liberals are not reasonable.

In the face of Bill 210, the so-called Patients First Act, Ontario doctors must lead action. We need to lead a protest that the public can see.

Not a strike. Doctors cannot strike.

Bill 210 is not about income. Bill 210 fundamentally redefines the doctor-patient relationship. It goes far beyond anything ever seen in Canada before.

This is a bigger change than the start of Medicare. Patients will remember our response.

Doctors Must Lead

In Bill 210, the Ministry of Health creates its own standard of care and enforces it.

The MOH will determine the kinds of services doctors must provide.

Low level bureaucrats – “investigators” – will have power to enter “without a warrant”, search private doctors’ offices, and examine all personal health records.

In section 21.1 (6)(a), investigators will access doctors’ private:

• books of account,
• documents,
• bank accounts,
• vouchers,
• correspondence and payroll records,
• records of staff hours worked and records of personal health information;

Note: Even if investigators can only search the clinics in which doctors work, there is no difference between clinic and personal MD information for many doctors.

Doctors will be forced to report how they spend each hour of the day.

Doctors shall report holidays and schedule changes to local bureaucrats for approval.

Contracts with local LHIN handlers must be signed or enforced unilaterally.

Family Doctors will take orders from appointed, local government officials, not patients.

Doctors Must Lead

Bill 210 is not about money. Doctors own the moral high ground in attacking this legislation.

Doctors have many options to respond. As a non-expert, here are some ideas:

1. Doctors need to inform their colleagues and patients ASAP.
2. Docs should flood social media.
3. We need a broad range of articles in major news outlets about government failures in healthcare. Things like:
   1. uncoordinated care
   2. lack of IT connectivity
   3. waste in PACS, repeated imaging
   4. waits for surgery
   5. lack of spine surgeons
   6. inadequate home care
   7. overcrowded hospitals
   8. overcrowded emergency departments
   9. high cost of NP led clinics
4. Doctors should hire expert advisers to lead this activism (not Liberal-supporting ‘experts’).
5. Consider renting buses for a few thousand doctors to demonstrate at Queen’s Park every lunch hour for 1 week. Different doctors could attend each day.
6. Organize a week of picketing in front of local MPP offices. Keep the picket times short.

A few thousand doctors attending a short demonstration will not adversely impact patients.

Bill 210 needs action. Now.

Doctors must go out and fight. The Wynne Liberals are not reasonable. They ram bills through the legislature with impunity. Doctors must lead a fight, or fail trying.