This picture stands in place of several thousand words. It lists a small platter of the things thrown at doctors recently.
But the picture is too small.
We could add hundreds of pieces of legislation, dozens of statutes and regulations; special interest groups, competing stakeholders trying to smother any status doctors ever had; the media’s attack on physicians driving public envy-cum-schadenfreude. It would fill a large mural.
- Why not Let Leaders Lead Healthcare?
- Who can stop and undo the Legislation Epidemic?
- Professionalism requires freedom. Will it be allowed to grow?
We need to communicate the same thing five times to get across one message. But some things are heard only by those who want to hear them.
High profile politicians inside Premier Wynne’s cabinet demonstrate they do not understand what’s happening in Ontario when they speak privately. If members of parliament struggle to understand the issues, how can we expect voters to see through?
Ontario has put doctors under siege. A siege delivers victory by attrition or assault. Getting the Ontario Liberals to negotiate with doctors would be a tiny step towards peace. But healthcare needs more; probably more than any political party can ever deliver.
[This post came from a local doc. He drew a sketch, took a photo and said, “Write the post!” Thanks, Scotty.]
Sometimes 140 characters is not enough :-0…
WE have allowed this to happen to ourselves…to our own detriment and to the detriment of our patients.
Every new piece of legislation and every new and ‘improved’ act of regulation tightens the chains that bind us and forces us to work ever harder for our patients. All the while patients, the media and, yes, the government force us to accept blame for the failures of the system. This leads to more legislation and more vigilant regulation while allowing the other health professions to ‘pitch in’ to help those incompetent MD’s.
The profession has not been vocal enough in the right places to get the message out that this health care system is not adequately working for patients for many reasons. IMHO, we have also been complicit in the deterioration of this system by doing things like swallowing the ‘hook’ of capitation. Sure we got more money after being starved so long under a moribund fee for service scheme. But access has plummeted as MD’s have signed up as many patients as possible but then hire other docs to work for the and/or go on vacation for weeks at a time several times per year.
To be fair, the Ontario Medical Association leadership is filled with well meaning docs who are trying to do their best to improve conditions for physicians and their patients. But the ‘tide’ is going out and will for years, maybe decades. It may not come back in unless MD’s and their associations are willing to stand up and vociferously point out the problems in the system instead of passively sitting by and accepting blame for the system’s shortcomings. Unfortunately, our well meaning leaders are also full time docs who are busy and getting busier. They are working against a well rested government and bureaucracy who work 9-5, get weekends off and take regular vacations.
I personally think that the profession would be very well served by a cache of physicians who lay down their tools to work singularly for the purposes of advancing and promoting the interests of the profession and, yes, our patients. Bottom line…if you look after the physicians and let them look after their patients, the ‘system’ will be better for it.
To continue blundering along in this system as it worsens and docs and patients alike suffer more is not doing a service to anyone. As things worsen, and they will, more blame will be cast onto physicians.
Great comments, Paul!
I agree. We are complicit.
Unions provide full time workers to fight for their members on every little issue. While I despise the unionist entitlement and disregard for those their profession seeks to serve, doctors have been forced to unionize. Although our approach lies outside official labour law, if we get mediation-arbitration, association versus union will dissolve into semantics.
I worry a little about the full-time workers you mention. I’ve heard many doctors promoting ideology that would work to undermine physicians, their opportunities to work, and their rights of self-determination. These were people serving in our association. Heaven help us if they were ever given a permanent, unelected position.
Thanks again for such a thoughtful comment!
Cheers
Shawn
Regarding full time physician workers for the OMA…
Why can they not be hired, so to speak, just like the OMA hires economists, lawyers, media relations people. Hired by the Board through an application process for a specified period of time subject to renewal as the Board sees fit. I’m not talking a la Gerace running his tin-pot dictatorship…
You are brave 🙂
Yes, I could see that working. I suspect we’ll need an army of MD union reps to deal with all the work grievances once we get med-arb.
Hi Shawn
Isn’t that what you are now, albeit unpaid …. an “M D Union Rep” ;-))
Hello Mike!
As always, you said it well. We came to a fork in the road and took the one most traveled.
Great to hear from you! I have fond memories of visiting with you and watching you and Allan collude at the end of the table. 🙂 I hope you are well!
Thanks so much for taking time to read and say hello.
Warm regards,
Shawn
Excellent summary Shawn. We, or at least our colleagues, are complicit with the demise of our profession. Again and again the government and the CPSO assault our freedoms and yet the majority simply take it with the resignation that getting maltreated by government is somehow inevitable.
How is it that the CPSO passes new regulations without the direct participation of physicians? How do they violate our privacy rights without the consent of the profession by direct vote?
Why do we continue to be the only profession who is denied the basic right to decide if we want to work for the government or ourselves?
The FHO system was not so much a bribe as bait. Bait for the trap of signing contracts directly with MOH. Now in the trap, the FHO Docs are at the whim of bureaucrats, but then again so are FFS docs but for much less money.
The problem is, not enough docs are even aware of the danger we are in. Not until the gate on the trap swings shut and it is too late. Our only choices to reverse the current state of affairs is either union-like activity including strikes or a complete withdrawal from the government system with a direct challenge to the Canada Health Act.
Great comments, Ernest!
Wow, imagine the CPSO passing regulations with direct participation/vote of physicians? Never. They want feedback but so often they carry on with what they wanted to do in the first place. I don’t understand why there isn’t more outrage at them posting when charges get laid even if they are dropped later. They said they are working on a process to keep the information up to date. Interpretation: they might get around to removing the information, but not before ruining MDs’ reputations with false information.
I’m sure there must be a way to directly challenge the CHA. Perhaps we need one MD who is retiring to accept cash for checking someone’s BP. Then we could start a court case when the province stepped in.
Thanks so much for reading and commenting. I suspect many docs just shrug and assume there never was any option to how things work now.
Best regards,
Shawn
I wonder…does being a self regulated professional mean that the regulatory body can ignore rights the physicians have under the Charter of Rights and Freedoms.
Sure newspapers and media print up criminal charges of citizens in the paper and this would certainly apply to physicians should they be charged under a section of the Criminal code. But does any other regulatory body in Ontario or Canada or anywhere else do this to the health care professionals that they regulate.
CPSO has clearly run amok and is busy doing the government’s bidding in aiding and abetting the controlling of physicians as well as reacting to headlines in big Toronto media.
That the increasing over-regulation of physicians is harmful to patients in not a connection that they are willing and able to make.
Excellent comments, Paul.
I find it interesting that tiny groups of physicians launched a lawsuit against the CPSO for trampling on MD rights of conscience.
S
ORPP arrow #22….more to come.
Excellent. Please feel free to add a list! Not enough room…
You posted this to Twitter. Which I believe leaves it open to comment from more than just MD’s. After working for Doctors. I’ve seen the good and the bad of Doctors and how they are treated by Government, Patients. But I’ve also seen how doctors treat patients both positive and negative. I’ve seen how patients treat doctors negative or positively. One thing I could never understand.. Is why doctors, after hearing from their patients about bad experiences with other doctors or seeing bad practitioners in action DO NOT COMPLAIN ….is it because your licence is at risk? or your reputation?
why be silent..look the other way?
My question to you is why did you become a doctor in the first place?
If it’s all about making a lot of money. GO TO THE USA.
I know it’s unfair not being able to strike…but I for one am very greatful that you are not allowed to strike… people get sick and that IS IN NEED OF AN ESSENTIAL SERVICE. I have no problem with work to rule to make your point. My ex boss charges for get this..referral notes to a chiropractor or physiotherapist. I told this to one of my “old school” professional specialists and he thought that was disgusting. So again…why did you become doctors?
I could list off the GOOD and bad experiences I’ve had with doctors. But, that’s my problem. I notice doctors do not appologize when they screw up..out of fear of getting sued, which doesn’t say a lot about our society…It’s MONEY, MONEY, MONEY.
On the other note: I have written my MPP and it’s fallen on deaf ear. so, we are both at odds. I have no one to stand up for me. and you are in the same predicament.
FOOD FOR THOUGHT. What is the next step?
Thank you
Ms. Barbara McKenzie
Medical Administrative assistant.
Thank you for taking time to write such a thoughtful note, Barbara! Excellent.
“Strike” was all I could fit into the box in the graphic. No one wants a full blown strike. But, all job actions are prohibited by the CPSO. I’m glad to hear you agree that some actions might be appropriate.
I agree. You cannot go into medicine for money. Unfortunately, we are forced to discuss it when the government legislates arbitrary cuts with no warning. I have staff to pay and had to use my line of credit to pay them this spring. We cannot run a business this way.
Patient service remains a major theme on this site. I hope you get a chance to read a few of the post here.
As it stands, patients lose out unless doctors are compensated in such a way that they can maintain a viable business. Right now, with my tiny rural practice, I must look for part-time work elsewhere.
Many Canadians believe doctors should be paid the same as any other civil servant. Many doctors are tired of being blamed for everything and shouted at for talking about money; they would love to go on salary and obey the clock instead of responding to patients. Salaries would cost the system much more and deliver worse service, but that’s where authoritarian socialism always ends up.
Thanks again for taking time to write.
Best,
Shawn
Dear Ms. Mckenzie,
To put this into your context as a medical administrative assistant, I would like you to consider the following.
I will assume that you are being paid a salary for your work. What if your boss announced to you that since the Ministry of Health had decided to pay the doctors less money for each service provided, he/she would reduce your salary accordingly? Would you be upset that you will be paid less for the same work while the cost of living goes up, and after you have not had a raise in several years?
What would you do?
Respectfully,
Monique Moreau, MD
Thanks again, Monique!
I became a physician because I wanted to care for people in need of medical help. That is what I do and that is who I am.
Forgive me for wanting to be compensated for the work that I do at a fair level. OHIP does not cover everything that patients request or need; that is a reality.
Charging a fee for a note for massage therapy, which is required to be reimbursed by the patient’s insurer, is not an insured service under OHIP. That means that when a patient comes in strictly for a note to cover massage and meet insurance requirements, I am not permitted to bill OHIP for that service. That is why I must bill the patient, because I have to be paid, so I in turn can pay my bills.
I am a physician. I am not mercenary. I do bill less or not at all when the circumstances dictate; I do have a heart but I have to support my family. Those who say it’s all about the money are generally in salaried positions and do not understand the fee for service model. The plumber who provides services to my office charges more per hour than I make.
I am not asking for more money. At the same time, I reject the responsibility bestowed upon me for health care cost containment while maintaining responsibility for the safe keeping of my patient’s health. Who should decide if Mrs. X should have an MRI of her knee because it is still sore six weeks after a minor injury and she insists on knowing what is going on inside her knee, and the orthopedic surgeon she insists on seeing will not accept a referral until she has an MRI? I am not perfect and I am not God. I am tired of being held responsible for every mistake, limited in what help can assist me in caring for my patients, and made the scapegoat of a health care system that has lost the caring for its users and its providers.
Wow, WOW!!
What an awesome response, Dr. Moreau! I am going to post this as a separate, stand-alone blog post. You said it best.
Thank you!
Shawn