Most people are too polite to tell you what they think. Even when it feels like someone was courageously honest, they still held back their strongest opinions.
This week, several dozen doctors met just west of Toronto to tell the OMA what they thought. It was one of many meetings booked across the province. Dr. Virginia Walley, OMA President, handled the questions and feedback.
Most docs pulled their punches and were polite. Even so, they offered bitter medicine.
Doctors Want Action
The meeting opened with questions like: What happens next? Doctors wanted to know what the OMA plans to do.
How does the OMA plan to get a contract for doctors? The current situation is intolerable.
Doctors also wanted to know why the OMA refuses to campaign against Premier Wynne.
And why wasn’t the OMA running a public campaign against Bill 41?
As usual, doctors thought the nurses were running a better public relations campaign, and they already have a contract.
Attitude Adjustment
One doctor reported that some Board members said the contract failed because, The Board got too far ahead of the members. If members had been properly educated about the concept of co-management, then the contract would have passed.
Taken out of context, this sounds bad. It sounds arrogant. It fuels suspicions that the board is out of touch.
While I disagree with the comment, I understand why it was said.
If members had debated and discussed co-management for months before the tPSA, then maybe it would not have surprised doctors to see it in the contract.
Co-management is the latest health policy fad, again. It was popular in the 1990’s social contract years, when government needed rhetoric to support its 10-year attack on doctors.
Most physicians do not pay attention to trends in health policy, so it is understandable that they would find ‘co-management’ more shocking than the Board did. Still, co-management needs debate.
Being out in front does not mean you are out front in the right direction.
Doctors Want Change
A number of docs wanted to know how to prevent a repeat of the last 6 months.
One doctor said the whole Board should resign.
Others asked for focused resignations. Many of those listening rolled their eyes and scoffed at blowing up the Board.
With almost half the Board up for re-election in a few months, it seems like an ideal time to run for election and be the change docs want. Let’s hope those calling for resignations will also run for election.
Doctors Want Accountability
A few people asked why they should pay mandatory dues to an organization with failed negotiations. Of course, this blame falls on the government, too, but many docs do not see it that way.
Someone said that all the provinces have voluntary dues, except Ontario, and most of them have good contracts.
Even unions must hold a referendum every few years to see if union members still support the union. The OMA Dues Act enshrines MD dues in law, without referenda.
Non-Partisan
The OMA must decide what it values most: stakeholder status with government, or the trust and devotion of 42000 doctors.
Organizations always want tight relationships with government and support from their members, at the same time.
But sometimes, even unions have to fight the leftist parties they campaigned to elect.
If government determines to fight, you are in a fight whether you want it or not. Dreams of being non-partisan are irrelevant nonsense.
An organization must fight on behalf of its members when the government insists on war. Refusal to fight guarantees that many of your members will not trust the next contract you deliver.
The OMA is in a fight for its existence. In light of government attacks since 2012, the OMA looks like a failure, when it comes to defending members’ interests. Without surprise, unrest fuels grassroots organizations to usurp the OMA monopoly through disruptive takeover. This is totally preventable.
Appearance is everything. In relationships, we are judged on effort, less on outcome. Of course, outcomes matter. But people rarely criticize someone who dies trying.
Doctors Need a Champion
Doctors say that they want their organization to campaign against government with at least the same energy it spent campaigning for a YES vote this summer.
They want a passionate campaign against Bill 41. This bill means more than just involuntary inspections of a few thousand doctors’ offices.
This fall, Dr. Walley has done a brilliant job of listening, apologizing for mistakes, and welcoming input from the front lines in her listening tour.
But the grassroots are mobilizing.
The OMA must figure out how to lead with positive change, win the respect of the moderate majority, and broker peace with doctors who feel disenfranchised.
Docs need a champion, now more than ever. The OMA must convince doctors that it fills that basic role, or others will win the trust of physicians and become the voice of doctors in Ontario. Doctors’ best bet still lies with the OMA; they just need some concrete proof that this is so.
Photo credit: http://superheroacademy.net/be-your-own-hero/
Hi Shawn
Great post. I liked that this post is a little less opaque and has a little more SW in it 🙂
Sounds like you believe the current OMA should be the Doctor’s champion.
What else can the current OMA Leadership do to become our champion do you think? It seems even over the past two months of apologies and more assertive statements it isn’t enough; proof being the recent proposal put forth.
Thanks Del! Great questions.
I’d start with asking docs what they want. If docs do not have concrete suggestions, I’d start with a paid campaign around Bill 41 that was at least as flashy as the tPSA campaign from the summer. I’d also have 1-2 articles in the major newspapers each week that addressed ongoing issues in the healthcare: lack of IT interconnectivity, lack of access to PACS/having to re-scan people because their images were done at a different facility, delays in the legislated LHIN review, highlighting the Auditor General’s call for a LHIN review, highlighting the Auditor General’s identification of a 40% error rate in CTAS scores in the ED, hammering on wait times, etc, etc, etc.
If we want to be taken seriously, we need to stand up and speak for issues that docs struggle with every day, not just flus shots and seatbelts….. but that’s just me.
Thanks for taking time to read and share a comment!
Cheers
Shawn
Hi Shawn,
Great post and nice reply to Del’s post. I agree that the OMA should create a strong public campaign against Bill 41. It will go a long way to reassure members that this ship is changing course. I caught the tail end of the District 5 meeting, and I liked the changes that seem to be coming.
My question is… you have great suggestions and ideas. They make sense. Does the rest of the board see things your way and if so, why can’t he boards influence change things more quickly. If there are board members who don’t believe in what you post, what do they opposing board members think and what is their reasoning?
Thanks,
Rohit
Hey Rohit,
Great seeing you this week!
Membership associations feed off input from members. I am a bit odd in that I actively seek out what doctors think in my spare time (My kids would say I’m odd in lots of other ways, too). Member input changes how an association thinks. But it does more than that: member input changes the culture of an association. It becomes a vicious cycle. Asking for input begets more input which creates a need to search for input.
The problem is that associations ask for input and get very little, or they ignore the input they get. A negative feedback loop virtually smothers future input: docs see little change from the input offered and stop offering more in the future….the association sees anemic input and assumes docs do not care. The culture assumes an attitude of not looking for input, “Because no one ever comments when we ask for comments anyways.”
So your questions about how people see things are only a symptom of the deeper issue. If the culture changes such that the association relies more heavily on member input, then you will see ideas, tone and behaviour change in a way that more closely reflects what doctors think on the front lines of care. Unfortunately, this change requires energy and time. It require continual engagement, feedback and correction from other doctors, just like you are giving to me right now. But just because it is difficult does not mean that we cannot see this happen.
I believe that the Board can make changes very quickly if it is in intimate contact with what doctors think. The only reason I appear to think differently is because I spend so much time interacting with doctors like you.
Thanks for asking such great questions!
Looking forward to visiting again soon,
Shawn
Shawn…just how long will majority pay dues & see little or no progress with a govt that’s clearly bent on having it their way? With Bill 41 moving forward, docs upset, new grads seeing a dim future- I believe it’s us patients that need a champion. Govt has decided that patients can be sacrificed for their funding mismanagement and they’re asking docs to be the ones to limit services.
What in hell are patients to do when all players appear to be against patients. We’re left to seek help OOC at our expense. Clearly the front line docs are being ignored by their employer. Little consultation with docs who are patients only representatives.
I understand physician frustration but how long are the listening tours going to last? Govt watched while system started to experience long wait lines, operating rooms not used, docs closing practices and patients left to wonder…..gods sake don’t let me get seriously sick because we’re either old and or funding has dried up. “Sorry no help for you.”
I wish docs luck but until you take control of your own destiny, OMA is not helping you or us.
Wow. Powerful comments, Don. You are so right!
Ultimately, this is about patients. Doctors need to speak up strongly in their historical role as advocates for patient care, for access, for patient service. If we do not have medical associations that act boldly and speak truth to power, what hope is there for patients? You are a rare non-physician who understands these issues. But you do not have $50 million to use to amplify your voice.
Doctors need to speak up. It’s the right thing to do.
Thanks so much for reading and sharing!!
Best
Shawn
It’s hard to be a patient advocate when you and others in your field are employed directly by the hospital.
True! Misaligned interests. And you take huge risks for speaking up…need to stay anonymous. 😉
Great blog Shawn. There is, undoubtably, frustration from the membership and they are looking for someone to blame. OMA must accept responsibility as they are our ONLY legally allowed representatives which was tied to the 2012 agreement. In years prior to this, the OMA was always viewed as serving 2 masters. Trying to balance the wants of the membership but also trying to maintain dues Randed by the government.
Easier to piss off the limited engaged membership than the government with their big stick of rand removal. Dissenters were just complainers and groups that were marginalized in deals had no way other than to try and sue the OMA for lack of representation.
Fast forward to now and the OMA has removed the governments weapon of the rand but failed to help represent the membership. It again dealt with the government before even engaging the membership. This time the disenfranchised not only have social media, but lists of doctors that previously held in secret by the OMA, were now legally required to be released to others. Groups organized,and complaints that were dismissed by the OMA, found sympathetic and complementary goals. Voices muted by complex and may I say archaic corporate structure of the OMA forced a one person, one vote, outcome in the general meeting.
Now the OMA needs to change. To reinvent itself and show that its not an “old boys club” of perennial appointed people waiting for a ministry advisory position but to show that it can be that change. Dr Walley’s road show is encouraging but the structure of the OMA needs to change so that it can be more nimble and respond to membership concerns quickly and appropriately.
Until that happens they will not be the champion the membership is so desperately seeking.
Great comments, Brad!
You nailed it with “…the structure of the OMA needs to change so that it can be more nimble and respond to membership concerns quickly and appropriately.”
We live in a new world. Traditional media has been usurped by alternative and social media. Organizations must adapt, too, or be taken over by disruptive innovation.
I believe the OMA can do it. All the pressure from the grassroots has helped to force change. In the end, we will have a stronger voice. The process of getting there is painful.
Thanks for taking time to share!
Cheers
Shawn
While I agree that we probably are not best served by a Guy Fawkes sort of revolution, we do need revolution. I felt that the roadshow “listening” tour was anything but. What I heard was excuses for what they did and old OMA still trying to tell us we are stupid to resist “co-management” and even Bill 41. Scott Wooder was at ours and was arguing that Bill 41 has good things in it so we should be accepting of it despite the glaring faults. He got a frosty reception but I don’t think it even registered. The OMA certainly isn’t listening or hasn’t listened when it appoints the disgraced and sun-setted bargaining team as the new PSC. The OMA cannot serve 2 masters if it is incapable of its primary responsibility. Promoting government programs at the expense of physicians well-being is a complete negligence of the fiduciary duty of the bargaining agent. They cannot and probably never will be reconcilable. We cannot co-manage anything if the government does not respect and value our input and experience. It is just a show that the government wants to put on to fool the public into thinking their interests are being looked after. We can’t be advocates for our patients if we are weak and powerless. We shouldn’t ever be held responsible for the mess the government is making of the healthcare system and we should never accept less than our full value to somehow prop up the teetering house of cards of the healthcare bureaucracy. We have been there and we have done that at it has helped no one except the drones in the government bureaucracy.
Fantastic comments, Ernest.
Most organizations would find it almost impossible to serve 2 masters, even at the best of times. When one master becomes pugilistic, our association must reconsider who matters most: members or government.
Until we define co-management, it’s ludicrous to debate its value. So far, I’ve only seen co-management to mean co-managing rationing or forced relativity corrections. Doctors will never be an equal party given the current legislative structure in healthcare. Thus, co-management is limited at best, and more likely a myth in reality.
Doctors must be able free to advocate for patients. They must be free to critique government. As soon as we are so close to government that we fear loss of influence for speaking out, patients will suffer for it.
You packed a tonne of truth into a short comment!
Thanks again for writing.
Best
Shawn
Remember, remember the 5th of November….(very timely blog and comment indeed!). 🙂
Thanks once again Shawn. Your blog should be mandatory reading for the OMA Board…
Thanks Elizabeth!
The more that grassroots doctors ask for change, the more likely change will occur. Keep speaking up!
Warm regards,
Shawn
Justly I was also caught off guard with the “co-management” concept too, but I am open to debating this. It is naturally human to resist change, but I realize I need to be more flexible.
Your “A negative feedback loop virtually smothers future input” is accurate. This is I have personally experienced as a physician, OMA member and past R.A. delegate especially.
The biggest issue for me is time. Busy physicians feel that they don’t have the time to stay up to date with health trends like co-management etc. or the time to offer feedback, completing surveys and voting usually shows only a third, and that is generous, of the members or voters participating. Particularly as an R.A. delegate I often heard ” We elected you to do this” from physicians in my district.
But, there is no other way, if we want to see reform we have to put in the time.
Thank you for being “odd”, for putting in so much of your personal time on our behalf.
Thanks for such a thoughtful, kind comment, Wayne. I hope you stay involved! We need people who see through the issues, keep an open mind and stay fiercely devoted to serving members.
Thanks again!
Shawn
Shawn,
Thank you for all your thoughtful hard work. I admire your fortitude. I have a dozen work-related things to work on, but feel my stamina for work fade with the ongoing local and provincial political drama. But when I put my apathy for self-preservation (and November windsurfing) aside, I have but one thought on all of this –
It is time for action.
No one is going to ring a bell and tell us to get in there unless our leadership builds the case through aggressive PR, and gives us the action plan.
We’ve paid a lot of dues to the OMA to lead us in this moment.
Let’s not watch as the government spends ?billions enacting its Bill 41 without investing a cent in frontline care.
Let’s not sheepishly follow British Columbia’s recent decline into administrative purgatory.
No one is going to thank the OMA for doing nothing.
Let’s secure our BA rights and a PSA, and fight for our patients.
Let’s act.
Will our OMA lead us?
Best regards,
Clay Hammett
Well said, Clay. Well said, indeed!
Always a pleasure to read your thoughts Shawn.
Looking back at newspaper articles from 1986banf the early 1990s, I’d say the OMAs failures goes back before 2012. Doctors were unhappy then with the OMA and are unhappy now. The question is why? Why can’t a group of intelligent people with a well funded organization can’t better advocate for its members?
I believe it’s because the dysfunction is engrained in the OMA. It continues to cozy up with the ruling party and if you peel back the layers of the “onion”, you find numerous examples of cronyism and palm greasing (so to speak) with the current Liberal party.
Speaking of the tPSA, why was negotiation done in secret without input from our own negotiation committee? Why was there coordination and vetting of information dissemination to members? Why was 3 million dollars spent to convince us to vote yes and nothing spent to objectively analyze the agreement?
Liberal directives to the executive to pass this, that’s why.
Without consequences, behaviour will not change. The arrogant culture of the OMA leadership will not change.
It is with certainty that the executive must resign. The organization should be leaned out and made far more transparent. Finally, being an advocate does not mean you’re non partisan. It means standing up for your members when smacked down.
Between the unilateral cuts, imposed contract, and the anemic efforts to halt the progression of Bill 41, the OMA has proven that history repeats.
Thanks for putting these thoughts out in the open, Deron. Many feel the same as you.
I agree with your comments about OMA malaise in the 1990s. I want to push back a little on an assumption underlying your thoughts: The OMA is actually changing all the time. From year to year, it takes in new people. If those people refuse to speak up, I agree, the old culture continues. But as you remember, the Coalition of Family Practice took over the Board in the late 1990s and made major changes to the how the OMA acts.
You are correct about the money spent on selling the tPSA. Bad move. Having said that, the OMA also spent time and effort analyzing the deal. It’s unfair to paint the OMA so completely lopsided. This is NOT to excuse what happened. Mistakes were made.
Finally, you talk about cronyism and apparent deals. These allegations would be very hard to prove, so I’m not sure it helps to suggest them. It tends to sour the debate, but that just might be me. As they say, “Don’t attribute maleficence when ignorance explains things well enough.”
Thanks again for sharing your thoughts! I hope we can have sharp debate and, at the same time, try to stay positive through it all.
Best regards,
Shawn
Wonderful article. Shawn, the time to act is now. The President should be elected by the membership. I encourage everyone to sign the petition.
https://coalitionofontariodoctors.ca/petitionresolutions/
Hey David,
Thanks so much for all your passion and energy. I think doctors are open to governance changes right now. Dr. Walley said that she was open to changing how the President is elected, when someone suggested this at the meeting last week. I think you are on the right track with governance changes. Hopefully, we can find a solution in the most cost-effective way possible.
Highest regards,
Shawn
I’m ready for change and so is the membership. If legal costs are kept to a minimum, there is no reason why a general meeting should be an expensive affair. Democracy comes with a price tag, but the alternative is always more expensive in the end.
Best regards and keep up the great work!
David, the real reason a general membership meeting is not so great is that the membership is scattered over the whole province. I think trying to get a representative meeting is very difficult and puts a hardship on those of us serving in far flung communities. If there is to be a general coming together we would need multiple centres connected by internet/video feed. This is technically possibly but practically very unwieldy. We do need something to mobilize the apathetic majority though. Unfortunately when its the OMA asking for participation, the eyes roll an no one wants to waste their time on what they are certain is a waste of time. A general gathering that attracts attention of the apathetics would have to be post reform of OMA and called for by new management. OMA central doesn’t even want to release a membership list to its own representatives. They are not going to cooperate in any way that threatens the status quo. The only way to jar the OMA central committee is a petition signed by at least 40% of the membership because that’s the legal threshold for calling for a vote to decertify the bargaining unit. The challenge now is that OMA central is emphasizing that it has some 44,000 members, but many of those are retired non-practising or student (undergrad members) and should not really have a say in pay negotiations when they themselves are not part of the working membership. We need to clarify or stratify voting rights on money matters. That might be something to push at council. You move it and I’ll second it if you like.
I agree, as you know with many of your points, but first things first. We need to tear out the barriers to accountability. This includes having the Executive step down and a President elected by membership. After this is achieved much will be accomplished.
https://coalitionofontariodoctors.ca/petitionresolutions/
That’s right but because of the problems getting the general membership together on anything, a general meeting is not feasible. Petitions are easier esp when presented to a superior court judge it the OMA resists.
On that I will disagree. The last general meeting was highly successful in stopping the PSA. The next will be equally successful at restructuring the OMA.
Great discussion, Ernest and David!
You guys are batting around the exact debate that so many doctors are having right now. Thanks for doing it here, so others can follow along!
Cheers
s
Fair points!
#1 A contract is evidence of an understanding. The tentative agreement was evidence of an understanding between the OMA Board and the MOHLTC. Our vote does not judge the OMA’s sincerity or intentions, just the understanding. Our vote determined, on balance, by rejecting the agreement, it failed to addressed our concerns.
#2 The OMA board is not “too far ahead”. It mistakenly accepted a deal with some short terms gains and miscalculated sufficient numbers. Given the OMA is a cost of doing business in Ontario, and I see this latest product, I am no longer certain it is best value for money.
#3 We are devalued because of what we are perceived as doing. We now spend too much of our time advocating for patients in a system that is less than optimum, if not frankly obstructive, and unconcerned. We spend far too much defending ourselves from patients who identify us as the cause of why the system is inadequate. This is not what patients want to pay the doctors for doing. Is it any wonder they might feel we may not deserve more?
People can’t judge the value of medical outcome. In fact they diminish it. Look at executive physicals and how much people are willing to spend a fortune on meaningless interaction and investigations. (NEJM Oct 2, 2008 page 1424-1425) and the “War on Ugly”.
Excellent observations, Ed!
Unfortunately, people take things personally when you disagree with their understanding. They conflate argument with personal rejection. It blinds them to further discussion.
Value for money rests on many doctors’ minds these days. Most come to the same opinion.
I really like your comment about docs getting blamed for dysfunction. Should we expect anything different? If we do not discuss the cause of dysfunction, how can patients come to any other conclusion?
Thanks so much for taking time to read and share!!
Best
Shawn
I think that the OMA could start to win back members with some simple concrete steps that any other professional organization would have done long ago. I get the feeling that for some reason they sometimes forget exactly what they are.
1. The OMA should send out a form to all physicians (a template of which may be found in any US hospital) stating in clear terms that the patient is required to pay any portion of their bill that is not paid for by their insurer. It should also state why this is necessary and the fact that, while morally and professionally obligated to care for patients while unpaid, we are not legally obligated to do so and their government has left them exposed
2. When claw-backs occur doctors would then send out bills to patients for the full amount of services rendered with applicable interest and service charges. This should be legal as we are able to bill for uninsured services and if the government stops paying us all services are uninsured
3. These bill would include instructions for submitting them to the MOH for payment. This would make it clear just who is not meeting their obligations under the Canada health act
4. If the ministry refuses to pay we have lost nothing and doctors could choose whether or no t to hold patients responsible for the balance.
5. We should also seriously consider direct charging all patients for all unilateral fee cuts and giving them a receipt to submit to the government. Again the point is not the money but to make what the government is doing apparent to
everyone
6.Last point. Having faced cuts due to “supposed” lack of government funds the OMA should immediately run a series of Ads demanding full transparency in the health care budget as has the federal minister. They should be quite aggressive and clear in the fact that it is the public’s money and they have a right to know how it is spent. I have a strong feeling that a good deal of this mess comes from the minister being afraid to take on the MOH bureaucrats and consultants and once that it is all out in the open I but we fall fairly far down the line to the chopping block
4.
Great points, John!
Those ‘simple steps’ you mention seem straight forward enough. But the problem is: They sound a bit creative. That might be a challenge.
I agree with your call for ads. That should have been happening for a few years now. But again, that requires courage and creativity.
Thanks so much for taking to read and share some comments!!
Best regards,
Shawn
I agree that they are “creative” but creativity has been needed since the MOH suddenly threw out the rule book. We need to do creative stuff to show the public the core strategy that the MOH is using which is: we are taking or doing this and we are counting on the fact that you won’t let people die over it. Thats just dirty pool and beneath even politicians.
Also I’m not sure that they are as creative as it seems. I don’t know what the Canada Health Act well but I am fairly certain that it does not consider something that you are not paid for as an insured service. I suspect that with claw-backs it is the MOH that is violating the act in this case. All people who receive services that are covered by insurance are on the hook if their insurer does not pay so why should this situation be any different.
In any other profession all work would have most likely stopped at some point over the past several years and would stop when payment stopped. The govt is only getting away with this because if we stop work people die and that is unacceptable to us morally and professionally. This actually applies to both sides but the govt has counted on the fact that we won’t let that happen. They have said “at some point we will not pay you to save this person whos care we are responsible for but we are counting on the fact your morals will make you save them even though it is no longer your job since you are not getting paid”. We need to do what must be done to make this visible to every patient. There really is no other way. Also remember that the point of billing the patient is not to get money from them anyway, just to get them to hold our unpaid bill and sends it to the government so that they know what is happening. If there are concerns from legal, as there always are, we need not ever collect from the patients but at least we have put it in terms that make sense to the average person. I talk to my patients about this stuff all the time and frankly they are very unhappy with the government but also obviously disappointed in us. We are their most important advocates so how do you think they feel when they see how we let ourselves get trod on again and again. They need us to be well paid and respected and if we can lay bare the MOH attempt to change that people will be very angry.
Shawn, by the way this was my middle ground in terms of “creativity”. I’m working on something that is much more creative that hopefully you will hear about in a positive way. I don’t mean to be secretive but it is still in early days
John, what does Oma legal say about all this? These look like good ideas.
I hadn’t run it by them yet but I’m not sure that it matters
I think that this would be better as an OMA communications campaign to raise public awareness and also show the government that the public support us because it is really clear that they do when they know what the facts. In fact they are downright angery. Would you want a cheaper doctor?
It would work exactly like my billing plan except instead of real bills we give them a informational bill with the amount that the government has not paid us for that visit and a summary of our objections to there recent actions.
It would in the section that you would usually return with payment we would have a letter to the premier that people could sign demanding binding arbitration ect. We could even include a preaddressed or even stamped envelope to their MPP.
That way we would make everything clear to our patients and show the government that the public trust and support us almost infinitely more than they do them. It will also remind the government that a doctor campaigning for a political candidate could be work hundreds of votes.