Category: Politics

Philip McGraw built a career by asking, “How’s that working for you?” He learned early that no matter how hard you try, only outcomes matter.

“You can’t eat intentions, only results.”

“I suppose that’s how I came up with one of my favorite questions: “How’s that working for you?” When I ask that, I genuinely mean it. How is what you’re doing working for you? Are you getting what you really want and need?“

Dr. Phil might ask doctors, How’s this working for you?

Did you ever imagine spending your spare time fighting government?

Doctors’ Response to Cuts

Doctors at the lowest end of the fee scale and those with the biggest cuts react first. They are marginal customers, those most sensitive to changes in quality or price.

Initially doctors just grumble, work more and adjust their services. As cuts deepen, doctors lash out. After years of repeated cuts, blame and slander, doctors give up. They reach a point of readiness for substantial change.

Grumble and Shift

Doctors cope by working longer and harder. It’s their first response.

Then, they adjust their clinical time. Doctors start to:

• Offer shorter visits.
• Consider fewer problems per appointment.
• Down size their practice.
• Move into cosmetics.
• Take more time off.
• Close satellite clinics.
• Spend more time operating on WSIB patients
• Expand time with military clinical services
• Retire

These are not threats. They are facts.

Speak Out

After 2 1/2 years of cuts, grassroots doctors explore activism.  Small coalitions of frustration pop up. A group of Ontario MDs formed on FaceBook with over 11,000 members. They met with MPPs, media and mobilized to Queen’s Park. They got heard.

Seek Substantial Change

But activism without outcome does not satisfy. Doctors diagnose and treat. They care by doing. Without tangible outcomes, doctors start to fidget. By nature and training doctors want to identify work accomplished.

Doctors have two options, change work or change the system.

Journalist Andre Picard wrote an article telling doctors to relax. Stop sounding so entitled. Empty threats of leaving sound pathetic. Government should just say, “There’s the door.”

Many have left. Young doctors plan to leave as soon as they can.  Two patients asked to join my practice last week; their doctor had gone back to Florida to escape Premier Wynne’s attack on doctors.

But even more doctors leave in a different way. They check out. They give up trying to change the system. They turn attention to work that offers tangible outcomes. A number of physician leaders in medical politics have said, “I’m done.” They already have jobs in related administration or some other area.

In many ways, this helps government.  Government would love novice or less passionate doctors to step up.

Doctors tell unbelievable stories.  They talk about horrible hours, disrespect and a grim future for medicine. At some point people start asking docs, “So, how’s that working for you?” What they really mean is, “Why don’t you change jobs?”

Doctors are human.  They cannot perform when demoralized. We do not want doctors shifting their time away from patients or considering other careers. But it’s happening. As healthcare unravels, we might ask voters, “So how’s that working for you?”

photo credit: pinterest.com

We learn from our mistakes, at least some do. The Toronto Maple Leafs won their last cup in 1967.   Maybe the saying should be,

“Some people learn from their mistakes, but most rarely take the opportunity.”

Ontario’s doctors see 2004 and 2008 as big wins. By 2012, docs had finally caught up to inflation after losing since 1986. While everyone takes credit for the victory, the feds probably deserve most valuable player. They shovelled billions as Canada Health Transfers starting in 2004 growing at 6% per year, $13 billion in fiscal year 2015-16.

It created a new economy in healthcare. Relationships and collaboration ruled the day. Cooperation reformed primary care for the first time since Confederation. Bureaucrats and physicians partied at the same events.

But every binge ends poorly. Liberal governments have a fierce and jealous love of debt. Ontario now has more of it than any sub-sovereign borrower in the world.

MD-Government Relations

The economy collapsed in 2008, the biggest slump since 1930. It happened just after Ontario signed a 4 year deal with doctors. The government was too weak to renege, even though it tried in 2011. So government took revenge in 2012 and has abused doctors ever since. It looks like the fights of 1970-2003.

Doctors need to refocus, start over with reaffirmed thinking.

New Perspective

• Do we want a physician services agreement or the freedom for physicians to serve?
• Should doctors focus on special programs or basic principles?
• Do doctors value partnership with government more than self respect?
• Are some things more important than getting ‘stability’ or a small raise?

New Process

• Are we best served by a small group of physicians negotiating on our behalf?
• Do we need a Buzz Hargrove to guide us?
• Do we need new blood with innovative thinking?
• How should our structure change to deliver different results?

New Presuppositions

• Do we believe government bureaucracy can ever manage healthcare?
• Is more government better?
• Are doctors the cause of all, or most of, the problems in healthcare, or are they the solution?
• Does the Canada Health Act give government the right to usurp control of healthcare?
• Should public administration refer only to the collection and distribution of taxes?
• Should the government provide oversight or micro management?

Fail Fast

A great leader said recently, “Fail fast.” Pay attention to performance and abandon losing strategies. Failure is inevitable. Repeating failure is not.

Doctors fought hard in the 60s and 70s. But after a few years of Medicare, doctors could not deny that universal everything is a really nice way to practice.

Until the money runs out. And be sure of this, doctors will get blamed as services and access decline.

Will doctors try to mend relationships and recreate the glow from ’04 and ’08, more of the same? Will we become the Toronto Maple Leafs of medicine?

photo credit: thestar.com

Experts need 10,000 hours to perfect a skill. We inherit talent but acquire mastery.

Conflict requires its own training. Some professionals spend years developing the art of rhetoric and debate.

Doctors spend years learning to avoid conflict. They work to help and serve, not to pick fights. Doctors see people at their weakest; prostrated patients looking for relief, not conquest.

Medical schools choose students bent on service. Schools stopped accepting students with nothing more than a great transcript 30 years ago. Modern interviews try to identify the most gentle and selfless. Patients love altruistic servants. But self sacrifice leaves the medical profession weak and defenceless.

Doctors have little clue about real self protection. Schools pound the fighting spirit out of students. By genetics and training, doctors prefer compromise over victory.

Doctors Trained to Surrender

David Esser MD asked whether we select doctors, and train them, to sacrifice and give in? He said:

How we select and train physicians puts them at a disadvantage when dealing with Government. 

It’s difficult to get into medical school. 

Only a select few are admitted. 

Those that get in are dedicated and hard working, ready to sacrifice time and income to train and learn. Docs spend many years training; always being available; getting a small income.

At work, we are trained to keep our wits about us and work through a crisis without getting worked up; patience and persistence. 

What we have learned and practice daily acts as a major barrier to physician action. 

Calm and Reasonable

Calm people can be scary. They often look placid right before they fly into a rage. Pacifists never learn to wrestle. By middle age, they have only two faces, calm and crazy.

Most doctors hate fighting. If government handles them well, doctors lose every battle just to avoid the fight. Physicians have never practiced engaging worthy opponents.

Government should still tread softly. Everyone has a breaking point.

Despite an almost complete lack of fighting spirit, some doctors insist that they would fight for something they believe in.

How about:

• Multiple cuts to medical funding for vulnerable patients?
• Or unilateral actions that target new graduates?

Maybe all medical schools should include 10,000 hours of training on how to fight government to prepare doctors for practice in Canada? If doctors cannot fight, we need to find someone who will do it for us.