Legolas trained his ear on Caradhras, “There is a fell voice on the air.”
The entrails of lynx and the hump of hyena divine the portents. Palm readers foretell young widows, poverty and bankruptcy.
Doctors plumbed new depths this weekend. Starving sailors cast lots on whom to eat first. After six years of cuts, OMA council seems to have voted to attack colleagues. Rob Peter to pay Paul. Is the profession imploding?
When the day looks darkest, and the opposition insuperable, it is the worst possible time to cast lots on whom to throw overboard.
You might as well surrender. You have lost the ground to govern. No amount of rhetoric can justify support for even greater cuts to specific sections at the depths of the deepest cuts of all times.
After the warm glee of internal combat subsides, government should panic. Its greatest hope lies in negotiation with one party of doctors. Chop up the Ontario Medical Association and government faces a nightmare, no chance of victory.
Every good and dark movie has a scene of portent and foreshadow. Luke sees a vision of his father in the Dagobah marshes. Macbeth’s witches, the Weird Sisters, conjure visions. Macbeth cries, “Thy crown does sear mine eyeballs!“
The Ontario medical system enters a scene unlike any seen so far. In the past, the narrative pitted oppressors on victims. Evil power mongers pulled levers to push public sentiment against doctors. Mongers heckled and slandered. They invited attack. Voters crushed the mongers into non-party status.
A new era began. A new government, green and unsure, took charge. They hoped to rebuild quickly but did not realize – or refused to see – how deep they must dig to create a new, solid foundation. Fallout from the last regime corrupts all sites. Only by digging deeper, beyond the scorched landscape, can a new regime start a solid foundation.
In a modern Canticle for Leibowitz, Ford Conservatives must rediscover what and why medicine meant anything to citizens before the apocalypse.
Medicine cannot save itself. Doctors cannot pull together without help. They’ve shown the same survival instincts that sailors show on a lifeboat with no water or food.
If natural disaster sets the boat adrift, we blame God. But Medicine drifts at government command. Wynne Liberals set it out. Ford Conservatives inherited the boat. As doctors debate whom to eat first, patients suffer on wait lists.
A ship full of starved sailors makes an easy target. What pirate could resist? But politicians are not pirates. So early in office, government must know that it owns the outcome, whether government chooses to capture or capsize the vessel.
If government is wise — and I believe it wiser than we allow — it must rescue the sailors in a way that the sailors think they have won. Give them water. Give them food. Let them know that they will not lose their businesses, their careers, and their identities for God’s sake. Let them win to fight another day. Be a hero by letting your opponents survive.
The medical profession has been broken, critically wounded. Government should not gloat at crushing such an easy rival. Indeed, it should blush.
Government stands to win by rescuing its opponent instead of pushing her under. Government stands to win, and patients stand to win much more.
Will government have the courage to win through magnanimity, in medicine’s darkest hour?
I am not sure the Ford Govt will get to read this but if they do , hopefully they will realize that this is not hyperbole that you speak Shawn . It really is that bad in my opinion.
Well, I’ve tried to be as obtuse and poetical as possible.
The issue I’m trying to bring out — I always try to spark discussion — is whether doctors should attack each other at this point. I think it’s the wrong time. After 6 years of cuts, I do not support more cuts of any kind. Period.
Thanks for your comment!
Hi Shawn
Love your articles and the sweeping allegorical themes. And I appreciate all that you have done for the physicians of Ontario. That said, I would respectfully challenge your position that “politicians are not pirates”.
A loose definition of a pirate is a person who attacks other ships and steals property from them. There are other connotations for piracy, but let’s stick with this description. I do not believe it is a stretch to make the assertion that physicians in this province, and especially family physicians (of which I am one) are under a direct governmental assault.
As for the “stealing” component, one needs to look no further than the egregious tax changes to corporations imposed upon us by the righteous Bill (short for “billionaire”) Morneau, or the outrageous position on primary care put forth by the the Ford government at the Arbitration proceedings.
If we accept the pirate analogy then our most appropriate recourse as physicians is to meet this assault with overwhelming force and resolve. Unfortunately, the divisions within our profession will likely prevent us from doing so, and as a result we will end up serving as the arbiters of our own demise.
So I do not hold out much hope.
As they said in the movie Jaws when they realized what they were up against: “We’re gonna need a bigger boat”! Sadly, I don’t see that boat anywhere on the horizon.
Regards
Charlie
Brilliant comment, Charlie.
And I LOVE the fact that you pushed back on the pirate bit. I hear you and agree. Piracy rings true in the way you’ve presented it. I guess I was writing in a way, hoping that maybe someone in government might read it, hoping that they would choose their better selves. After 6 years of cuts, chopping at docs can become a new normal. I was appealed to a side that, I hope, would eschew cuts. If they choose more cuts as a new government, then we have every right to call them pirates.
Again, great comments. Very thoughtful. Thanks so much for taking time to read and comment!
Cheers
The OMA is beginning to resemble the Russian ghost ship “Lyubov Orlova” , that was taken over by cannibalistic rats as it drifted aimlessly for years in the ocean….eventually to sink out of sight in the Atlantic Ocean.
The medical profession can be seen as a cross between Atlas holding the burden of the world on its shoulders and the idealistic and loyal Boxer, of Orwell’s Animal Farm , with his “ steadiness of character and tremendous powers of work” who was thoroughly exploited and worked to death by Napoleon and the collectivist elitist pigs.
A crushed and demoralized medical profession is of no good to anyone and not to themselves and their loved ones…depriving Boxer of his feed whilst demanding more and more productivity from him is a foolish self defeating recipe for disaster for all concerned.
What if the unappreciated and maltreated medical Atlases simply walked away from the burgeoning burden?
All the generals and officers in the government and the MOHLTC finding their trenches empty, the battlefield abandoned , helpless in the face of an advancing enemy unimpressed by their guidelines, protocols, rules and regulations would be overwhelmed in seconds….not minutes…seconds.
Well said, Andris. Well said, indeed.
I, too, believe that we are at that point. The system is far more fragile than those in government realise, I think. The board of arbitration needs to know it too. This is not just about dollars. It is about the life of medicare in Canada. I don’t mean to be histrionic, but there’s only so much that a profession can take.
Thanks again. I hope everyone’s read Orwell!
Cheers
I am going to totally geek out here, but I like the Lord of the Rings reference. It is actually a good analogy.
When all the factions of Middle-Earth banded together, they defeated the Dark Lord Sauron. But, Sauron gave each of the kings of men their own ring of power. This divided them as they used the power of the rings to fight each other seeking wealth and fame for themselves. This weakened them and they ultimately became ring wraiths and all served Sauron.
The government posesses the One Ring with legislative power and has eluded to each faction getting their own minor ring of power. “One ring to rule them all and in the darkness bind them.”
I wonder how many docs will make like the elves and ultimately sail away instead.
Loonie Doctor, this is exactly correct. And in the story men loved the lesser rings. We have ignored the core problem. I feel more sad about this than about all the turmoil to date.
“Even in the darkest hour, when all hope seems lost…there is light.” LOTR
Always agood read Shawn. The problem with the post is not the content, but the timing. We are in agreement tgat this past weekend a line in the sand was crossed that should never have been crossed. The funny thing about lines in the sand is that once they are crossed, they cannot be uncrossed. This represents not the end of internal cuts, but the beginning.
As to your cannibal sailor analogy, it means very little to the first man who was eaten that the remaining men, while picking their teeth clean of his flesh with scaps of his bones, that they all now disavow their barbaric act.
The end was authored by the overwhelming majority who voted to enrich themselves at the expense of their colleagues. They only took a nibble this time, but seeing no consequence, they will be back for a more fulfilling meal in the near future. I won’t be around for that and neither will a great many sections of specialists who can read the omen and divine the future.
I hear you, David. Either we are a people who cut, or we are not. We cannot have it both ways.
As Nadia’s President Update said, the board delayed taking a position on this advisory motion until after Phase I of arbitration. Furthermore, the motion is advisory. There are far too many moving parts to simply say we must tear up the original mandate and start again with a new mandate, at this point. As you know, the board adopted a mandate that included these principles from the start:
1. No more cuts to any doctor
2. Return the stolen money to the doctors from whom it was stolen
3. Do not rob Peter to pay Paul
Until such time as a decision is made to cut any group of doctors, I hope all doctors will stick together and try to fix this. Once a binding decision is made to adopt a position to cut colleagues, the honourable thing would be for the those who aren’t cut to help those colleagues leave. We cannot say we are an association that exists to improve the lives of all doctors while cutting the incomes of certain doctors. This is not just my opinion; it is current board policy.
We must find a better way to address relativity.
Thanks for taking time to read and post comments!
Cheers
Agree with david jacobs’ comment above. The damage has been done. The moment that the OMA voted to harm its own members is the moment that its fate was rightfully sealed.
Once a number of specialists leave, there will be family doctors (FFS vs FHO), psychiatrists, general surgeons, neurologists and a few others left to fight amongst thsemselves (though I suspect that at that point, this idea of taking from others will simply be voted out).
The OMA special council meeting was a very sad day for the OMA and Ontario doctors indeed, as it showed how greedy some groups are.
I agree, Upset.
The “special council meeting was a very sad day” for me too.
I also agree that some damage has been done, but not in the way you say. Even IF the motion had been binding, the complexity of the arbitration process would make it impossible to simply drop it into the mandate, unchanged. We have no idea what cutting means when it comes to intra-sectional relativity. There’s a good chance that cutting could lead to cuts to those doctors who are already earning lower incomes simply because they are members of a higher income group.
Three hundred people in a room cannot make operational decisions. It does not work. Some docs are thrilled to hear about cuts to colleagues. But even IF cutting gets adopted at some point in Phase II of arbitration, those who support cuts will be frustrated when they see how convoluted it gets in arbitration. By definition, we do not control arbitration.
At this time, endorsing cutting would send exactly the wrong message to the board of arbitration. Government has endorsed cuts from the start. We have resisted, from the start. We continue to argue against cuts of any kind.
We need to pull together, not apart. I have spent the last 6 years railing against cuts to doctors’ incomes. I have not changed my mind about cuts, regardless of any glorious end the cuts are supposed to deliver. Cuts are bad for doctors and bad for patient care. Full stop. If the OMA adopts across the board cuts, it will fracture the organization far more deeply than ever before.
Thanks for taking time to post a comment!
“ 300 people in a room” can result in “ group think” ….having 300 intelligent people in a room does not mean that there is one gigantic collective brain in that room…the result is often a “ weak, meek, submissive and impotent collective mind” as occurred in this case ( herd like “ Group think “ is characteristic of what passes as socialist conformist “thinking” these days).
Thanks Andris. I usually agree with council. I do trust their wisdom when asked the right questions.
But as Aristotle warned, direct democracy can lead to tyranny, if we let it. Give voters the chance to “eat the rich” (a book title) and they will vote in favour. We need representative democracy based on a set of principles/constitution.
The starving sailors,as a matter of survival,will continue to seek food … indeed.
What they need is a new,innovative ship that will value each sailor for their skill (true ‘relativity’).
That ship is a parallel private system that will serve as a pressure valve,and allow choice for patients and docs….similar to the UK.
I have watched over the last 25yrs as gov’t has pitted doc vs doc …. very sad ….. to the outcome of this past w/e.Yet docs keep moving those with power/influence to the front of the line,and those with money go south.Losers are docs and ‘the middle class’s ( as Mr Dress up likes to call them ).
I hope Dr Jacobs is successful,as I would at least like to see Randing gone by the time I retire ….
I agree with everything you said up until the last line. At this point, deep in arbitration, we could not think of a worse time to fragment. I would welcome a debate on RAND once we have a contract in hand. Right now, we need to stick together. Those who want to fracture the OMA are making it worse, by orders of magnitude, for all of us, including themselves. That includes the special council meeting too.
I wish people could understand how terrible it is to foment division right now. But greed and fear drives people to do irrational things, even it if hurts them in the process. Very sad.
Hoping for a better outcome…
Thanks again for posting!
Shawn , well said .
We can’t strike . But I can quit . You can quit. If we all quit at the same time what happens . It’s not a strike . We are not asking for anything , we are all just quitting and in peace leaving the government to cope . We won’t even have finished the call to the Realtor to list our homes before the government is on its knees . There is no law against quitting ( give patient 12 weeks notice etc ) …. and there is no rule saying more than one person at a time cannot quit !
You nailed it, Zoey.
I worry that those who can, will. And doctors will be blamed. As Andre Picard is fond of saying to any doctor who mentions quitting or leaving, “Don’t let the door hit you on the way out.”
As always, when patient care becomes entwined with politics, patients lose out. The next 6-9 months will be very interesting for sure.
Thanks for taking time to read and post a comment!
Poetic justice would be for all of those who voted in favour of attacking their colleagues by greedily attempting to take their money to be left in the remnants of the OMA once many specialists leave, to then fight amongst themselves. In particular, psychiatry, who have been extremely aggressive throughout this.
The OMA Board and president have failed in their responsibility to protect all of its members. Either now, in the near future, or in the distant future, the OMA will eventually be broken up. A line has been crossed, and most on Council too stupid (or greedy) to understand the implications of that line.
These groups have now lost my support.
Thanks, Done.
To be clear, as the President said in her last update, the board will delay taking an opinion on this until after Phase I of arbitration. The OMA continues to fight for all doctors in Phase one: no more cuts, return the stolen money, no PSB cap, etc…
But I hear you. I feel very sad. We need to find a way to pull together, especially now.
Thanks for taking time to read and share a comment!
Thank you DONE. Very Clear . I as a newcomer (though have not got one benefit from Justin’s Newcomer’s Immigrant Program)
I understand Sean’s response and hopefully as it an Advisory Ruling it can be ameliorated and diminished and reduced to becoming meaningless. I said on the OMA Floor two years ago that this was bound to happy at the time of what I call the ‘ Young Turk’s’ rebellion. I understand Shawn’s )and others reluctance to move thru the stages of grief . (and like your good self Shawn I in no way mean to be offensive or harsh or troublesome or disruptive as I value too much – I love what you and Nadia are doing with the OMA) .
Every President hopefully brings in “signature reforms ” and you have ensure quite a few. (Enough of my “brown nos …. now)
If indeed this is recent advisory motion is reduced to being practically non-existent , we must ACCEPT that this FACTION generation that the OMA is experiencing will continue as long as we are FORCED to be Members. (and pay for the privilege and it is not a privilege , it is a RIGHT !)
Thank you, Dr. Foley. Very kind comments.
Just to be clear, NOTHING has been reduced, diminished or become meaningless. It’s just that, for the work at hand, the motion does not help. Also, I’m just a past president now. I still care deeply about doctors and the OMA. I care because if doctors are in disarray, patient care suffers also.
You make some great points about factions and freedom. I hope we can stick together long enough to get a contract. We can have a debate about separation after that.
Thanks so much for reading and sharing a comment!
Cheers
Large elected councils were created to be the political mind of an association. Boards of directors were created to be the corporate mind. Large elected political bodies have no fiduciary responsibility to the enterprise. Boards do. Political bodies are designed to pursue the self interest of the majority of the moment. Boards are designed to pursue the longterm interests of the enterprise they govern. Boards should be responsible and accountable for negotiations because it is part of the board’s role in developing, directing and providing oversight to strategy. Large representative bodies composed of clusters of self interest that meet infrequently and do not have access to up to date information in a rapidly evolving environment should NOT be directing negotiations. OMA continues to suffer the consequences of poor alignment of roles and responsibilities in its governance structure. Fragmentation of the power of the collective whole is one manifestation of that organizational flaw.
Glenn,
Brilliant comments, as always. Thanks so much. It sure helps to hear from you as a seasoned governance expert. These issues will keep coming up until we figure out the governance. ONCA would force us to clarify things, but until then, we struggle along.
Great to hear from you!
I agree with the vein of what ‘Done’ and a few others have posted above.
This came down to a tyranny of the majority. Council has maliciously (and as ‘Done’ wrote, very STUPIDLY) voted to take money from their colleagues. This amounts to an attack on their colleagues, fuelled by greed.
The leadership of the oma failed in their duties. That council meeting should never have even been allowed to form. And the RAC should be immediately disbanded… *** Host deleted one sentence. Explanation below *** …There demonstrates a clear bias. I have heard rumours that dissent within the committee was squashed and disallowed from seeing the light of day. Were there no dissenting views? Somehow I seriously doubt that the answer is a yes.
Now, we all will pay the price. I have no intention of staying with the oma if given the opportunity.
The oma has absolutely no moral authority to continue to demand dues from its members.
Let the greedy *** deleted word *** and others fight for their own fees with the arbitrator.
Does anyone really believe that the government will be willing to pay psychiatrists so much more such that they’d be the highest paid in the entire country, and maybe world anyway?
Good luck with that.
Angry,
I deleted one sentence, and one word, in your comments. Although I want to bring out all the energy we can, I really try to avoid names, if possible. I left the rest of your comments as written, even though some show potential to inflame/hurt. I hope you can understand.
You make some solid points. Direct democracy often leads to tyranny and suppression of minority interests. A Glen Tecker said in a comment on this post: bad or unclear governance will lead to bad outcomes, if we let it.
I agree that IF we — the OMA — decide that we will support and apply across the board cuts to certain groups of doctors, then we have completely changed as an organization. IF that happened, we could not claim to represent the best interests of all doctors. We would have no moral ground upon which to demand dues. I am surprised that this idea wasn’t developed more on the weekend. We cannot demand that people stay and cut their incomes at the same time.
I appreciate you taking time to read and comment. I sure hope we can pull together on this. I keep hoping there’s some solution that will come out of arbitration.
Glenn Tecker so true and this is indeed the Legal definition Per Companies Act (England and Wales) and as furher defined by various other Jurisdiction using English Common Law .
However , in my experience multinationally with for Profit and Not for Profit Organisations – both Political and Non Political , either having significant Fiduciary duties (Such as a Fortune 500 Insurer) and one with little Fiduciary Duty (Voluntary/Mutual with no fees paid by Members -yes they do exist) NOWHERE did I see these duties being taken seriously by the BOARD or the EQUIVALENT OF THE COUNCIL.
As I result of being pointing this out to the BOARD and it’s COUNCIL I am now “banished” to Toronto and other places before this.
Are you telling me that the OMA is not at all like these organisations (used the Original Word for ORG before “North Americanization”) where I nearly drove myself mad as a senior executive.
Look me up if you dare ? I have given many clues and cues.
All in the spirit of health debate Glenn I don’t mean top be confrontational , though I would have preferred you gave us your opinion instead of a what I perceive as a lecture 🙂
No apologies for my tone . the days for apologies are gone.
I’ve closed comments now. Although it was great to get passion, we were collecting a number of anonymous posters. While I appreciate the need for anonymity on some topics, especially to express concern, I worry about anonymity becoming a cover for sharper comments than we might use otherwise.
Thanks again to all of you! We need more dialogue, more discussion. I hope you can continue to talk about it with your colleagues at work.
Cheers