People find creative uses for things. We use lifejackets as cushions, books as coffee coasters and paperclips to fix bra straps.
But we never forget their original design. No one confuses new creative uses with original purpose.
Medical associations formed to do things that doctors could not do on their own. Doctors joined to promote education, safety and best medical practice. They soon began to advocate for MDs in talks with government and other stakeholders.
Medical associations became the home doctors relied on for everything from insurance and estate planning to incorporation and collective bargaining. Associations serve as the place doctors turn to for unquestioned support.
Doctors need their associations. Many associations forget that they need their doctors even more.
Medical Associations
Many medical associations face a crisis. Voluntary members do not renew memberships like before. Involuntary members grumble or decline requests to help out.
Across North America, members leave if they can. Those forced to stay are not happy. Associations grow by focusing on recruiting new members instead of keeping the old ones.
Good
Great associations make their members proud.
They tackle issues that members care about and do it in a way that draws praise from outsiders. The public admires the association.
Annual dues offer great value for money, and members are happy to contribute time and energy on committee work.
Bad
A few associations embarrass members. They forget that power rests with members, that leadership requires followers.
Bad associations help governments and other stakeholders get ahead at the expense of their own members.
They pretend medical politics has nothing to do with politics. They promote partisan issues in tasteless fashion and presume to speak for all without evidence of support.
Irrelevant
Many associations simply lose touch. They desperately seek the majority opinion, trample on diverse views and end up speaking for no one.
Irrelevant associations cling to legacy above all else. They care more about what they did than what they do. They fear change and adjust course only when disaster proves certain, not a moment before.
Many join the ranks of social justice warriors and special interest groups. They let their vision get hijacked; desperate to win the approval of vocal social influencers as a way to boost legitimacy, and hopefully memberships.
Irrelevant associations have members, but not committed ones. Members would leave if they could find the same services somewhere else. They stay because they have no better option, not because they love their association.
Getting it Right
Like lifejackets, doctors need their associations in a crisis. While their associations served all sorts of creative functions in between crisis, they must not fail in those rare times when the sky truly falls.
Lifejackets do not remove all sense of panic. People still feel they might drown or freeze. So too, associations cannot remove all sense of panic while they lead doctors to safety.
Thomas Edison tested over 3000 prototypes before submitting his first commercial patent for the incandescent light bulb in 1879.
Unfortunately, associations do not have 3000 tries to get it right. They usually take ages – sometime years – to realize they’re failing. By then, there’s little hope of success. Failed associations look more like bridges that don’t meet in the middle than quaint attempts at creating light.
Medical Family
Accidents will occur in the best-regulated families (Dickens). Our families only appear as kind, smart or as thoughtful as the people out front, in the public eye.
Every doctor has a medical association family. If doctors want their association to be bright, articulate, kind and relevant, then it will only be as bright, witty, articulate and engaging as the members who get involved.
Especially in a crisis, medical associations need as much help as they can get. Their power comes from members, from doctors’ passion and energy.
Doctors need great associations now more than ever. Strong associations rely on equally strong support from their members. Let’s hope associations remember why they exist and that doctors remember their associations are nothing without member support.
photo credit: www.goodreads.com
I think that medical associations have become large bureaucracies that exist for themselves. The constant is the salaried workers who stay for years and not the elected and volunteer physicians who pop in and out over time. Thus physicians who see patients and know the day to day workings of a front line medical practice do not have enough influence in their own organizations. Bureaucracies, whether in government or associations, expand their scope to justify their own existence.
A recent example of two bureaucracies helping each other is the 2012 fee agreement with the Ontario government. The initial proposal by the government for fee cuts was rejected by OMA while the OMA proposal for a freeze was rejected by the government. The government walked away. When the affected physicians fought a public relations campaign against the government independent of the OMA, the government came back to the OMA with another agreement. The change in the proposal was that the agreement would give the OMA exclusive bargaining rights for Ontario physicians while basically keeping the cuts in place. The OMA accepted this deal and pushed it to its members. The initial deal offered Cuts; the new deal offered Cuts + Bargaining rights to OMA . The OMA accepted more for the OMA while getting no more for its members. The OMA seems to have thrown many of its own members under the bus in order to protect the existence of its own bureaucracy.
The devastation to physician payments that we see now in 2015 is the result of the poor bargaining done by the OMA in 2012. Many OMA members seem to be more angry at the OMA than at the government as the OMA seems to have failed its members in what doctors thought was the OMA’s most important mandate, fee negotiations.
I hope that the OMA is up to quickly taking back the trust its members put in it.
Great comments, Gerry. Thanks so much for sharing them!
I’d push back a bit on your description of 2012. The cuts legislated in 2012 were significantly rolled back, doctors got assured representation rights that outlined a process that government had to follow AND doctors got an agreement. The representation rights codified a process. The OMA already has all it needs from members under the RAND legislation (that’s a separate discussion and one that should happen!). We cannot diminish the value of rolling back the cuts AND a negotiated agreement that the membership ratified. It gave stability for a few years.
Having said all that, I think we all (or most of us) expected that 2 years of stability, along with some fairness in the next negotiation, was worth accepting a less than ideal agreement. We all know now that that was mistaken. The government pretended to negotiate but just kept repeating their inflexible demands for a fixed cap on medical care and then legislated just like they had in 2012.
We need – desperately need – to have all doctors passionately and entirely devoted to fighting government. We must speak clearly to the OMA. What will we never tolerate? What must happen in the next agreement? Without loud, strong voices from front-line physicians, we cannot hope to accomplish much.
Again, thank you so much for bringing this out! We need to discuss these details and flesh out every perspective. I appreciate your support, advice and direction on this. I wish you were able to help out at OMA council, too!
Highest regards,
Shawn
The fact that you sometimes push back against my opinion just shows that our agreement on other topics is so real.
I was unaware that some fee cuts were rolled back in 2012 as my section of Ophthalmology and the other sections that fought so hard against the government were severely cut after the deal anyway. These were the sections that worked their guts out to bring the government back to the bargaining table. While these sections took the major hit, “The MOHLTC recognize[d] the OMA as the exclusive representative of the physicians practicing in Ontario for the purposes of these negotiations.”
I do not believe that the doctors of Ontario wanted the OMA to be “exclusive representative” of physicians. Check some of the comments after my Opinion Piece on Healthy Debate in early 2013: http://healthydebate.ca/opinions/is-the-oma-an-appropriate-vehicle-for-negotiating-doctors-fees
In my opinion, the government had been in violation of the Canada Health Act when it walked away from the bargaining table in 2012 and imposed fee cuts. The government was over a barrel but the OMA saved the government bureaucracy by “allowing” itself to become the official physician representative. Thus the OMA entrenched its own bureaucracy by helping the government bureaucracy: two bureaucracies acting in each others’ best interests. Many Ontario physicians would love to end the RAND legislation. If the OMA were not representing doctors in fee negotiations then the RAND legislation would probably no longer be applicable and Ontario physicians would no longer be forced to pay “union” dues to the OMA.
Shawn, I believe that the 2012 deal was a terrible deal for physicians as it gave the government the power it now has to trample over us in fee negotiations.
Thanks for writing back again, Gerry! I agree, we see eye to eye on most things.
I’m out of my league when we start discussing legal nuance. But that never stops me from trying… 🙂
My sense is that the representation rights 1) codified a process of negotiations that included facilitation and conciliation and 2) identified the OMA as the party to represent MDs. It did this to prevent the government from beating up on one tiny group of docs AND to prevent sweet side deals for groups who bent to MOH pressures or advances.
As for bureaucracy, you know I’ve been vocal against excessive bureaucracy as a system or structure. It’s not about the individuals working in it. I’ve met some amazing people serving as MOH bureaucrats. They are truly outstanding. But a massive system constrains them.
I can assure you that physicians in Ontario are blessed with some of the most impressive staff I have seen anywhere, ever. They are amazing. Seriously.
With hindsight, I agree that the the 2012 agreement was a terrible deal. Who agrees to multi-year cuts? Having said that, I still believe that it was the best deal we could get at the time. Yes, the best deal at the time. We faced losing a few fingers versus getting a limb chopped off.
We can only scrape at the details buried in all this. The best way to improve our associations, our healthcare system and the plight of doctors everywhere is for all of us to pool our passion and make the strongest group possible. I think our provincial association shows the most promise and your efforts – our efforts – make a real difference. I see that difference. Please do not give up. I would so love to have you attend council and lend your wisdom, insight and counsel! I understand if you cannot.
Again, thank you SO much for taking time to write. I know hundreds of readers consider your comments carefully.
Highest regards,
Shawn
An association that has to work for it’s membership numbers is one that will work the hardest to promote and defend it’s members.
The OMA has been ‘gifted’ a 100% membership by the Ontario government. The OMA is also a corporation and the Board of Directors have a duty to the corporation. What is to be done when the interests and the needs of the corporation are not the same as the needs and interests of the membership?
With the stroke of a pen, RAND could be taken away from the OMA by the same government that grants it. The bureaucracy of the OMA has grown and it now has many different departments and even other companies under it (Ontario MD). What happens to the OMA if RAND is rescinded. One might argue that this would be the best time for government to do it if it was going to do it? Would the doctors of Ontario rally around their association after 2012 turned out to be a mistake and then 2015 happened?
Sadly, for the profession and the OMA, the representation rights agreement turned out to be a House of Cards. If government has the right to impose terms after Facilitation and Conciliation fail, does it take a rocket scientist to see how this was going to end up? In securing the representation rights agreement, the OMA has been ‘checked’ in the game of chess and may have secured their own irrelevancy. There is no agreement. The previous agreement is over. The government is now free to do as it pleases for as long as it wants to the medical profession in Ontario. We are free to accept the blows and plunder on or retire/leave.
There is a lot of anger out there at the OMA for what happened in 2012. Members can now clearly see that the OMA was badly outplayed and remember how hard the OMA sold that ‘deal’. It may have been better to have lost that limb in 2012, because we ended up losing it (and much more) anyway. With October 2015, now we know that the cutting is unlikely to stop.
We now also know, with the Baker-Price report, that the government is done consulting with the OMA on future health care system transformation. It looks like the government sees the OMA as irrelevant. The membership has woken up (finally!!). They are watching the OMA and this is truly the OMA’s ‘watershed’ moment…
Thank you, Paul, for writing such thoughtful comments!
While I agree that a board must always serve and protect the corporation, you make it sound like a corporation exists to serve itself. I challenge you a bit here. The board seeks to move the corporation to fulfill its mission through the strategy, goals, budget, etc. The direction of the corporation gets shaped in partnership with members.
The OMA exists to help physicians help patients. It is “Dedicated to doctors. Committed to patients.”
The crux of this comes in your last paragraph. Members watch the OMA closely and “this is truly the OMA’s watershed moment.” I agree. Doctors face a crisis, and we all look to our organization for help.
At the centre of the crux (the crux of the crux?), we find the inescapable fact that doctors and the OMA need each other equally as much. While there’s an element of “What will the OMA do next?” there’s also an even bigger question, “What will doctors do next?” Doctors direct the OMA to act. The OMA acts on the clear direction of physicians.
The special meeting on Oct 17th is critical. I hope you can attend and lend your wisdom!
Thanks again for taking time to share and pull out this discussion!
Highest regards,
Shawn
Shawn:
Thanks for this posting. I have great respect for you. Uou are one of the few Board member that is willing to speak up.
However, I have to agree with Gerry and Paul.
OMA did a strong sell on the 2012 agreement at council. Council was sold on “This Is the best deal at the time”. I do not recall the possibility of the scenerio of Oct. 2015 was ever bought up by the president or the “Expert opinion/lawyer” .
Well that was history and not much we can do about it.
However, I wonder what is the Board is prepared to do. I am sure you are aware of the huge negative sentiment about OMA out there with the membership. I am afraid that you are right. If the association is NOT looking after its member’s interest but the Corporation interest, it is a BAD association. Maybe it is time for the Board to do some real soul searching.
Nevertheless, thanks for the posting.
Thank you, Michael, for your insightful comments. As usual, you get at the core issues with wisdom and grace.
Like my responses to Gerry and Paul, I agree with so much of what you said. I worry a tiny bit that you make it sound like information was held back from members in 2012. When you say that “Council was sold…”, it sounds like the OMA misled the members and painted the 2012 offer as something it was not.
I understand this. But I want to assure you that the OMA did everything in its power to communicate all the facts, analysis and debate involved in this decision in 2012. As you recall, members met for special meetings and spent hours with the material. It was not an easy decision, but we made it all together. I still believe that it was the best decision at the time. History has proved me wrong.
I agree that the board must do some soul searching now. All doctors must do it. We need to ask ourselves how we can strengthen our representation. How can we measure and improve our performance? What do we want? Are we destined to more and more frustration by propping up a system of negotiation that Justice Winkler said was on a “collision course”?
The OMA relies on doctors so much and vice versa!
Thank you for taking time to share. I look forward to visiting again soon (maybe next week at the special meeting in your area?).
Highest regards,
Shawn
“While I agree that a board must always serve and protect the corporation, you make it sound like a corporation exists to serve itself.”
I have been saying this for years. Like any bureaucracy, the OMA acts to preserve itself.
Gerry
Thanks again, Gerry. If you mean that it preserves itself so it can serve physicians, then I agree. If you mean it to the detriment of physicians, I disagree. Furthermore, it’s our responsibility as physicians to guarantee that our organization delivers outcomes we need. We should get involved to make it so.
We must challenge everyone serving in the OMA – that includes me! – to maintain their vision.
Kind regards,
Shawn
“Many join the ranks of social justice warriors and special interest groups.”
Associations serve the self interest of their meme bets, not broader concerns like social justice. If they did engage in social justice, that would not be a bad thing. The levels of income inequality in society is absurd. Gains in worker productivity over the three decades have not tickled down to worker wages as the 1% has sucked up all these gains for themselves. Not to mention that five decades after the civil rights movement, there remain tremendous gender and racial disparities in society. This is a great societal shame, and people should take as a badge of honour to be considered a social justice warrior.
Thank you for sharing your thoughts, Raj!
Doctors need medical associations to work for doctors! I do not want to pay dues to any organization that uses that money for any social or political purpose that I personally disagree with. I join medical associations to serve my needs–that why “I” pay.
I have seen medical associations take sides in political issues that are totally opposite to many members’ views. Recently some CMA investments are being sold to satisfy the moral needs of some “Green” Activists that happen to be physicians. Don’t mess with other doctors’ money because of your personal beliefs. The CMA has hired professionals to do that. I came within a whisker of resigning my membership.
Keep medical associations for clear medical issues. There are other venues to work on your favourite personal issues.
Well said, Gerry. Many share this frustration. I’d love to talk more about this in person someday….
Gary, the issue is that the social determinants of health have more of an impact on population health than the quality of the health system. If the purpose of the profession is allow individuals to have longer and healthier lives, we can not divorce our practice from broader societal concerns.
I have heard that refrain about poor health to disease. These are correlations. Do the studies of social determinants of health take into account that a person born with a disability will almost invariably earn less money. Someone who suffers brain damage in infancy will almost certainly earn less money. A person making a good living can become addicted to heroin. He then becomes sick and then poor.
People who are sick usually earn less money. I believe that many are poor because they are sick.
Sorry, I got side tracked.
Even if the purpose of the PROFESSION is to allow individuals to have longer and healthier lives, it does not mean that the MEDICAL ASSOCIATIONS should not put its own MEMBERS’ needs first.