Vision for a Great OMA

pass-the-torchI resigned from the Board of the Ontario Medical Association yesterday. I believe that the OMA can do better.

The OMA exists for one reason: to serve doctors, so that doctors can focus on their patients.

As I leave office, I want to share what I think a great OMA might look like.

Vision for a Great OMA

Great organizations start with solid principles. Great organizations make courageous changes to flawed and dysfunctional structure. Finally, great organizations have a clear vision while remaining open to new ideas along the way.

Principles

Humility – The OMA exists to serve, and service requires humility.

Doctors are smart. They know medicine and have great ideas about how to improve healthcare. Doctors respond best when they sense that politicians, bureaucrats, and administrators truly value doctors’ opinions.

Pride makes it impossible to value anyone’s opinion other than your own. Humility means people take themselves lightly; they do not interpret debate as a rejection of their person. Great associations are humble.

Courage – The OMA exists to fight for doctors when no one else will.

The OMA must stand up against popular ideas, even if every other stakeholder thinks that doctors are crazy for doing so.

The OMA cannot work to please all the experts and politicians, who love a new fad, if that fad is bad for patients and doctors. The OMA must fight for doctors, so that doctors can keep fighting for patients.

Politics must not be a popularity contest.

Honesty – Doctors demand greater honesty than other groups.

Doctors cannot continue in clinical medicine by telling lies. They get caught. Eventually, a patient with a glass eye will prove that a doctor did not examine the patient before charting, “Pupils equal and reactive to light.”

Administrators can promise one thing today and then say that circumstances changed tomorrow. Doctors cannot.

Medical associations must operate to a higher level of transparency and brutal honesty, than other businesses or organizations. Dishonesty, obfuscation and secrecy destroy trust.

Structure

The OMA needs to start with the following governance changes:

A. The OMA Board has a barnyard of committees, according to one governance expert.

The OMA should sunset all but 1-2 committees of the Board. The Board only needs an audit/finance committee and an HR committee.

Staff manages; Boards govern. The dozens of committees and sub-committees should be filled and run by non-Board members.

For goodness’ sake, no Board should ever need a Committee on Committees. (No joke, the OMA has one.)

B. The OMA Board has a dysfunctional and outdated Executive structure.

It should create a three person Executive: Board Chair, President Elect and President.

The President Elect should be elected by the broader membership, not a small group of a few hundred people taking direction from the Board.

The Board chair should be recruited for his/her expertise and should serve for a 2-3 year term, with an annual performance review.

C. The Board needs to recruit people based on a skills matrix.

The Board should know what skills it lacks.

A group of 25 people will never be representative of the membership, so identity politics (GP, Specialist, young, old, etc.) should stand secondary to skills in Board composition.

Vision

Put the Doctor-Patient relationship first.

This is the touchstone of medicine and must be the guiding principle for every policy, negotiation and activity.

Ideas and fads must be measured by one question, “How does this impact the doctor-patient relationship.”

Great medical associations put this relationship before great ideas about saving money or boosting efficiency.

Build on Creativity and Innovation.

Doctors struggle to meet patient needs. Doctors want to find solutions to help the patients they serve.

Great associations believe in doctors. They believe that doctors want to help and that creative doctors will find far better, cheaper ways to care for their patients, if we let them, than experts will ever find in the latest policy journals.

Great associations fight for doctors’ freedom to serve and innovate on behalf of their patients, without undue regulation, oversight and audit.

Champion professionalism.

This faddish word gets twisted to mean everything from supporting social contracts to protecting the public purse. Professionalism is more than that.

Associations need to learn how to articulate what professionalism means for medicine in a gritty, rigorous and attractive way. Associations need to champion the very best of what it means to practice medicine.

Advocate for System change.

Doctors know what’s wrong with the system. They need to advocate for change in the popular media.

A media-savvy doctor said, “You can get the media to listen. Just give them a story. Get the stories from your doctors. It is not that hard. Do not edit what they say.”

Medical associations have a duty to publicly critique our healthcare system and offer solutions. They need to do this in a way that regular people can understand.

Great associations offer aspirational visions of how we can do better. They do it in a way that regular people can talk about with friends and politicians.

Failure to critique shows a fawning obsequiousness to power.

Secret of Success

I have many dear friends within the OMA and on the Board. They are good people. But they are trapped in a culture that rewards risk avoidance and that exalts historic protocols, regardless of performance.

Membership associations will never be great if they forget one crucial point: Great associations stay connected with their members.

They know and value what members think. They trust members with information and ideas. There are no major, long-term secrets. Confidentiality should be rare and short-lived.

As soon as Board Directors become isolated from members, from how members think and feel, Directors becomes arrogant, out of touch, and irrelevant. This leads to incompetence. Inevitably, failure gets blamed on members’ lack of vision.

After 15 years serving in the OMA, with 6 1/2 years on the Board, I still believe that the OMA is the best place for doctors.

The Ontario Medical Association desperately needs help from engaged, enthusiastic doctors, who will bravely speak the truth.

It needs doctors willing to hold their elected offices lightly, with an open hand, ready to give up their position at a moment’s notice. They need to care for truth and character more than title or power.

Serving in the OMA has offered some of the most rewarding and challenging work I have ever done.

With change, the OMA will get through the current crisis and become stronger and better able to represent doctors in Ontario.

It is time for me to pass the torch. I look forward to seeing how you build on these ideas and make them even better.

Highest regards for all of you.

Photo credit: nbcolympics.com

48 thoughts on “Vision for a Great OMA”

  1. Shawn,

    Thank you for being a champion of thought and ideas for our profession. Many of us share your vision and will continue to work to bring about much needed change to our Association and our healthcare system. When a foundation is crumbling, it can’t always be fixed from the inside. Sometimes to repair a foundation, you have to dig it up from the outside first. I hope to see you in the trench!

    David

    1. Thanks David!

      It is easy to say what needs to be done. It will be very hard to keep pressure on our organization to see the changes come about.

      Thanks for staying positive.

      Cheers

      Shawn

        1. Thanks John!

          I just resigned. I did not die. 🙂 Still very engaged…just changed hats.

          Looking forward to visiting again sometime.

          Cheers

          Shawn

  2. Thanks for your service Shawn.

    I don’t agree with every word in this essay but the foundation piece, that the OMA must serve its member’s interests, rings true.

    Good luck in whatever comes next.

    1. Thanks Scott. I really appreciate you taking time to say that.

      Best wishes in all that you have planned, too!

      Cheers

      Shawn

  3. You wrote the book on how to run an emergency department and now you have written the blueprint on how to run the OMA.

    I am proud to know you, Shawn.

    1. Wow, thanks Gerry! That was really nice. You won’t get away without a hug next time I see you. 🙂

      1. Soon. See you at Maddie’s talk. I will bring my wife. She looks forward to hearing and meeting you.

        1. This is great news, Gerry! I was hoping to visit in person again; this is sooner than expected and makes me very happy indeed. I look forward to meeting your other half, too!

  4. Shawn,

    It is disheartening to see you go. Your professionalism and integrity are some of your many strengths. Your resignation has taken the wind out of my sails.

    If circumstances improve I hope you would consider a return in the future. Your vision and leadership are needed.

    Will you keep blogging? Now you are unrestrained. 🙂

      1. 🙂

        Believe it or not, there’s still only so much we can say. This is a very small world. I will say what needs to be said, but I cannot light my hair on fire (if I had any to do so).

    2. Very sorry to hear that this is depressing, Del. I sure appreciate all the passion you have brought to these discussions over the last few months. I really hope you plan on standing for election!

      I am still very passionate about medical politics and improving things for doctors, so that they can focus on patients. And yes, I hope to keep blogging. Thanks for asking!!

      Best regards,

      Shawn

  5. Shawn:
    I am sorry that you have to leave the Board. I thought if we have enough Board members with your vision can make a change in OMA. I agree with most of what you said in the essay. The governance rule/statement now is really to protect the interest of “OMA” rather than for the interest its membership. Minor change here and there in OMA will NOT change the culture. There will be strong resistance from the administrative staff for major change that is needed. Is there a solution.
    It has been a pleasure to have know and work with you. I have a high regard for you.
    Michael

    1. Thank you, Michael! The feeling is mutual. Your insight and dedication to doctors has helped physicians more than they will ever know.

      You are right. The OMA needs some structural change. We need to expect strong resistance. I cannot understand why they do not just make changes…but I realize that change is very hard. Doctors are usually far too polite.

      Thanks again. It has been a pleasure working with you. I look forward to our paths crossing again, soon.

      Best wishes,

      Shawn

  6. Thank you for all the great work you have done over the last few years, and for all the contributions I know you will continue to make. Your leadership, honesty and fairness will be missed
    Alison

    1. Thank you, Alison. I really appreciate you taking the time to share that. From someone like you, who has done so much good for doctors, it means a ton.

      I’m sure we will visit again sometime soon.

      Shawn

  7. Hi Shawn
    I was hoping with this upcoming OMA meeting that you would stay on and help guide the OMA to do what’s necessary to change. Much harder to effect change from the outside. Your blogs have always bring a refreshing insight to the problems we face in the medical community.
    Good luck on everything, and continue to blog.

    1. Thanks so much, Brad.

      I believe that we should always try to change things from the inside, first. But at some point, we all come to a decision: Can I tolerate this one more issue?

      I am still passionate about improving the lot of physicians, so that they can focus on patients. I will just work from the outside now, or perhaps, from council.

      Best regards,

      Shawn

    1. Thanks Dr. Todd. While another GMoM seems a blunt way to influence change, in desperation, I completely understand the need to try it. The material on the petition warrants open debate. I wonder why the OMA doesn’t just make it happen without having all the fuss of the petition?

  9. Dear Shawn-I wish I had met you sooner. Your diagnosis of the OMA’s structure and function
    ( actually malfunction) is precise. The solution is surgical.
    As a neurologist, I do not do surgery but I am determined to see the OMA change for the better,
    much sooner than later, and will be happy to be any surgeon’s assistant in the process.
    Indeed, your critique of the organization is far too diplomatic.
    One needs only to witness the resignation of the PM of England after the Brexit referendum,
    to understand what honorable and responsible leaders do, when they fail in their mandate.
    I wish you well and would welcome a personal meeting- something the OMA leadership, not to mention the MOH, has failed to accommodate.
    With great admiration,sincerely, Keith Meloff MD, FRCPC Neurologist
    Acting Chair-Section of neurology OMA; former member of the Editorial Board-Medical Post

    1. Wow, Keith. Thanks so much for this kind note.

      I tried to avoid negativity as much as possible, so I really appreciate that you thought it was diplomatic. I will send you an email shortly. Looking forward to a chat.

      Thanks again,

      Shawn

  10. Shawn
    This is the second saddest news I’ve heard today …. or perhaps it’s the saddest ….

    I can only guess at the inner turmoil.

    The bright side is that you are rejoining/reinforcing a lot of colleagues with your penetrating ability to criticize constructively …. and now without the restraint of unnecessary confidentiality.

    1. Thank you, Mike.

      I always smile at the end of your notes. I could not agree more. This is NOT [edit: forgot the ‘not’ in first draft!] a resignation from medical politics, just a resignation from the Board. I fear that change will require more effort that most of us want to admit. I suspect you sense the size of the job. Having said that, doctors need a strong high-performing OMA, and we can help improve it.

      Thanks so much for taking time to share some encouragement!

      Warm regards,

      Shawn

  11. Integrity is demonstrated by action and your action is a reaffirmation of your integrity. It must be hard to stand on the inside and defend the indefensible. You have been and I hope still will be a leading voice for change. Unfortunately talking sense in a quiet and respectful manner hasn’t swayed the ossified core of the OMA. Change is what is needed and you are clearly taking step one in the change. In an ideal world the people who really ought to resign and step away would do so, but it appears a push is what is needed. I too have tried to stick to reasoned argument but I admit to not having your energy to be nearly as good at it as you are. Patience is a virtue they say but getting rolled over time and again is not patience, its defeatism. I know you are not defeated and I trust you will still be able to attend the council and fight for change. I wish I could be at the Halton Medical Society meeting on the 24th but am schedule to be in Victoria that day. I’ll be at council though.

    1. Thanks for seeing through this, Ernest. Well said.

      You are exactly correct: this is not defeatism or an exit from advocating for physicians. I am more passionate than ever about seeing things improve. We can visit more in person, but as you said, there comes a point when we have to admit that things are not changing in the direction you had hoped.

      Thanks for all you do and for being involved for so long!

      Talk soon,

      Shawn

  12. Shawn
    You’ve been a tremendous asset to the OMA, to docs and most importantly to patients in Ontario. Your dedication, honest voice, and integrity of service will be missed. Thank you for all that you’ve done and I look forward to hearing about your next steps.

    1. Hey Shobana,

      Thanks so much. I really appreciate this…and I send it right back at you. Thanks for all your work as Chair during the busiest time, ever, a District 5 Chair has ever seen! Sure appreciate you stepping up.

      Talk soon,

      Shawn

  13. Shawn, I do not know you well other than at council meetings. I have always been impressed with your sincerity and wisdom.

    I quite enjoy your blogs and hope that you continue writing.

    I thought this piece was well thought out and gives a lot of food for thought and debate.

    I am also saddened by your post. Mostly because over the last two years, social media and blogs seem to have brought all of us closer together.

    Will you still come as a delegate?

    Good luck in your future

    Chandi

    Chandi Chandrasena
    Family, Ottawa
    District 8

    1. Wow, that was really kind of you to take the time to share this, Chandi. Thanks!

      I am on the hunt for a delegate position to council. 🙂 For the time being, it looks like I will have to wait for the spring elections. Thanks for reading the blog! Readers love the comments best, so please feel free to share anything anytime.

      Thanks again,

      Shawn

  14. Shawn,

    I’m sure this was not an easy decision for you . But reading between the lines of the last several months worth of your articles I am not surprised.

    If this is what you need to do to be in a position where you can have the greatest positive impact on the political situation … I get that . If this is how you feel you can maintain your personal sanity , integrity , and values , then ok.

    My only concern is the message your resignation sends to Physicians in general . I think you are popular, and considered a solid trusted Physician that represents the views and values of so so many . For you to resign from the Board sends a huge message to MD’s. Bigger than I think you may appreciate. It could be a game changer for a whole lot of doctors .

    No matter what – I support you .

    1. Candace, thank you!

      You are right. This was a terrible decision, brutal. I firmly believe in trying our best to change things from the inside. Working to fix a mess means tolerating the mess while you work on it. But there comes a point, when ‘little’ decisions pile up into an intolerable mound, I had to say enough. Clearly, I could not effect the change that I expected. You summed it up perfectly with, “If this is how you feel you can maintain your personal sanity, integrity, and values…”

      Your last paragraph is also right. I am a little embarrassed to admit that I did not anticipate, nor appreciate, the impact this might have on other docs. I assumed that if a No vote had such a small impact on the organization, my resignation would have none.

      My only hope is that this might spark positive/active change. The changes will not be easy or painless, especially if it means juggling positions and elected offices. But it needs to happen.

      Again, thank you so much for such a kind note!

      Shawn

  15. Shawn,

    The vision you have outlined above is EXACTLY what the OMA and the OMA Board should be. Sadly, you were clearly not able to get the Board to accept this vision from the inside. You must have felt very frustrated and felt that you had no other choice than to make the move that you did.

    Change will be coming to the OMA Board in waves in the very near future. They would have been brave and forward thinking to embrace and accept this. Instead, they resist and hunker down, determined to resist the waves. They create a committee that threatens any dissension in the ranks.

    The OMA Board had shown how out of touch it was with membership in accepting a disaster of a deal then heavily promoting it with a zealousness never seen before by the OMA. Meanwhile they seem content to handle the government and the media with kid gloves. An ‘olive branch’ of mea culpa could have been extended to the membership with resignation of the entire Board Executive and those Board members that heavily promoted the deal. The OMA Board itself could have initiated changes in it’s structure to make it more accountable to the membership. But neither have happened and the Coalition and COD are not going anywhere or fading away.

    I wish you well…the OMA Board has lost a truly amazing one of a kind talent…

    1. As usual, you have captured the issues very well, Paul. And you speak for so many thousands of other doctors (tens of thousands).

      The last 5 months were preventable. They did not need to be half as disruptive. We can do better. Physicians desperately need a strong, sophisticated association that never loses sight of its mission to serve doctors so that doctors can serve patients.

      I sure appreciate you continued engagement in these issues! Doctors need your experience and wisdom; please keep pushing for change.

      Hope to talk soon,

      Shawn

  16. Bravo Shawn!
    I wish to congratulate you and I feel greatly saddened at the same time.
    You were a shining light on the Board. You leadership and your writings inspired many and provided much guidance in the confusing world of medical politics to which so many of us are naive.

    I am sure your wisdom and presence on the Board will be missed by many. The Board has lost much today and they will be lacking the guidance of a visionary force. At the same time, I hope that this will bring to light the very critical condition of the OMA and be the catalyst for some real structural and significant change.

    The general members need to be awakened and become educated as to what is at stake and what will be required for this to happen.

    It is my hope that you will come back to be the Champion and leader that our Association desperately needs. Thank you for all your work, your dedication, your sacrifices and your vision. This has not gone unnoticed amongst the general members.

    With gratitude and hopefulness,
    Ken

    1. Ken, you have a gift for words. Thank you so much!

      I am still passionate about improving things for physicians. I still love medical politics. I will continue to serve to fill whatever need arises. If my resignation sparks some positive change, I would be thrilled, but I did not expect it to have any impact at all. If 24,000 members voting No did not cause seismic changes, one person resigning will do very little. But then again, straws break camels’ backs more often than major changes.

      After all your years serving and staying current with OMA issues, it sure is encouraging to see you still speaking up for docs.

      Looking forward to our next visit,

      Shawn

  17. Thank You Shawn for writing and sharing this. The words ring true on so many levels and brings a unity to our situation as Ontario Physicians– in a situation that has become divisive and rudderless since the tPSA. I sincerely hope that this act of true courage on your part inspires our colleagues to galvanize and act in a meaningful and cohesive manner. I also hope that what transpires is an OMA that is functional in the 21st century as opposed to the relic that we are currently looking at daily with sometimes shock and horror. Thank you for reminding us what we should expect from the OMA and what we should expect from ourselves. As usual you are SPOT on.

    1. Thank you, Sandra! I really wanted people to focus on something positive out of this. There is so much work we can do to improve the association. It needs to start with a willingness to change a number of straightforward, concrete structures as soon as possible. Referring it to another committee will not solve our current crisis. The basic changes could be made in a week, so that we could rebuild from there.

      I hope the OMA wakes up to realize the crisis and devote itself to meaningful change. Like tearing off a bandaid, some things hurt less when they get done in one, quick motion.

      Thanks so much for taking time to share!

      Shawn

  18. Shawn, I too admire your stand and can really identify with you. In the 70’s I along with many other physicians believed that doctors should keep an arms length relationship with government and bill their patients directly for services. We also strongly believed in and supported a national health insurance program but felt this should be a contract between our patients and their government. The federal government then announced their intention to introduce a new bill, The Canada Health Act, that would effectively conscript all Canadian doctors into government service. At that time I was, like you, a member of the OMA board and exhorted them to begin a vigorous political lobbying campaign and public dialogue about the inherent dangers of complete government control of health care planning and funding. The OMA told doctors that the government had assured them they would be treated fairly and were not to worry and thus they did nothing. Well, the rest is history. Sadly, once again more control is being sought through Bill 41 and the OMA’s response is basically the same. It is time for doctors to regain control of their only advocate, the OMA. It is impossible as you and I know to do this from within. We need to support the reform being called for by the Coalition of Ontario doctors and we need to do it now. If not now, when!

    1. Thanks so much for this, Joan! I did not know that you were on the OMA Board.

      I agree with everything you wrote. We need reform yesterday. Medicine faces a crisis in Ontario. Let’s hope docs stand up and support positive change. The OMA could change, if it wanted to. Let’s give them a reason to improve. Too many conflicts of interest…

      Thanks again,

      Shawn

      1. I sat on the board from 1976 until I was asked to resign in 1980. I was very upset about the lack of response to such an important issue for the future of medicine. At that time, the OMA was actually run by the Executive Director, Dr. Tom Porter. He pulled all the strings and the board and executive were expected to be his puppets. He took me aside and said if I towed the line and stayed quiet I had a future on the executive. They convened a special meeting of the board when I refused and basically asked for my resignation. I gave it happily and immediately formed a new association, The Association of Independent Physicians which I ran from 1980 until the Canada Health Act was passed. We hired a full-time lobbyist and met with all MPs in Ottawa. I also travelled across Canada to other provinces and also found they had their heads in the sand. Well, you know the end of the story…we lost! If more had been done then a lot of careers would have been different and we wouldn’t be in the current situation.

        Joan

        1. Thank for sharing this, Joan!

          I would love to visit with you someday and hear more of this story. Seriously. I find fewer and fewer people know or even remember the details from those years. I will send you an email privately.

          I sure appreciate you sharing this story. How does it go? Plus ca change, plus ca la meme chose?

          Talk soon…

  19. Shawn
    Your integrity is your greatest asset. I hope that we in the trenches can continue to look to you for guidance in the upcoming weeks and months. Many thanks for your service to the profession. Let’s hope the OMA gets the message.
    Mick

    1. Thank you, Mark!

      I am certain that we could see positive change, if the will exists. OMA needs to make peace, open their arms and pull doctors in, not push them out.

      Sure appreciate you taking time to write.

      Cheers

      Shawn

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