23 thoughts on “Ford Fools Physicians on Arbitration?”

1. Shawn, I’ve always liked your blogs. I’m a little less naive than most…I never thought we had arbitration in the first place. The arbitration act is very specific…but it does not apply to physicians. We are not employees…we are not governed by labour acts either. In fact, all we have are basic human rights as defined by the charter. People say that we cannot strike…it’s a bit like saying a restaurant owner cannot close their shop. We are no different than any other business as it relates to the exchange of money for goods or services. Perhaps the only difference is the services we sell and the payer. We also have a college that defines how to withdraw services. The government can decide to pay zero for our services tomorrow…what then? They can do anything they want at any time. The only thing we can do is decide not to provide services as defined by the college. You know, I was reflecting on the Twitter comments and Facebook comments for the past few days…everyone is blaming the specialties association…wow, that is so naive. So, an association of 3000 people can convince a government to change course? Where is the leverage? Everyone is blaming this David Jacobs guy…ridiculous. The government was going to do this anyway. We need to find another source of payment for our services. This is unsustainable.

   1. Great comments, Concerned Doc.

      IF we are private businesses, then we can’t expect much. But they treat us like serfs. “The government can decide to pay zero for our services tomorrow…what then? They can do anything they want at any time. The only thing we can do is decide not to provide services as defined by the college.”

      Our only option is to not work. Even then, we might be on shaky ground. It would be hilarious to see a government write back to work legislation for a group of independent contractors!

      You make good comments about blaming Jacobs, et al. I think government was looking for an excuse to step back. They didn’t need much. This whole thing is a mess. I just wish — desperately wish! — that we could just make a deal and get to work fixing all the other problems in the system!

      Thanks again for taking time to read and share a comment.

      Cheers

2. I would like to see the actual letter that the govt sent the OMA. I suspect that the government has suspended negotiations until the OMA-OSA situation has been sorted out.

   I don’t think arbitration is literally terminated for good. I think that once the dust settles both the OMA and OSA will be bargaining and arbitrating for their own members.

   I do not believe that Doug Ford, who made health care one of his major election planks, would wish to make worse.

   Again, would like to see the exact words in the letter from the government to the OMA so I can interpret the words myself as so far I have only heard interpretation of the letter.

   1. I found it. Let’s look at the letter that was sent from government. In this letter the government has not said that there will be no binding arbitration. It wants to resolve WHO represents physicians first. This is the last couple of paragraphs.

      “The MOHL TC believes that the issue of who represents physicians needs to be resolved. The MOHL TC wants to have a broader dialogue with the medical profession and various organizations within the medical profession, including the OMA, to discuss representation and compensation issues, among other things.

      The MOHL TC will be in touch with the OMA early in the new year to initiate that consultation.”

      1. Thanks Gerry!

         Good points. Having read all the letters, and in light of the government firing its appointee to the board of arbitration, I don’t think we can assume other than that the government thinks very little of arbitration in general.

         Having said that, if the government returned to arbitration, it would be a good show of confidence that it respects the rule of law. However, it could still just as easily walk away from the final ruling. But at least it would be abiding by the rule of law.

         Of what an exciting time!

         I do hope that calm heads can come together and make something of these crushed lemons.

         Thanks again for reading and sharing a comment!

      2. Dream on.

      3. Dream on.

      4. “Will be in touch early in the New Year…” Does that sound like a sense of urgency? You, my friend and compatriot are being played. Doctors in Ontario have been blindly played for years with delay tactics and the OMA has been almost complicit with gullibility. Wake up.

         1. Fair points, Brian.

            We’ve been fooled many times. I think the whole approach is built on a faulty model: “Free” care can never deliver all that care that people want. However, we could have a discussion about ‘necessary care’ and paying only for that.

            Without fundamental change, we are locked into demanding more and more with government offering less and less.

            Thanks for reading and posting a comment!

3. By walking away, the government is basically saying they no longer support Fair payment for Physician Services. They’ve basically told us they don’t want to pay us fairly. Perhaps they can’t afford to pay us fairly. That’s fine… Perhaps it’s time for them to get out of the insurance business. If an insurance company can’t afford to make adequate payments from the premiums they’ve collected, then it’s time for the insurance company to declare bankruptcy. Oh wait… There’s that pesky thing called the Canada Health Act. So I suggest it’s time to open the discussion to allow other, perhaps private revenue streams to allow for fair compensation. We have our own fee schedule which as the years have progressed, is becoming increasingly a joke for our members. If we wait any longer, reasonable compensation will appear so disproportionate it will seem unrealistic. We need to act now before all of us give up on the idea of maintaining any semblance of independence… Or is it too late already..?

   1. Great comments, Rob!

      I think that this government, more than any I’ve seen in the last few decades, would have the appetite to be disruptive in the way you suggest. Ideally, there’d be an agreement in place with docs so that we could build the transformation together. Are we dreaming?

      Thanks for posting!

4. ‘The beatings will continue until morale improves….’
   I hope it is now clear to all physicians in Ontario that the gov’t has no intention of paying what physicians want.
   The ONLY option for docs is to work/do the absolute minimum required by the CPSO,until patients scream/put pressure on the gov’t to come to us.
   Once again our feelings of moral superiority have negatively impacted us financially.
   This is why the only countries where it is illegal to pay for doctors services for medically necessary conditions,is Cuba,Nort Korea and CANADA …. congrats !!!

   1. Great comment, as always, Ramunas.

      You nailed it with: “The ONLY option for docs is to work/do the absolute minimum required by the CPSO…” This is exactly what’s been happening for years. Docs work faster, spend less time explaining, and work to meet the bare minimum required. What can people expect for a $30 visit. No professional — NO ONE ANYWHERE — costs $30 for ANY opinion. [I hope someone tries to prove me wrong on this point.] When the most common fee billed by 15,000 doctors in Ontario is A007, the system will deliver exactly what it is designed to produce.

      Surgeons figured it out years ago. Short consult notes. Get to the point. Do the work. Supplement with work outside OHIP. Smart.

      Thanks again for reading and posting a comment!

5. The only option we have that is sanctioned in the Canada Health Act is to resume extra billing or as I call it, “facility fees”. Shawn you know that there is a this or that clause that says if we dont have binding Arbitration we can extra bill. Now we have to unify in the push to change this Zombie health care system.

   1. Good point, Ernest.

      Justice Emmett Hall’s second Royal Commission on health care, which led to the Canada Health Act, made a clear call for a binding dispute resolution process for doctors.

      I prefer the term ‘balanced billing’. Docs started doing this in the 1970s to balance out the unfunded gap they had promised. They promised to fund 90% of the OMA schedule of fees. Now they only fund around 48%, I believe.

      Thanks again, Ernest!

6. It’s good that the government has agreed to return to arbitration. However, it is vital that the OMA has a plan ready to put into action as soon as the government refuses to abide by any final decision of the arbitrator, or pulls out of arbitration again. That is a very real possibility, if not a certainty.

   1. The OMA must ALWAYS have a sanctions ready to unleash. Doctors have the power if we are willing to use it.

      1. Agree.

   2. I agree, Coryn. It is all but a certainty now that government would overturn anything it did not like in arbitration. If that happens, it will get ugly. OMA is ready, but I can’t see how anyone will win that war. Mutually assured destruction?

      Our only hope is to have both sides reach something they can live with, then renovate the whole system.

      Great to hear from you!

7. On the OMA…
   When the government informed OMA leadership that it had decided to walk away from binding arbitration the OMA recommended to its members that it write letters of concern to their local MPP. ‘Dear MPP, please do not allow your government to break the law. ‘
   (Cut to January/February 2019) – After a final decision by the arbitration board which the government indicates is economically unfeasible to implement (this potentially will be any increase to the PSB), govt has decided not to honour the decision. The OMA leadership has recommended ‘job action to its members by not participating in committee work, and taking a long time to complete forms.’ Legal time frame for resolution 2-4 years.
   Why do the more sanctimonious among us fear ‘impacting patient care’ when we consider our options? Why do we individually fear the shadow of the CPSO? Until we collectively (and I would suggest that this is the most important function that OMA leadership has in the near future) address these two questions we will continue to fight a losing battle for ourselves and our patients. Anyone who convinces themselves that we have not been impacting patient care by our current approach is a fool.

   1. Richard, smart to ask, “What about next year?”

      I agree. Given this week, it seems unwise to place any hope on an arbitration outcome that the government finds unpalatable. I suppose as slightly unpalatable ruling would not be worth the political cost to overturn it. But I’m not sure Ford cares. He might overturn it to make a point to other labour units.

      You make a great point about impacting patient care. Patients are impacted right now, just by docs trying to exist in the system. You could argue that if we really cared about care, we would take radical action to improve it. But that does not seem to be in our nature. Most docs are more likely to try to work harder to sustain a dysfunctional situation than to say, “Enough!”

      If we cannot work out a deal, I think the time is coming soon, as you say, when we will not have a choice but to take action. I suspect the action that most docs will consider first is to find a way out.

      Thanks again for your thoughtful comment!

8. Shawn, you know what we are? Suckers. Suckers, plain and simple. It is long since the time when we should have developed a system like Belgium, France, Germany, Switzerland, Australia… you name it.

   I went into the hospital yesterday to see a complex hand injury patient. She can’t get access anywhere in a timely fashion (1.5 years or never) for consultation – I have tried. I again took a careful history, exam including specific dynamic test, and xrays including special views. We now have a provisional diagnosis. She is relieved and thankful. My net pay for taking care of her covered the mileage on my vehicle for the round trip to the hospital.

   What other professional works like this? Ridiculous. The only way I make a living is working unsociable hours and banging through volumes of patients in a manner inconsistent with optimal care.

   I’m in my late 40s and plan to have the option of being out of this game within 5 years. I could see what was coming and spent the past 3 years laying the groundwork – 2019 will be the first time I can reduce my clinical work and earn other income outside of medicine. And it’s a shame because I love much of what I do in medicine, but I’m not going to keep doing it for wages that are often laughable or care that is constrained by a dysfunctional system. Moral hazard indeed.

   1. Wow. Powerful comment, MD!

      Nothing to add. I hope people take the time to read and consider your experience on the front lines. Demoralizing is too polite.

      Thanks so much for taking time to read and post a comment!

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