Category: Politics

We all have something in our family that we never mention. Every family has skeletons. Yet, we work to promote our best family face.

We talk about our children’s accomplishments and awards. We want people to know the best about who we are. We cringe if someone asks about our struggles.

“All happy families are alike; each unhappy family is unhappy in its own way.”

― Leo Tolstoy, Anna Karenina.

Every doctor in Ontario has a family name. Our family name is the OMA. The Ontario Medical Association is only as smart and witty and compassionate as those of us who get involved.

If doctors want the OMA to look or behave differently, then doctors have to help to make that change.

It’s Your Family

If we hate how our family behaves, or what people think of our family, we work to change the impression. We spend time improving behaviour and reputation. We work with other people in our family to make things better. We never publicly criticize our family.

But that does not mean we fawn and gush over our family, either.

We courageously admit when things are hard. We accept when our family stumbles and disappoints, or even embarrasses us. But we never disown our family. We own our family’s failure just as we own its success.

Believe in the OMA

Doctors have tremendous power, tremendous opportunity, with the OMA. It is our organization, our family. Any doctor can stand for election and get ‘inside’ the political structure. Anyone can influence change from within.

The OMA stands unique in that it unites doctors around the one thing that doctors hold in common: caring for patients.

The founders of the OMA gave power to working doctors. They invested authority in a group of 250 working doctors at council. Council members direct the board to do the daily work of the OMA. They hold the board to account. If the board disappoints members, then members vote them out.

Over the years, many groups have tried to improve the OMA from the outside. The Coalition of Family Practice campaigned against the OMA in the 1990s. Eventually, they infiltrated and got 8 members elected to the board.

They overhauled how the OMA looked and behaved in the early days of primary care reform.

Today we have new groups: Ontario Doctors for Justice, Concerned Ontario Doctors, and others. These groups inject passion into the OMA.

They serve a valuable purpose. Members from grassroots organization run for office and transfuse enthusiasm and energy in a crisis. They work to renew and transform our organization.

Flawed, Like All of Us

The OMA is like any other human invention: flawed. But it is the best that doctors have. The OMA offers the best opportunity to create change in Ontario. It provides the most organized, funded, and powerful voice in medical politics.

If you want to be at the centre of medical politics, you MUST get involved in the OMA. There isn’t any better way.

A Personal Note

I started at OMA council because I was mad. I thought,

How dare they force me to pay dues! They do not care about my life, my work.

I got involved because I wanted change.

So I attended my first council meeting. I met scary smart people who had spent their lives – literally 30 years – trying to improve our healthcare system. They had made dents here and there, but they had not seen the transformation they hoped for. Still, they refused to give up. I realized that change in medical politics is hard, impossibly difficult. 

Years later, I still want change.

If readers look through the comments on this blog, they will find many times when doctors attack the OMA. Many of my posts invite those attacks. I want people to say what they think. I want to wrestle with the issues beyond slogans and hyperbole.

I believe in the OMA enough to want to make it better. I work passionately to improve the OMA. I do not pretend it is perfect. I do not cover its faults. But I never stop believing that it is the very best way to drive change in healthcare.

When people care about something, they work to improve it. They do not ignore its failures, or pretend they do not exist.

If you take the time, you will find that every time someone attacks the OMA, I defend it. I admit where we could have done better. I share the struggles at the time. I invite ways to improve.

But I always defend our organization. I stand by the OMA.

I will quit, if I stop believing that.

After years of service, and countless hours of unpaid advocacy, I still believe the OMA offers Ontario’s doctors the best vehicle for change.

If doctors do not like what the OMA is doing, then they need to get involved and change it.

If doctors get involved, they see how the OMA’s job is almost impossible. Doctors who get involved see how hard it is to change things in Ontario. They get a peak at all the work that no one sees on the outside, which no one can talk about publicly.

I believe healthcare in Ontario needs major change. And I believe the Ontario Medical Association is the best vehicle to make it happen.

If you want to see change in Ontario healthcare, then you need to be involved in the OMA. Stand for election. Get inside. Help out. It’s your family name.

 

There is a first time for everything. Doctors, patients, and concerned citizens have never marched together in protest over cuts to healthcare in Ontario.

For the first time, doctors, led by the Concerned Ontario Doctors group, marched in Toronto to protest cuts, on April 23, 2016.

They did not just gather on the lawn at Queen’s Park, like in 1986. They marched through the streets under police escort.

A careful head-count at the rally spotted over 1000 people. The parade stretched around a full city block. Drivers honked and waved in support.

Patients, members of provincial parliament, and organizers spoke before a row of media in front of the legislature. The crowd held a minute of silence. Speakers shamed hospital cuts and patient waits.

“If liberty means anything at all, it means the right to tell people what they don’t want to hear.”

George Orwell,  Animal Farm

The End of Doctor Protests

Since 2012, communications experts have told doctors to speak up: get on social media, write to local newspapers, and meet with members of parliament.

The end of doctor protests was to raise awareness, to apply pressure to politicians. The means were writing and speaking.

Just never hold a public gathering, the experts said.

Every time anyone asked about a rally, some older physician – a wizened expert on medical politics – would tell stories about doctors jumping barriers the last time they gathered at Queen’s Park in 1986.

It sent chills through us all.

God help us! Someone might misbehave in public.

Provincial governments across Canada keep watch on Ontario. If Ontario gets away with unilateral actions against doctors – legislating without discussion – then other provinces mimic the tactic to save money.

Nova Scotia just overturned their laws on binding arbitration. Quebec legislated the number of patients doctors must have in their practices.

Define or Be Defined

Post modern society judges a cause by the amount of outrage it creates. No outrage? Your cause must be lame.

Calm, principled intransigence comes across as unfeeling condescension in the face of real injustice.

Public Attack

When someone attacks you publicly, time stops. We ask ourselves, “Did that just happen? Did they just say what I think they said?”

The audience looks to us in disbelief. They withhold judgment waiting for our response.

If we quibble and stutter some inane argument, we lose. The audience, as jury, decides the attack is legitimate. We lose the battle of public opinion, even if we have the best argument.

Peace trumps war most of the time. But there comes a point when calm, reasoned responses work against us. There is a time to fight.

At least once – even just for one tiny moment – we need to speak up with passion. We might just get a tiny bit angry, if only for a few seconds. Our response to outrageous attack defines us.

“In the animal kingdom, the rule is, eat or be eaten; in the human kingdom, define or be defined.”

Thomas Szasz

The End of Protest

In The End of Protest: A New Playbook for Revolution, Micah White, founder of the Occupy Wall Street movement, describes why public protest no longer changes society. It does not work. The Occupy movement tried to change too much. It asked for something that no one could deliver.

Doctors ask for something that government can deliver. Doctors ask to stop cuts to healthcare. They ask for binding arbitration, as suggested in the Canada Health Act.

After 4 years of cuts to medical spending and 9 years of sub-inflationary spending on hospitals in Ontario, government must fulfill its promise to provide healthcare, or give the responsibility to someone else.

The end of protest is change.

Doctors need to protest more, not less. The public gauges the merit of an issue by the degree of outrage.

Doctors act like a Baptist pastor at a barn dance. They avoid the event, or stand stiffly in a corner in case any dancing breaks out.

Cuts harm patients. If doctors believe that, they will gird their loins and speak up. The end of protest is change. The time is now. Can doctors show some emotion for their cause?

“In a time of universal deceit – telling the truth is a revolutionary act.”

George Orwell

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?