Like a scene from a teen dystopian flick, doctors in Ontario face a major decision. Do they stay on the government train that speeds deeper into bureaucracy? Or do they risk a jump for dreams of change?
Doctors must decide next weekend.
- Do they believe that government knows best?
- Do they really believe other countries outperform Canada?
- Do doctors want more of the same, more central control?
- Do they want substantive change?
- Do doctors want to jump off the government train?
- Is it even safe?
Doctors must choose, and they need an association to lead them.
Apolitical?
Some try to discuss healthcare and pretend the issues are apolitical. But even a short list of issues forces us to examine our political perspective:
Choice – Do we think patients should choose their physician or be assigned one?
Control – Should physicians find creative solutions to meet their patients’ needs, or should a central authority plan and implement solutions? Can we force complex systems into a complicated design?
Equality – Should worker’s compensation patients and veterans get early access to tests and have reserved beds in long-term care, or should everyone wait in the same line?
Excellence – Should patients get the best care from the most highly trained physicians, or should patients get most of their care from nurses and RPNs?
Access – Should elderly, rural patients have to drive over an hour into town to get simple blood-tests and ECGs, or should doctors be allowed to provide the service close to home (should it be funded)?
Rights – Should doctors accept arbitrary government cuts, or should docs have legal options to fight back? Should it be illegal for MDs to work outside Medicare in Ontario?
Services – should Medicare cover everything from infertility treatment to sex changes, or should it limit treatment to life-saving therapy and chronic disease?
Each of these, and dozens more, forces us to examine how we think society should function. Everyone wants great healthcare, but we differ on how to get it.
Doctors Decide Future
Doctors must choose. Not deciding is a choice for more of the same. We can stay on the government train and hope it’s headed for Elysium. Or we can jump off. Despite what our hearts tell us, change is actually more like stopping the train or choosing a different track.
I hope doctors realize the opportunity they face at the council meeting on May 1st. The puree of Green-NDP-Liberal-Conservative council members stands at the door of the train. They will have to choose. Can they?
“Pretend the issues are apolitical.”
I nearly died laughing! (OK an exaggeration).
I have been using this same expression for years!
Both the general public and physicians have a tendency to observe changes (or status quo) as free from political forces which it totally bogus. In fact, if certain organizations pretend that politics don’t matter, I don’t even support them charitably! Ex. World vision, Red Cross, etc. EVERYTHING is political. EVERYTHING happens when the political movers and shakers say so! Things collapse over failure to employ legislation, policy, etc.
Shawn, Can you comment on, for your readership, the significance of May 1st?
Thanks.
KB
Thanks for commenting, Ken!
I struggled with what tone to take. I think many genuinely believe some things are not political in healthcare. I’m glad you provided the balance! 😉
Council members will take part in a pre-council session on the future of healthcare on May 1st. Then on Saturday, May 2nd, council will debate the legal options open to Ontario physicians. Both days will be (could be) turning points in Ontario politics.
Thanks again for reading and commenting!!
Best,
Shawn
I wasn’t going to make much of a comment on this post – don’t think it’s my place. But then I read Ken Brown’s post. Of course everything is political in health care these days. I don’t just spout off on twitter and doctors’ blogs, and I think many more patients than you might think are of the same opinion about the gov’t and healthcare. The challenge is to get them doing something about it. Anyway, I’m not on my soapbox regarding this post – just wanted to wish all doctors who participate in the conference next week the best of luck. Hope you are truly, honestly and sincerely “heard”.
Thank you, Valerie!
It helps to know others, like you, worry about government micromanagement.
I sure appreciate you taking time to share!
Best,
Shawn
Thanks. For docs that can’t attend, is there anything to do?
This is an OMA council meeting. Now there’s politics. I am sure there will be a good exchange of ideas. But with all due respect to the OMA (who is bound to the govt by their own prior agreements / mandate I believe), and the dedicated individuals with the OMA, but it is unlikely they will make moves that would ask the OMA and their baggage to “move out of the way”, and render themselves irrelevant. Feel free to set me straight, as I am out of my expertise zone here.
Link to website:
https://www.oma.org/documents/council/index.html
Great questions and comments as always, John.
Writing to the health policy department would get your ideas into the debate but not as much as just showing up. (register first) It adds sizzle when even one doc shows up on their own time to express concern.
As for choosing to diminish their relevance, I can think of a number of things you might mean here. I suspect you refer to negotiations. As long as there is a government system and government insists on collective bargaining, the OMA will have work to do with government.
However, only 30% of the budget goes to negotiations. So there’s plenty of work to be done outside of that.
There are many more things I could say here about issues like RAND, focus, structure, purpose, etc. But it would take us off track.
Thanks for taking time to share!
Best,
Shawn
So, the gist of what your saying, is that the OMA does have the potential to be a force for change, with respect to Medicare, physycian rights, legal challenges etc?
It seems to me the sentiment in the grassroots physician community, rightly or wrongly, is that the OMA is impotent in this regard.
Historically at least, it seems they’ve left the thornier issues to be taken up by the College, the Ministry of Health, and the CMPA.
Massive potential.
Variable will.
For example, when we populated the board with a group of exercised Coalition members, their focussed will drove change.
Will comes from the grass roots. If people who see the need for change don’t get involved, we end up with more of the same.
Wynne did us a favour. She inflamed the will for change. Let’s hope it doesn’t fizzle.
Thanks again for writing!
Yes we have to choose if for no other reason that if we are going to live in this province we need this healthcare system too. We cannot accept the status quo. We cannot afford to pay family doctors in family health teams very well to see 60 patients per week. On the other side of the coin doctors who see 60 patients in an eight hour day and address only one problem per visit should not be rewarded handsomely either. Shift the money to the high performers if people want to be low performers they can stay they just won’t be paid so much. What if we had binding arbitration and it was decided we all should be paid more? That doesn’t solve much because under the present system we are already going into +++debt. Let doctors take care of groups of patients in their own way. High performers will group together and find efficiences. Low performers will have to find their own way. My previous two doctor office was highly efficient we saw each others patients if one of us was off for a day because we got paid extra for it. We were in a rural location we did bloodwork in the office because we got paid for it. Not alot but enough to make it worthwhile. In my present family health team system we only see each others patients in a few narrow time slots called ‘evening clinic”. There is no incentive to see a few extra quick patients (a child with an ear infection for instance) in fact it acts to your detriment you get farther behind and get nothing for it.
Thanks for this, Len!
You packed a tonne of content in it. It’s impossible to respond fully to everything you raised. No one wants to talk about incentives in medicine these days. God forbid that we talk about ‘low performers will have to find their own way.’
We also have to acknowledge that regional differences impact practices. I just set up a tiny rural practice near where I live. Everyone said, “You’ll be swamped in 3 months.” After 1.5 years, we still have <1000 patients. I have to work outside the clinic to make ends meet. But that decreases access...which slows growth... Of course, I could just go into debt for a year and staff the clinic every evening and wait until people came out. But I am not ready to go back into debt at this point in my career. I do not want sympathy. I'm just saying that volumes per practice differ for different reasons.
But I heartily agree with letting the low performers close up (including me, if I do not get my numbers up!). [PS. they're growing steadily every month]
Thanks so much for taking time to read and share a comment!!
Best
Shawn