Identity Crisis – Whose Side are We On?

25 thoughts on “Identity Crisis – Whose Side are We On?”

1. Thank you.
   Let’s wear one hat at a time.
   Eric Hoskins, an MD, can surely see the points raised by MD’s signing their leases and paying staff, but he certainly doesn’t articulate this in any public way.

   1. Great comment, John. Well said.

   2. Ontario Physicians must recognize that in his present incarnation, Eric Hoskins is a politician who happens to have an MD after his name. That is not a “moral indictment”: it is just reality.

   3. Perfect, Shawn.

      1. Thanks Gerry!!

2. I accept your challenge.

   Though a little help in getting the message heard would be appreciated.

   1. I don’t know whether to smile, wince or do both at the same time, Graham. Very poignant!

3. Shawn,

   It’s sometimes a challenge to read between your lines. But if you’re looking at war analogies, we have to start with the presumption that doctors function as a cohesive “army”. I’d argue that the hoopla surrounding the recent vote on the tPSA in Ontario is pretty strong evidence that doctors are anything but cohesive. A proper union – teachers, nurses – can operate cohesively under marching orders from the top (let’s ignore Hoskins’ insincere invitation to the OMA to unionize).

   Doctors’ associations are more like a loose confederacy of infighting tribes, even mercenaries…always at an uneasy peace, and unreliable partners for one another when faced with an outside enemy. Though such tribes have historically been brought to heel by a strongman (the Khan Mongols, Philip and Alexander of Macedon, Saddam Hussein), I don’t see a “strongman” being a realistic possibility in Canadian medical politics.

   Even if you can find a leader that will bring the many parties together to cooperate, there’s one other truth of great leaders: they are either peacetime leaders or wartime leaders. Pericles built the Acropolis and made Athens a veritable empire; he also led them into the bloody war with Sparta that left Greece in ruins, under foreign rule for thousands of years. Churchill led Britain out of World War II; he wasn’t terribly effective once the peace was won, and drove the West into the pointless and expensive Cold War against the Soviets.

   Can the OMA get its act together, even with the singular outside foe of the Wynne/Hoskins regime? I doubt it. Time can’t heal any wounds when lawyers are busy twisting the knives that made them.

   1. Very astute observations, Dr. Warsh. In 1962 physicians in Saskatchewan opted to engage in aggressive public warfare with a government that implemented publicly funded and publicly administered medical services (Medicare) against the majority will of the profession. For a while the profession was successful in mobilizing public opinion on its side. However after 28 days of withdrawal of of all non-emergency services, the profession was compelled to accept a negotiated settlement because public support for a medical profession engaged in outright war with a duly elected government is not sustainable in the long term. Without wide-spread sustained public support, any battle with a democratically elected government is doomed to fail.

      The profession then thought its stars might align under a different government. Many physicians became vocally partisan in their effort to achieve “regime change”. History proved that no political party is reliably more”doctor friendly” than any other.

      Notwithstanding Shawn’s assertion that medical associations must “choose sides” between members and the government, I have observed that some medical associations do successfully sustain membership support and sustain a mutually respectful and productive working relationship with their respective governments. The Saskatchewan Medical Association (SMA) has proven this to be possible over the last two decades.

      I served as the President the SMA in an era of publicly hostility between the SMA and government. I excelled at generating antipathy toward the government among the SMA members. That is very easy to do.

      I observe the capacity of current SMA leaders to build and sustain a sense of shared goals between the SMA membership and government. That is not easy. However successive SMA Presidents have proven that it can be done and I deeply admire their capacity to do so.

      I have respect for the current OMA leadership and believe it may be possible for the OMA to identify and support some shared goals with the Ontario government. Working together to achieve those shared goals may be the starting point for a renewed mutually trusting relationship.

      Continuing internal warfare within the OMA is destructive. Physicians who seek to depose the current leaders based on a belief that they could better serve the members by engaging in more aggressive warfare with government are misguided. At best, such an approach might increase the probability that the current government might not bet reelected. If physicians don’t learn how to work collaboratively with government, it is sheer folly to expect that the “heavens will open”under government of a different stripe.

      1. Thanks Dennis!

         As you know, internal warfare started because we lost touch with the membership and asked them to accept something they were not ready or willing to consider. Too much ‘relationship’ with government caused this fiasco, not the reverse.

         As I said in the post, we need peace. We need a truce. But treaties and cooperation must never be confused with a loss of identity. Government is government. It has its own objectives. Docs need to stick to their objectives of caring for patients. Hopefully, governments will bend to our resolve to do what’s best for patients.

         Best regards,

         Shawn

      2. Dr. Kendel, It is a commonly held misbelief that “without wide-spread sustained public support, any battle with a democratically elected government is doomed to fail.” Not long ago, Lorrie Goldstein wrote the following about the 1986 Ontario Doctors Strike:

         “After the dispute ended, I asked a senior Liberal cabinet minister who was a key figure in the passage of Bill 94, what the government would have done had the doctors shut down the entire system.

         ‘They would have won,’ he told me.

         He said while such a strike could have been declared illegal by the legislature, nothing the government could have done — mass prosecutions, imposing fines or revoking doctors’ medical licences — would have solved the problem of the unacceptable risk to patients.”

         http://m.torontosun.com/2015/10/10/docs-wont-win-fee-battle-with-wynne

         I am glad to hear that it was very easy for you to generate antipathy toward the government as that also paves the way for a more balanced long term “partnership” with regard to shared
         goals between physicians and the government. I agree that, “no political party is reliably more ‘doctor friendly’ than any other,” but government “regime change” is not the real goal that many of us are aiming for. I once heard former CMA and SMA President, Dr. Marc Baltzan repeat what Canadian Health Minister Monique Begin had told him in the mid-1980’s. She told him that the physicians of Canada do not have to worry about politicians’ pushing doctors around because politicians fear the huge amount of power that physicians have. After all these years, physicians, governments, consultants and the media have forgotten about physician power in this context; in fact, most physicians do not even know that physician power in this context even exists.

         It is time to level the playing field between government and physicians by making politicians fearful of physician power again. I do not say that the physicians of Ontario should destroy every politician that they disagree with and on every issue: physicians just have to show that they CAN destroy politicians if they feel it necessary.

         I also agree that “continuing internal warfare within the OMA is destructive,” but if by the current OMA leadership, you mean the current Executive, then your opinion should change after reading the following. This is a Lawyer’s Summary of the last few months with regard to the Deal recently presented to OMA Members for a vote.The content is all from OMA documents, court findings and affidavits sworn in court. Unless the information shown in this document is shown to be false, the current Executive of the OMA must leave and let others take over in the rebuilding of relationships with OMA members and the government.

         http://coalitionofontariodoctors.ca/wp-content/uploads/2016/08/coalition_aug25.pdf

         1. Thanks for sharing this, Gerry!

   2. Thanks for sharing such a thoughtful note, Frank!

      I especially like: “Time can’t heal any wounds when lawyers are busy twisting the knives that made them.”

      I think most docs prefer to stick together. We just need to give them a reason to do so.

      Thanks again,

      Shawn

      1. Shawn – my observation over the last 2 months is, if anything, doctors have become more connected than ever before. We are connecting in real time, on multiple different schedules, and across multiple specialties. We are “networking” like we have never done before. It has taken a few docs with a talent for IT and media, who have applied the scientific method about what we needed, and were able to apply and deploy it, to all of our benefit. These are all good things. The social networking platform has allowed ideas to surface, percolate, masticated upon, and polished in a short period of time. And why not?We just needed something to bring us all together. If nothing else, we have to give the OMA credit, that it was able to mobile physicians all across Ontario, get them thinking critically outside of medicine. It has allowed us to demonstrate that we really are not apathetic. We just need to be prodded out of our rut every 15 to 20 years to remind the OMA what their raison d’être is. To remind them that their first priority is to Ontario Physicians. And that OUR collective responsibility is to the welfare of out patients. All else is secondary.

         1. Brilliant comments, Connie!

            “To remind them that their first priority is to Ontario Physicians. And that OUR collective responsibility is to the welfare of out patients. All else is secondary.”

            Well said, indeed. Thanks for taking time to share it!

            Best regards,

            Shawn

         2. “we have to give the OMA credit”

            Connie is there another word than “credit” to use? Something like the difference between “famous” and “infamous”? 😉

4. Shawn, although I have read your many excellent blogs over the past few months, this may be your best. It is certainly the most emphatic.
   The physicians in the trenches, shouldering the wheels of an increasingly ineffective system, need to know that the OMA has their backs. And if the OMA doesn’t truly fight for average physicians, alternative factions will be born to fill the void. It seems this has already happened. Hopefully, the OMA is getting this message- better late than never.

   1. Hello James!

      It seems that every medical association faces the same challenge: How can we get regular, working doctors inside our organizations? All associations – the OMA is no exception – must continually ask, “What do members think? What do they want?” Unfortunately, many associations drift into, “How can we get our members to think differently? Why don’t our members want the ‘right’ things?”

      Once moral supremacy drifts in, service goes out. Then, every complaint raised by members about working conditions, taxes or incomes gets interpreted as coming from yet another uninformed doctor.

      The secret to making associations relevant is to have regular, working doctors get involved in their associations. And that takes effort!

      Thanks so much for taking time to share a comment!

      Warm regards,

      Shawn

5. The organization that requires to recognize that it is not on the same team as the government and that it is certainly not a partner with the government and never has been ….is the OMA.

   It is a vassal organization that enjoys only those rights that are granted to it by the government, is subordinate to the government, the MOHLTC under the leadership of Hoskins who is himself, the very obedient vassal of the Premier.

   Hoskins expected and expects obedience, homage and allegiance from it’s vassal organization.

   In the latest incident, the President of the OMA , failed to deliver the OMA membership self trussed to be sacrificed on the altar of Primary care reform in the name of social justice for the common good and for the votes required for reelection in 2018…as a consequence the disappointed Hoskins became furious, angry and malevolent….the full extent of his malevolence is yet to be felt.

   The government has one goal, reelection in 2018, it has its time table commencing with the Ontario Assembly opening on September the 12 th. 2016…free health care has to be provided to the growing number of insatiable voters of Ontario…the trussed up OMA members are supposed to be reduced to movable interchangeable widgets under Bill 210 , to be distributed under its wise guidance throughout the deliberately under doctored province ( Canada having 1 Doctor for every 470 Canadians and Ontario with 1: 522 ) and who will have work harder for less money.

   1. I just love how you write, Andris! I always find it interesting, indeed. And I tend to agree with much of it, too!

      I want to push back a bit on your ‘vassal’ comment. I blame the government for their relentless intransigence on a fixed physician services budget. They want doctors to assume ALL cost risk. This is like an insurance company forcing auto repair shops to accept all cost risk rising from the increasing number of accidents and claims. Hoskins et al. know how desperate doctors are for some stability. They dusted off their same old offer, added a few tweaks, and…well it’s history now.

      You are one of a handful of people who want to talk about usurpation by government. Most people so not see the glacier of bureaucracy slowly crushing out innovation, industry and professionalism. But that sounds too alarmist.

      Again, thank you for taking time to share your thoughts!

      Best

      Shawn

      1. Vassal: a holder of land by feudal tenure on conditions of homage and allegiance.
         synonym: dependent

         I believe that Andris’s metaphor is correct

         Premier > Hoskins > MOHLTC > OMA

         1. I stand corrected, Gerry!

            I misunderstood vassal to mean more like servant. I obviously missed this. Thanks for correcting me!

            Cheers

            1. Vassal has multiple meanings and connotations, Shawn. So you are not wrong just incorrect.
               Vassal also means:
               serf, dependent, servant, slave, subject,

               1. 🙂 You are are gentleman, Gerry.

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