I almost drowned at summer camp. I told everyone that I could swim.
I just didn’t say that I could only swim as far as I could hold my breath.
I always wore a face-mask. It let me see my next hand hold, somewhere to pull my head above water.
Our summer camp offered one, main activity: swimming. Kids spent all afternoon jumping off a raft, avoiding the leeches near the shore.
The raft floated far out on the water. Could I swim there on one breath? After 2 ½ days of avoiding the water, I started drawing attention. Wanting to play with the cool kids, embarrassment overcame fear.
My breath took me within 10 feet. I saw flashes of raft and swimmers, whenever my mask broke the surface. I flailed, and sank. Kids cannonballed and wrestled around me. They shoved to get on the raft. I gasped and coughed and lost sight of my target.
The next thing I remember, my hand gripped the ladder. Shaking with exhaustion, I crawled up, rolled on my back, and faked a smile. Kids pushed and jumped in the water like I did not even exist.
Desperate Doctors
Doctors tell patients, “Everything is going to be all right. Your lung has collapsed. But we can fix it. We need to place a tube between your ribs…”
What happens when desperate doctors start to panic?
Premier Wynne’s government has attacked doctors and treated them worse than any government in recent history. Wynne has unilaterally cut almost 8% of gross funding, in less than 24 months, and has completely ostracized doctors from decisions about medical care.
Then without warning, in the middle summer, when no one reads newspapers or blog posts, the Wynne government decided they want peace with doctors and offered doctors a new deal.
No one even knew doctors were negotiating, including doctors. The government offered another take-it-or-leave-it deal, like they had in 2012, 2014 and 2015.
The government sweetened this offer a bit. They promised to fund 2.5% of growth, double what they had been funding, but still less than the historic 3.1% growth to cover new patients and doctors.
Most importantly, government offered the Ontario Medical Association (OMA) a spot in ‘co-managing’ healthcare. They offered doctors a spot on the raft.
Thick as Thieves
The Wynne government faces 5 criminal investigations. Premier Wynne’s approval rating sits at 18%. The Ontario Liberals are famous as the most indebted sub-sovereign government in the whole world, having borrowed to win votes and fund windmills, gas plants and pension plans.
Health Minister Hoskins boasted for two years that his government has given 1.25% percent more to medical services. He sounded like a deranged parent boasting to Children’s Aid that he gave another 1.25 oz of formula to his baby, even though the infant needed at least 3.5.
Now the government – under criminal investigation! – has offered desperate doctors a spot on the government raft.
The OMA rejected a deal in 2014 because it underfunded growth and offered a fixed budget.
The board faced a sharp decision this time: Do we choose more unilateral cuts, uncertainty and no voice in the system? Or do we choose collateral cuts, less uncertainty and trust that we will get a ‘voice at the table’?
If the OMA is shunned from all decisions, how can it advocate for members?
Aren’t predictable cuts better than unilateral ones?
Isn’t it better to sit on the raft, while government throws Bills like 210 and 119 into the water?
Or should doctors fight back, on principle?
Regardless of the pros and cons, or what you think of this contract, government has doctors over a barrel. Either way, doctors must dance. They lost their say in the matter in 1967.
Doctors Vote
The OMA has done everything – short of parades and door prizes – to convince doctors to accept this deal, leveraging every ounce of good faith in the process.
A large group of doctors has called for a ‘General Meeting of the Membership’, the second one ever. The last Meeting occurred in 1991 over a similar, less than ideal tentative contract. It foretold a decade of cuts. Doctors accepted the contract, and the next one in 1995. By the end of the 1990s, 2 million patients had no family doctor. Bestsellers like, Code Blue, predicted the collapse of Medicare.
Not Cool
After nearly drowning, I sat on the raft and hugged my bony knees all afternoon. The kids ignored me. I was not cool. I do not remember getting back to shore, or ever going back to the raft.
Desperate, divided, powerless and panicked, doctors must make a terrible decision. The government will do what it wants. Doctors can be part of a dysfunctional government or have dysfunction forced upon them.
Faced with any other option, everyone chooses to not drown. People get that. But it’s a terrible way to make an important decision. Surely, patients deserve better than this?
(Disclaimer: In case it was not obvious, this post tackles the nature of the decision, not the content. Please do not read into this any more than it says. My official, approved, public opinion on this deal can be found here.)
I have distrusted government for a long time. Now. because of the actions of what to me seem to be OMA insiders in suppressing other opinions than those of OMA on the current deal, I no longer trust the OMA to represent the physicians of Ontario in a transparent way. It appears to many that the deal is not in the best interests of physicians and patients of Ontario. In order to promote a Yes vote to this deal, the OMA has been advertising for the deal and even spamming members with emails advocating for the deal. The last few days there have even been robo-calls from the President of the OMA to doctors advocating for the deal. Today I heard from colleagues that even individual phone calls by human beings have begun.
Many colleagues have said that they would rather take a cut in income than have the OMA’s being complicate it in the continued rationing of health care in Ontario. One of the key points that the OMA seems to be that physicians trust the government to keep their end of this bargain even without Binding Arbitration to fall back on. There is much more than have said in other places but I don’t want to take over your biog. completely
I present the following as evidence that even back in 1994, the OMA was gathering proxies to pass an agreement with government. Back then the OMA made an agreement with the government that the government subsequently reneged on.
My pal, Michael How croft was very active in OMA politics in the late 1980’s and early 1990’s. We lost a great one (medically and otherwise) when in frustration he moved to Iowa back then. He is aware of what has been going here in Ontario and sent this email:
Just to give you some history, the last time there was a general meeting was 1991.
I was section chair at the time and we were faced with a P.A. which would
result in physician “income caps” (350K for family docs and 400K for
specialists) and would give the OMA representation rights for all MD’s and
allow them to invoke the rand formula (mandatory dues). Obviously we were
not very happy. We engaged a health care law firm and I co-chaired a specialist coalition to fight the proposed agreement.
At that time, we only needed a 100 signatures from members
in-good-standing to petition a general meeting. I presented the petition
to the late Tom Porter (chairman of the OMA council) and he advised council
that they did not have rights under the by-laws to ratify the agreement and
that a general meeting of the membership would have to be called. The
only venue big enough was Maple Leaf Gardens. (I will never forget seeing Lary
Melnyk at the meeting in Maple Leaf Gardens wearing a baseball cap printed with “I’ve
been capped!”)
In the meantime, we worked hard to drum up opposition to the agreement and I did multiple media interviews regarding the issue. In the end, the president of the OMA (I think it might have been Mike Wyman) showed up with several thousand proxy votes and the agreement was
ratified.
The OMA board and council were very upset that they were circumvented
by the petition and subsequently passed a by-law amendment (initially known as
the “Howcroft” amendment) raising the required number of signatures
for a general meeting to 5% of the membership. However, I was
subsequently elected to the Board from Council.
I served the board in a number of capacities, including as a member of the 1992
Negotiating committee (with Dave Huggins (chair), Family MD, Timmins and Herman
Hugenholtz, Neurosurgeon ,London). We worked with the OMA labour law firm
in negotiating an agreement with the Bob Rae NDP government (remember the
“social contract “?). We developed a complex agreement that
included “delisting” a number of medical services and a provision for
incorporation by MD’s. After ratification, the government simply decided
not to carry through on many of its commitments but held us responsible for
ours. I remember the discussion at the board about what to do and what I
advised was never to enter into an agreement with them again. Discouraged
and frustrated I left the board not long after that.
If I had a vote, I would definitely vote no. Given their past experience, it’s
surprising that the OMA continues to negotiate with this government. I
would also sign the petition for a general meeting as this gives voice to the rank
and file membership. A general meeting is also a great media opportunity to
expose the OMA and government malfeasance towards the citizens of Ontario.
Mike Howcroft
THE GOVERNMENT SIMPLY DECIDED NOT TO CARRY THROUGH ON MANY OF ITS COMMITMENTS BUT HELD US RESPONSIBLE FOR OURS. I REMEMBER THE DISCUSSION AT THE BOARD ABOUT WHAT TO DO AND WHAT I ADVISED WAS NEVER TO ENTER INTO AN AGREEMENT WITH THEM AGAIN.
—Michael Howcroft, M.D. OMA former Board of Directors Member
Thank you Gerry!
You always Kickstart a great discussion. I think that we earn trust by what we do; we develop reputations. Organizations do too.
Unfortunately, trust takes years to earn and moments to lose.
I have terrible reception out here at the cottage. Will engage more later.
Be well
Shawn
When I find myself faced with a patient who is suffering abuse, my first piece of advice is always to get out. Get safe. By all means don’t stay with and appease the abuser because the abuse always escalates.
Wise advice, Ernest.