Healthcare Mismanagement – Ontario

wynne and hoskinsNo one writes articles criticizing close friends. Who publishes critiques about office associates? We share some responsibility for the behaviour of those around us. For these reasons and many more, the Ontario Medical Association almost never prints meaty criticism about healthcare mismanagement.

But times have changed.

The Wynne Liberals slander and lie about doctors. Notable doctor-bashing bureaucrats now hold prominent positions of power and lash out with impunity. The OMA-MOH relationship is in tatters.  Even talk about engagement, a nauseating pretence for partnership, has disappeared.

OMA as Health Critic

Doctors have a rare opportunity to speak frankly about waste and mismanagement. Physicians work around it every day. We apologize for it continually. Most of the time, we own some of the system’s performance. Not anymore.

Doctors of Ontario need to speak up, soon. In a few months, politicians will realize they risk even bigger mistakes in completely ignoring doctors. By then, doctors will be back into some sort of working agreement, and we’ll have lost our chance.

Healthcare Mismanagement

We need to educate voters on the rot inside healthcare. We should share examples. We don’t have to expose our own hospitals. But at least we can talk about global problems.

Let’s avoid asking for more beds, more MRIs, more drugs, etc. Asking for more just empowers government to take more control.  We need to show how centralized control created mismanagement in the first place.

For example:

  • The ministry of health got public hospitals to spend millions on their own information technology systems but never cared if hospital IT communicated with any other system. This leaves patient records fragmented and in many cases almost useless. Any real business knows its first priority must be to communicate with its business partners, like other hospitals and providers. But hospitals don’t need to worry about pleasing partners like a real business.
  • Diagnostic imaging results are not available for many days. Scans get reviewed within hours. But results often drag along days to weeks later with many still arriving by fax.
  • Archiving systems for digital images (PACS) are not shared and available to all hospitals in the province only small groups of select hospitals.
  • Family doctors make referrals only to find out weeks later that that particular specialist cannot accept any more referrals for months. Other provinces track referrals to consultants so that patients and primary care providers can follow referrals along in the process. Providers know which specialists are accepting new referrals.
  • Specialty services have long wait lists or are unavailable in many communities. For example pediatric psychiatry, neurology, and neurosurgery are notoriously difficult to consult.
  • Government massively increased the number of physicians 15 years ago. Now the government refuses to provide an opportunity for trained specialists to work despite long wait lists of patients needing care.

These are just a few examples of healthcare mismanagement that government could have prevented or could fix now.

Politicians dread talking about healthcare. They know it’s impossible to control a complex system from the top down. But they insist on trying anyways. Politicians want nothing more than to keep media distracted, even scandals are better than having to show their ineptitude at healthcare mismanagement.

Government cannot run healthcare all alone. It needs help. It needs doctors intimately involved with managing the system in the best interest of patients. I hope doctors take the opportunity to speak up. Please feel free to share more examples in the comments!

 photo credit: thestar.com

18 thoughts on “Healthcare Mismanagement – Ontario”

    1. …at a cost much greater than they are willing to pay a doctor for an assessment. But won’t cut that- patients like it.

      At this rate, I might be better off taking the telehealth job

      (Hmmm…do they hire docs?)

      1. Exactly. Been thinking of other non-OHIP jobs I could try.

        WSIB? Independent Medical Exams? Industrial Med?

        Thanks again for sharing your thoughts!

  3. Since phone calls aren’t OHIP covered, I have been thinking of running a primarily phone call based practice. They can call and discuss the problem…cash only.
    If they need to be seen, can come in on my limited office hours for a brief face to face… time allowed commensurate with the ohip payment.

    Might use Timmie’s to see them to save on overhead. (then maybe can bill a home visit???)

    1. Brilliant!

      I considered putting out a sign saying, “Notes for work. Drop in anytime. No appointments needed!”

      CPSO might not like the sign…

  4. I have been watching for more comments here- something useful maybe, and not just my lame attempts at humour.

    My feeling is that the govt will eventually draw OMA back to discuss and sign a deal that is marginally less draconian than what they have forced in place here. I don’t have the stomach for it. No trimming around the edges will make it worth pretending to be “partners”, and helping them sell their warped vision, that the public is getting great care for the money. They are the administrators, not us. We do too much of their job without any reward. I don’t see myself as a militant physician. I will stand up for a standard of universal care.
    But basically I am just a whiner. I have no concrete ideas that might be of benefit, since between the Canada Health Act, OHIP, and CPSO, there doesn’t seem to be any way out.
    It is a Legislative Death Spiral. (LSD….I just quoted that…Dibs!)
    If the OMA partners up again, it will be just like holding their coffee so they can fix their hair on the way down. And worse, we will be more likely to take the blame when the spiral accelerates. The Govt will split, their hair will be very nice, and we will be left standing, holding their cold coffee, with a stupid look on our faces. Cameras rolling.

    1. Wow. You packed a tonne of insight into your note, John.

      I agree, most of us aren’t into fighting and lobbying. This political game gets played by professional politicians. We fall far behind.

      I also worry that things will start to get really bad more quickly than we think. Government will feel pressure to get help from doctors again. They’ll offer a slight appeasement but no where near a reversal of their pound of flesh already taken. Public sentiment will suddenly be with government because now, only now, patients will actually feel the results of the fiasco. In the midst of this, doctors will look like the bad guys. “Why don’t the doctors get back to the table?!”

      No, they have us figured out. We play in the A-division without A-division players or coaches.

      Time for some deep soul searching.

      Thanks again for taking time to comment! Many read your thoughts even if they don’t add their own.

      Have a great weekend,

      Shawn

  6. Great points Shawn ! Where is the OMA. Let the public know how well the system is being managed!!

  7. The politicians are afraid of the consumer. Until they place some of the responsibility for system utilization on the patient/consumer, there will be increasing costs. I don’t know where the line lies, and have debated with family and friends for thirty years… How is it that patients are NEVER sent the bill or are aware of the cost of health care when then come to the ER for a hang nail then leave without being seen because the wait is longer than they anticipated. I am fully in support of sending patients mock bills for the services they received in ER, but administration thinks that is too militant of me. But until the public is aware of the cost, they will not change their entitlement to “free” health care. If they realized how much an ER visit costs (and how small the physician fee portion is) maybe it will start to change behaviour and change the burgeoning cost of health care provision.
    Oz

    1. Conservative government was going to do that in the early 2000’s but realized that (i) it would be expensive to do so (ii) it would make doctors look good and cheap (iii) unless the patient actually had to pay something at the point of service it would make no difference.

      Most people think that doctors make a lot of money…well…just because they are doctors. They have no idea what a doctor makes but it must be a lot. The public thinks that doctors make way more than they do. They also have no idea that doctors have to actually run a business.

      Before I left my practice, I took an anonymous survey of random patients to see what they thought I got paid per visit. The responses ranged from $75 -$300. That was when the A007 code paid $27.80. 80% of the responses were between $100 – $175. When I posted the actual fees paid, patients were aghast – some offered donations.

      OMA has always done a lousy job of publicizing fees…probably because it would make their negotiation history look pathetic or they think it is above them to do so. OMA used to publish it’s fee schedule to Ontario doctors. It is such an embarrassment that one has to work to find it on the website. Ontario doctors currently get paid 46.9% of what the OMA says they should be paid based on cost-of-living allowance increases

      1. Both excellent comments, Ozzy and Paul.

        When OHIP started it worked like all insurance plans used to: patients paid then submitted their receipts for reimbursement.

        I agree, complete insulation from costs encourages some of the behaviour you mention, Ozzy. I wasn’t working when things changed to the current system, but I wonder if doctors encouraged the change? MDs love to be insulated from all cost issues too.

        I love your points about fees, Paul. Government wins by keeping fees low, since MDs will run like hamsters. Either they work like mad on fee for service, or they sign up loads of patients and keep running too. By making it illegal to bill outside of OHIP, government removes all competition over fees.

        The average salaried voter has no idea about the hours and pace that doctors have worked (and many continue to work). Self-employed tradesmen or professionals get it. They work like crazy while in pain, sick or bad weather.

        It feels like we’ve come to the end everyone has predicted for years. Government has no money. Many docs have no work because government cannot pay. And still patients wait.

        If times weren’t so exciting, it might be easy to get depressed.

        Thanks so much for taking time to read and comment! Please try to come out to spring council, even just for Saturday. First weekend in May.

        Best,

        Shawn

  8. Just downloaded the April RA.
    That big chunk of change withheld this month should get some blood boiling. Just how were my family and I supposed to budget for this with a couple months notice?

    1. Exactly!

      It seems much bigger than expected. No warning. Feels like they clawed back for the whole year. We need an explanation.

      Sure hope physicians have good lines of credit. We should publish an analysis of how all these cuts and inflation hit the after tax bottom line. It will be bloody.

      Dark times indeed.

      Thanks for taking time to share your comment!

      Shawn

  9. It actually does look like its just the reduction of 3.15% for this month for March, plus the additional 2.65% from February, since they only took the 0.5% last RA.
    Adds up quickly.

    Fun Fact: Since overhead is stable, the reduction is more like 4 to 5% of take home

    1. And adding inflation, it’s 2% worse that that.

      I’ve asked for a report of what our spending power will look like in 2017 using 2012 dollars. In other words, how much have we lost with cuts + inflation + growth in overhead. I suspect it’s close to 30%. So docs earning 250k after overhead would be down to $187k. Then they’d fund benefits out of this which results in a ‘salary’ of around $140k. Wooohooo! Far less than a hospital administrator (RN).

      Good times.

      Thanks again!

      Shawn

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