Category: Politics

Doctors got an unexpected surprise this week: The Ontario government offered doctors a tentative contract, in the middle of July.

The board of the Ontario Medical Association (OMA) voted to support the new deal and share it with members.

People have asked what I think about the contract.

The Board voted to let the doctors of Ontario decide. As a Board member, I support the wisdom of the Board in this decision. If I absolutely could not support the Board’s decision, I would have to step down.

I found this decision very hard. I keep learning more about the deal each time I look at it. I’d love to hear what you think.

New Deal

Doctors in Ontario are desperate. After 2 years of attacks, cuts, and slander from this government, doctors beg for stability. This new deal seems to offer that.

Why Doctors Might Like It

No more unilateral cuts – Doctors will cheer for anyone who offers to end cuts. Doctors cannot run clinics, when government cuts payments without warning. No business could handle such caprice.

Co-Management – This contract promises to welcome doctors back. Many find this irresistible. Government has usurped control and progressively shut doctors out of healthcare governance, over the last 40 years.

Modernization of the Schedule of Benefits – This deal proposes to fix relativity (Some doctors bill high fees for easy work; others bill low fees for hard work). Doctors have failed to fix this since the 1980s.

Charter Challenge Protected – This requires lawyers to explain, but they say that this contract will not undermine the Challenge.

Better Than the Alternative – Based on current utilization, the negotiated funding for growth, one-time payments, and two Schedule of Benefits modernizations is expected to keep spending within the planned PSB and one-time payments. We shouldn’t need further adjustments. But if government keeps to its current behaviour, it plans over $1.1 billion in cuts over 4 years of unilateral action.

Why Doctors Might Pause

No Reversal of Previous Cuts – The physician services budget (PSB) sits at $11.452 billion dollars, after approximately $700-800 million dollars of cuts.

Enough Growth? – The government has offered to fund 2.5% growth of the PSB. This means that the MOH has agreed to fund 2.5% more physician services per year.

Note: physicians’ fees stay the same. If a fee was $33 dollars last year, it is $33 this year.

A promise to fund 2.5% more services marks a huge improvement over the 1.25% that government funded last year.

However, growth has been around 3.2% for the last 15 years. Each year, 150,000 new patients come to Ontario, and almost 1000 new doctors start practice. Can anyone contain utilization?

One-time payments – These are expected to cover the difference in funding noted above, but only if growth is contained at 2.5%. Doctors could earn an almost 0.8% annual bonus, if all doctors work together to find permanent savings in each year of the contract.

Shifting Risk – This contract seems to give government the predictability they wanted in the PSB. Is that reasonable? Does this increase the likelihood of reconciliation if growth goes beyond the 2.5% + one-time payments? How will this be handled and will there be winners and losers?

Hard Times

Doctors in Ontario have faced cuts of up to 30% net, since 2012. At the same time, they struggle to find care for their patients.

For example, patients wait up to a year just to see an orthopaedic surgeon, in my area, and another 9 months to get their hip replaced. On top of this, government has cut hospital funding for the last 9 years and also cut over 1400 nurse positions.

Doctors are tired. They want a contract. A contract seems to provide predictability and lets doctors apply for loans to purchase equipment that patients need for care.

Members Decide

Doctors need to ask: Does this contract offer something good for patients and doctors in Ontario?

Doctors will not get a raise. Inflation will eat into their earnings. But doctors will get certainty for 4 years. Doctors will not get unilateral action.

What will patients get?

Do the pros outweigh the cons?

What will government do if doctors do not accept this deal?

What options do doctors have?

Doctors face a huge decision, possibly the biggest decision of their careers. They need to ask hard questions about: certainty, growth, rationing, and relativity.

Doctors need to do whatever they can to inform themselves.

Doctors needed something concrete from government. Members needed to see this contract, and the Board is wise to trust members with the decision.

The OMA Board has committed to inform members through special meetings and information sessions. Physician leaders across the province should be able to answer questions from their colleagues.

The current situation was unsustainable. Can doctors trust government again? Please ask hard questions. Let’s hope patients like how this turns out.

photo credit: www.brittanica.com

Note: OMA communications and negotiations reviewed a draft of this post. They offered helpful edits and re-focussed the content on the deal. I added a few comments and made final edits after that. I assume responsibility for all errors.

As you roast marshmallows this summer, you can learn how to roast politicians, too.

Oops. Freudian slip.

You can learn how to roast political ideas (if that inspires you more).

A few of you have asked about great books to go with your tan. Here are some of my favourite non-fiction titles designed to ignite revolutionary thoughts from your hammock.  I included only one healthcare title, for now.

Disclosure: I am an Amazon Associate and get a few pennies, if you end up purchasing items, after clicking on the links below. If you’d rather, just search for the titles yourself! Cheers.

Summer Reading

Free to Choose: A Personal Statement

If you vote, you need this book. It is a must read for anyone who cares about freedom.

It is well written, full of great quotes, and packed with fundamental ideas about freedom and democracy.

If you love the Toronto Star and want to live in China or Cuba, you can skip this title. If you plan to stay in a Western democracy, please read Free to Choose.

Doctors do not usually read Friedman, or any similar books. So it’s no wonder that health policies and legislation come out sounding like quotes from Mao or Castro.

Catastrophic Care

Malcolm Gladwell calls this book,

“A devastating and utterly original analysis of what has gone wrong with the American health care system. Read it, and take a deep breath.”

This book appeals to readers who love to hate the American healthcare system.

It also wins points with those who vote for people like Hillary Clinton and Bernie Sanders.

If you think government-run healthcare could do better, you will find ways to make care more like Apple and less like the Post Office.

Goldhill works as a CEO. He supports universal healthcare, but not universally bad care.

From the flap:

“In 2007 David Goldhill’s father died from infections acquired in a well-regarded New York hospital.

The bill, for several hundred thousand dollars, was paid by Medicare.

Angered, Goldhill became determined to understand how it was possible that well-trained personnel equipped with world-class technologies could be responsible for such inexcusable carelessness—and how a business that failed so miserably could still be rewarded with full payment.”

The Conservatarian Manifesto

This book aims at readers who support freedom and responsible governments, but do not get too worked up about what other people do in private.

Writing for an American audience, Cooke, an Englishman, rips into right-leaning ideas that are popular in the USA. He offers a new label: Conservatarian.

It’s well written and more thoughtful than most political books written in the US.

From the flap:

“There is an underserved movement budding among conservatives, in which fiscal responsibility, constitutional obedience, and controlled government spending remain crucial tenets, but issues like gay marriage and drug control are approached with a libertarian bent.”

What is Government Good At?

Savoie knows Canadian governments and tears apart the federal bureaucracy, during the Harper years.

It is not another anti-Harper diatribe.

Savoie exposes bureaucracy and shows how it bloats and rots, even under a leader who campaigned against government waste.

This title offers grist to fuel your angst about bureaucracy’s inherent waste.

The Road to Serfdom

If you love everything you hear on the CBC, you will hate Hayek.

It is a sacred text for those who support limited government and free markets.

Please do not read Hayek, if you want higher taxes and more government regulation. You will just grow smarter and make life worse for the rest of us.

The Road to Serfdom is not as easy to read as Friedmans’ Free to Choose, but still worth the effort.  Written in 1944, Hayek reminds us that Hitler came to power democratically.

Roasting Ideas

These titles are dangerous. They will change your thinking about almost everything that goes on in Canada and the US.

As you relax in your lawn chair, cold beverage in hand, I hope you let these authors subvert the messages that bombarded you throughout the rest of the year. I hope you get a chance to scrape off the mushy thinking that sticks to our brains like marshmallows, between September and June.

Enjoy the roast!

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