Is the OMA Distracted, Again?

52 thoughts on “Is the OMA Distracted, Again?”

1. Agree! Negotiations/arbitration will be tough and nasty. COVID19 isn’t over and unpredictable what happens next. Docs esp in the community and FFS are in a precarious position. Not the time for taking your eye off the ball. See my FB reply.

   1. Great comment, Hiro!

      There are literally thousands of important issues. Stay focussed on the ones we can fix.

      Great to hear from you.

      Cheers

   2. Next is the almost $400M in OHIP “cuts” to OHIP insured physician services. That amount in OHIP “cuts” was awarded to the Ministry of Health/OHIP by the Board of Arbitration in addition to the existing $83M in OHIP “cuts”.

      1. Oh Perry, why do you have to be focused on the details?

         [dripping sarcasm] (Sorry, these square brackets didn’t show up at first…sort of lost the effect…)

         Great to hear from you. Thanks so much for posting!

         Cheers

2. I am selfish. I can say it. Sure I have compassion for others. I have dedicated my life to helping others. I routinely sacrifice my sleep, my health and my relationships for my patients (and even for the deeply uncaring “system”). But in the end I want someone to care for me. To help me “keep on keeping on”.

   So I want an OMA that looks a bit more like a union and a lot less like a lobby group. I want someone to look out for my working conditions. Be that infection control during COVID or adequate Human Resources so I don’t have to scrape myself so thin to keep the “xyz” open and serving patients. I want an OMA that can manage to create enough solidarity among physicians to negotiate effectively with the MOH. I want an OMA that knows that the individual patient physician relationship is what really matters and can help the government see that it needs to understand that relationship and figure out how to measure it, if it wants to meaningfully impact quality improvement. I want an OMA that has enough of a backbone to realize that it can’t possibly keep all of the membership happy all of the time and as such sometimes small groups have to be made to see that they need to give on some issues to allow the greater good to continue to move forward.

   If and when the OMA can achieve those goals, there will be time to advocate for nuclear non-proliferation, racial diversity and inclusivity, gender equity and a thousand other issues that are profoundly important but can’t possibly be effectively advocated for when we are a fractured and diverted group. A fractured and diverted OMA is an ineffectual OMA which serves the purposes of government, EMR manufacturers, PPE suppliers quite well. A singular voice built through difficult but well fought consensus building is the only way forward. Just not quite sure how we achieve that?

   1. Dan, well said indeed. Focus on supporting docs so that they can care for patients. Pull us together.

      Brilliant.

      Thanks so much for sharing this!

      Cheers

3. As you know, I have recently written many articles on the need for income stabilization and sick leave for physicians.
   I was surprised that noone at the OMA or CMA had data on the percentage drop in fee-for-service billings during the first wave of the pandemic. Also, neither organization knew which provinces and territories had provided income stabilization, and what benefits were offered if a physicians were forced to self-isolate or contracted COVID-19.

   I ended up sending individual e-mails, followed often by phone calls, to the Yukon, and all provincial medical associations except for Quebec. Some Quebec data was provided to be by ProfessionSante.

   I compiled all of this data, and used it in my recent articles.

   As you know, sick benefits are NOT provided by Alberta, Manitoba, and Ontario.

   I am hoping that the premiers ask Ottawa for funding targeted for sick leave and income stabilization when the Council of the Federation meets in Quebec City later this fall.

   1. Charlie,

      You work on this is amazing. I am surprised that the last three have not been embarrassed into making this a major policy issue.

      FFS docs are in serious trouble, never mind the patients who need their care.

      Thanks for posting!

4. This phenomenon seems to happen with all kinds of organizations: a relentless pull to the left and abdication of the responsibility for which the organization was originally founded.

   That was certainly evident with thousands of public health officials in the USA signed a letter endorsing BLM protests in the middle of a country-wide lockdown. Nothing stops Progressives from their relentless quest to remake society.

   Probably the easiest way to reform an organization is to not reform it at all. The entrenched interests are just too strong. Simply start over with a new organization focused on whatever it’s supposed to be focused on and leave the old organization to die of irrelevance.

   1. “Multiply your associations and be free.”

      So said, JP Proudhon, 19th century socialist anarchist.

      Big, singular, and central always leads to a single citadel over which competing interest groups seek control. Banding together works until you have a few thousand members. After 10,000 or so, I am not convinced that bigger is better. Bigger often just means more oppressive and out of touch. We shall see how the OMA handles the current vacuum it has left in advocating for regular working doctors.

      Thanks for posting a comment!

      Cheers

5. The OMA has ONE JOB— to get us paid properly. That’s IT. Nothing more, nothing less. Not to digress into the environment, pretty posters at bus stops, ludicrous “research” into how women docs don’t know how to bill properly, Car insurance, discounts at restaurants, etc. And it has done a terrible job, hands down, for the last several decades. (Sorry Shawn that includes you, but we can still be friends). It’s a good thing it’s not a union because then we could revolt and fire the whole lot. We are in the mess we are in, financially and professionally, because the OMA works for Lord knows what (but it isn’t Ontario’s doctors).

   1. Thanks for posting, Jodie!

      I will let your comment stand as is…love it when people push back. You’ve raised a number of issues each worthy of discussion. Instead of trying to discuss each one, I will simply agree with your call for the OMA to advocate for doctors!

      Thanks again

   2. It is certainly not there to satisfy the ever increasing list of the wants of the social justice warriors that have penetrated our profession…the wants of every identity group imaginable other than that of the medical profession and their patients.

6. The evangelical progressive social justice warrior wokes have seized control of both the CMA and now the OMA…they all agree that greed driven doctors are the main problem, in particular the oppressive Capitalistic mysogenistic bigoted meat eating racist bigotted variety who should be gassed…or gas lighted as a bare minimum.

   As a consequence both the CMA and OMA have become pathetically spineless where the real world interests of the grass rooted medical professionals are concerned.

   They. should be cut loose to float off in their ideological navel gazing vessels debating woke philosophical topics such as income disparity between the various 100+ genders …as Charles pointed out neither the OMA or CMA have data and graphs concerning % age drop in FFService billings with COVID…but certainly they have piles of gender pay gap data with graphs.

   The remainder of all genders , possessing spines, should unite and form a proper union devoted to their overall wellbeing and prosperity.

   1. Yikes! So tell me what you really think, Andris. 🙂

      That was definitely your outside voice. Although I find your list of adjectives creative, I suspect that many will not be able to see the humour/satire/political-cartoon effect I think you are aiming at.

      Having said that, I still appreciate when you read and share your thoughts! This is your first comment in long time without a pithy quote or historical tidbit…readers love those.

      Thanks so much

7. Why is it again that we can’t be unionized?? Physicians at Health Canada are unionized and they fare much better than many of us do.
   Why do we need to provide health care infrastructure at uber-cheap rates for the Ontario government?
   Shawn, help me understand. It’s all so illogical.

   Can we please find out the reasons and simply change things?

   1. GREAT question, Alicia.

      The Labour Relations Act specifically excludes docs from forming a union. And building on that, the OMA has argued that because we cannot form a union, and we cannot strike (as an essential service), then we needed a binding dispute resolution process in negotiations.

      Having said that, many workers can unionize AND they have binding dispute resolution processes. So arguing for the latter does not rule out the former. But the latest round of legal battles would seem to give that impression.

      Bottom line: Docs exist in an extremely disadvantaged power relationship with governments in socialized medicine. It got better in the spring of 2017, but it is still a totalizing system; we have nowhere else to go unless we seek work outside the country.

      Thanks for asking!

      Cheers

      1. Is it not true that MDs are not classified as being “ essential” because if we were so classified we could form an Union…which the government doesn’t want.

         1. Sorry…the OMA has argued that MDs are an essential service. This is what I said.

            The lawyers argued that since we are essential and cannot strike then we should be allowed to have a binding dispute resolution process.

      2. One final thought on this. I have a master’s in social policy and I know Governmental statutes have been, and can be repealed. Sections of the Labour Relations Act have been repealed historically.

         Generally this follows a crisis of some sort that brings an issue into sharp focus. I can imagine just such a crisis, and it has nothing to do with leaving the country.

         1. Good point. (and very interesting that you have your master’s in this area!)

            Crisis does bring change. Having said that, I cannot think of any crisis that has brought more freedom other than the American Revolution and England’s Glorious Revolution.

            1. The “ Singing revolution” of the Baltic states 1987- 1991…my late mother who witnessed the involuntary “ liberation” of our homeland by Stalin’s USSR , an ally of Hitler’s National Socialist Germany, in 1940 ( with its purges and deportations etc., ) …then the re “ liberation” by the Nazis in 1941 ( with its purges and deportations) ….then the re re “liberation” by the Soviets in 1945 ( with its purges and deportations) re entered the wobbly Soviet occupied country to take part in the singing revolution wearing her national dress ( as did those with her)…to take part in the (hope to be ) final liberation .

               Soviet OMON troops fired and killed some holding barricades…but they were ordered to retreat…they threaten to return to this day…

               1. Fascinating. No one else can share these details like you can, Andris. Even historians are only sharing information with multiple degrees of separation.

                  Thanks so much!

            2. I believe government’s previously conceded the right to unionize because it was easier to deal with one entity in order to create stability and predictability in the workforce.

               Industrial sabotage was commonplace prior to unionization.

               In a healthcare context, if physicians cannot afford overhead costs they will be forced to change work. A physician up the road from me recently closed his practice to become a property developer.

               1. I have heard the same from many of my FFS colleagues. People do not notice the loss right now, but they will when everything eventually opens up again. By then, we will have a shortage of access I suspect.

                  Good point about negotiating with one entity — government ‘offered’ to bargain with one agent in the early 1990s. It made government’s life much easier.

               2. When the dust settles over the health care “ battle field” the Grand Poobahs from the MOHLTC will inspect the front lines to find the trenches empty…with no one , no widgets, left to order about.

                  I’ve heard of one of our colleagues entering the investment field…another retiring to his farm…it would be interesting to hear the tales of those who downed tools and voted with their feet.

8. The majority of membership expects the services of a union from the OMA. To be sure there would be some unintended consequences from that kind of identification for the organization. It would certainly change governance as well as some of the focus and dynamics of bargaining but ultimately that level of advocacy for the membership is what most members expect. Either as an organization we become much more clear that we can’t or won’t provide that level of representation in spite of expectations or we begin the work to shift towards what the majority of members expect. In a closed shop model, some will feel unfairly constrained by such a change but those are the consequences. I suspect the majority would be fine with it. Perhaps that is not acceptable to all. It never is!

   1. Well said. I think you are right; most would agree with you.

9. Agree. The OMA is going down a rabbit hole that will lead nowhere and will do one thing: waste time and resources paid for by RANDed members’ dues.

   I get the sense that the OMA Council is for those who dont have enough of their own work to do – i.e. not those who are FFS, at least for the most part.

   The OMA needs to stop picking up make-work projects that will lead nowhere.

   Cut the OMA down to 1/20th of its current bloated size. Negotiate a good deal for us. That’s it. Stop trying to save the world on our dime.

   1. Thanks for this, Enist.

      Your call for the OMA to focus on negotiations is one shared by many (most?) physicians. Sure appreciate you taking time to read and post.

      Cheers

      1. I think it’s important to note that the OMA is currently modernizing its governance structure and has made great strides in focusing on serving its members better.

         Whether that results in more members being happy, who knows?

         All I want from my association is for it to advocate for doctors, and to work with government in areas where our knowledge can shape health care in ways that help us care for our patients.

         I absolutely do not want anyone in our leadership to promote one party or another. Our leaders speak for doctors but not all doctors support the same party.

         1. Well said, Hal!

            Why do you and I agree on so much and yet appear to hail from opposite ends of the political spectrum? It is unsettling… 😀

            Seriously, you make a great point about partisan politics. Fight for doctors so we don’t have to get distracted from patient care. Every single party has attacked doctors. Work with whichever party will work towards the goals we hope to achieve.

            Unify the profession!

            Thanks again, Hal

   2. The “ picking up of trivial ideological make work projects” spending RANDed monies on accumulating the data to support them is a deliberate attempt to distract the membership from the real problems afflicting the profession…Charles’ attempt to gather data on more important issues and finding the cupboards bare was highly significant.

      The loss of professional freedom has gone unnoticed….much like the boiling of a frog placed in a sauce pan of cold water, gradually turning up the temperature…arriving in 1968 the medical profession the profession had a self confidence and a swagger about it that has evaporated ( the politically incorrect Movie Mash reflected it)…the OMA of the day was nothing like the modern obsequious faint hearted version, the government feared and respected it…no longer .

10. Well now … finally.
    As you know Sean,I have been advocating for a ‘revolution’ within the OMA for some time now .You are ‘spot on’ in your blog about relevance/agenda,and if Ontario’s docs are not in a crisis now,I’m not sure what a crisis is.Our hospital CEO has bragged about using the pandemic crisis to ‘tear the house down and rebuild it like WE want to’,in the process destroying departments/sites/programs.They are laughing all the way to the bank.FFS docs,especially in planned care,have no options ….. and the OMA is not helping.Instead,it’s progressive side has decided to push a different agenda ,worsening this crisis.
    The OMA cannot justify mandatory dues when it does not function as a union,and canadian doctors will not improve their quality of life until a parallel private system is developed …. full stop.

    1. Wow. Powerful comment. Thanks so much, Ram.

       I had not turned my mind to the idea of redesign while doctors are out of the picture. Of course that makes perfect sense. And the FFS issue has been bugging me for ages…I am hearing from people who are using bank loans to keep their clinics afloat.

       Thanks again. Let’s hope the OMA listens

    2. Hospitals have been turned upside down over the last 50 years…in 1971 our local hospital ( Peel Memorial Hospital) was basically a GP run hospital.

       The original administrators had an “ office “, a cubicle under the stairs ( where they should have remained )..the hospital board had GP’s on it…GP’s ( male and female) decided who came on staff and who didn’t …the first specialist to come on staff was an internist , then an OBGYN, then a general surgeon ( I could have the order wrong) ,I came on with a female internist and a female respirologist.

       I recall a staff meeting when the hospital was running into a deficit trying to block $10,000 for the administrator to up grade his office.

       Then the rot started, GP’s lost ground to specialists who then lost ground to the bureaucrats…now the hospital specialists live under the thumb of top heavy administrators with the GP’s replaced by hospitalists and ER docs etc.

       If we get a symbiotic hybrid public private health care system as per the world class health care systems…the private sector hospital sector should not reach into the present bureaucracy for administrators…there being far more talent outside the present health care system…an Elon Musk type viewing health care systems with truly revolutionary eyes.

       1. Wow. I just love these stories from 50 years ago. No one would believe that hospitals used to run with so much MD input and involvement. Thanks again!

11. Exactly Shawn. The best way to address the item de Jour is to re-write the Schedule of Benefits to reflect the value of each of our services. The old one is antiquated, out of date and as others have said, mysoginist. The OMA would best serve all of our interests if it focusses on its job and fights for all physician equally. That’s what we pay dues for, that’s what we expect.

    1. Having our own fee schedule ( think big) would be a constant reminder to the membership of what our services are worth and what the MOHLTC thinks it to be.

       It would create chronic dissatisfaction and , where those who complain about inequities would realize that their problems are governmental.

       Printing the fee schedule of plumbers , electricians and of the other professions would be educational.

       The OMA should be leading the way in this regard…but it is far too timid to do so.

    2. Brilliant comment, Ernest! Can’t add a thing. Thanks again

12. Shawn,

    I recall standing up at council during a negotiations year wondering why we were wasting our time debating whatever was the issue on the table instead of focusing our attention and energy on supporting and advocating for the docs at the grassroots. Needless to say, the issue was dealt with and I was “lectured” on the fact the OMA is more than just all about MD’s. Really ???

    Maybe you should get your name back on the President-elect ballot and try to affect some more change from the top down. Can you even hold another term ? Seriously Shawn, help the grassroots be represented and make us more of a union and voice for the docs to allow realistic fees and remuneration for services rendered or perhaps start the discussion about copay and allowing us to make up for the 95->45% OMA fee guide degradation over the last 30 years.

    Compared to dentists, vets and plumbers… I’m sickened at how we’ve accepted BOHICA just because we’re such goody two shoes and many don’t have the cajones or the understanding to fight for what it seems the minority feels we deserve.. Well, I guess just like Merica – maybe we get what we deserve after all…

    1. I didn’t see your contribution…exactly.

    2. I think I remember that council meeting, Rob. It was awkward to say the least.

       We do not need to attribute maleficence when ignorance (distraction) explains things well enough. Although it is possible that some people want to take over the organization and turn it into a vehicle to promote their own objectives, I suspect most people simply have soft hearts for any issue that people share, especially when it’s shared with emotion. The only way to not run after all the other important issues is to remain strict focus on the few issues we can fix…or that the members have told the OMA to fix.

       As for president, I was only part of a team of like-minded people who wanted change at that time. There were times when I could speak out on my own, and I took the ‘risk’ of always taking the side of doctors. It got me into trouble a bit here and there (e.g., the initial response to federal tax changes), but in the end, a principled commitment to always take the side of the majority of working doctors seemed to resonate well with members. But again, the big changes happened because a team wanted them.

       Great to hear from you as always!

       Cheers

13. Thank you for raising your concerns, Dr. Whatley. Your OMA is focused on making fundamental changes aligned to improving Membership satisfaction by increasing value to members; simplifying the Mandate to clarify roles, goals and objectives of leadership; Managing the agenda with government, planning for negotiations, and Modernizing the operations of OMA.

    Our top priority is negotiation and advocacy for members, and these are the things the Board and staff are focused on to better deliver that. I can tell you with more than 40,000 members, the diversity and volume of opinion, priority and expectation can be difficult to manage. Despite this, staying focused on items of importance to the broader members is priority number one. You played a big role in putting the OMA on this path, and for that you have my thanks.

    1. Fantastic comment, Allan!

       You have a terribly hard job. Really encouraging to see your commitment to staying focused on a few key issues that the OMA can truly change for the better.

       Highest regards,

       Shawn

14. It’ll be quite interesting to see the approach that the OMA takes to these negotiations.

    If they go after subsets of their members (i.e. relativity) again, or waste time on issues of the day that are far more complex than the most vocal subset of the OMA reps are pushing, or anything else that isn’t entirely about giving us the best contract that we can get, this may finally be the end of the OMA as we know it. And so it should be.

    The OMA has been taken over by those on salaries and FHOs, while FFS MDs are being sidelined. I agree with an earlier comment above that the FFS docs are too busy actually working to be able to waste time on these issues.

    NOt to say that some of the issues aren’t potentially important. But it seems that the OMA really has been taken over by a small loud subset of part timers.

    1. Thanks for posting this, Erin.

       We fall for the irresistible appeal of divide and conquer over and over. It seems we never learn. The OMA must ask and answer: What is the number one crisis facing us right now? What are the top 2 or 3 issues that we can influence for the better? Then focus on those.

       This does not mean the OMA hates all the other issues. Silence is NOT violence when it comes to lobbying, negotiations, and advocacy. Strategic focus wins results. We could pour 100% of members’ dues into some of the issues I’ve seen people raising and never make a single dent in the issue.

       Fight for doctors so that doctors can focus on patients.

       Thanks so much!

15. I have never worked FFS (not fully true, I do bill a small amount of FFS for occasional hospital inpatient, nursing home and palliative work that I do). I was a rural FHN doc, a rural FHN doc in a FHT, a rural FHO doc in a FHT and now a focused practice rural and small urban ER physician paid mostly via the ER AFA (or is it AFP I hate all the acronyms). I see the FFS model as antiquated and due for a quick death. If we as a group could accept that then we would move one and have a chance to negotiate some kind of alternative payment model for ALL docs.

    But we won’t let it die because a small group cling to a free market ideal that the model with its lower levels of external control will allow them to better manage their own practices. It’s a nice theory but unless you can individually itemize and bill for every activity (extra few Bucks if you have to call twice to review BW results) which the MOH will never accept (can you imagine the complexity of the Schedule of Benefits in that case). It also isn’t free market because it’s been completely gutted by the MOH/OMA in preference of all the more modern payment models. I can see some good features of FFS but it’s dead. It needs to be buried and we need to move on. The OMA has trouble negotiating because it is trying to negotiate twenty indifferent payment models. They can’t present a united front because their are too many models to unite.

    I’m looking at joining a CHC part time. Benefits, pension, predictable salary for predictable work. Tons of time to see patients and really delve into the social determinants of health. But I can’t adjust my income to adjust to my own personal needs. If you work 0.5FTE you get $xyz. If you work more but it’s not part of the contract, you get the same. So I’m keeping the other half of my time as an ER focused rural ER locum. One month it might be 72 hrs of ER on top of the CHC, the next might be 96hr. Depends on what my needs are and the needs of the community to some degree. A bit of FFS in an urgent care is also in the menu, just to give even more flex to the model.

    So if you can work it out, divided, unfocused negotiation can help you as you pull the best from each type of model and try to build what works for you. But lots of people can’t do that. Narrowly defined specialists, urban GP/Family docs who don’t have as many other practice environments to explore, late career docs with investments in physical office space, etc.

    We won’t get any meaningful percentage increase on gross Billings. Sorry, it’s not going to happen. If that’s all you can accept as a “win” then you might as well buy the bottle of whisky to cry into now. Wins will come from simplifying the billing system so less money is left in the table by all of us. Unifying similar payment models and allowing people to freely enter into any payment model they want given how far the capitated models have pushed FFS to irrelevance. Looking at how to offer specialistS which are much more FFS oriented, a way out to some kind of alternate model with more security. Somewhat more unpopularly, a much stronger push to a rational income spread between specialities.

    Of course this is an oversimplification but in some ways that’s what we need. I’ve only been a part of council for a couple of years. I was part of the executive of the rural section for something like five years before it disbanded. I am usually the most informed person on billing in most physicians groups I am part of. But I don’t have a clue, how physicians are really paid. I don’t really know how I’m paid. There are so many side agreements and retro active pay agreements and partial payments for some things and full payments for others. I have no actual idea what I will be paid until I look back at my computer printouts at the end of the month. Sure I work x hours at $y/hr and that is my base ER pay but I can make anywhere from 10-35% on shadow Billings, some places can pay 9hr pay for 8hr work to cover admin time. It’s too complicated. Try it across a dozen ER groups. I have no idea. People could rip me off quite easily. Supposedly the OMA knows but I’ve asked MOH and OMA advisors about certain payments and no one actually knows what they represent. Crazy.

    I know that was a wide digression but it’s just to give a flavour to why we need to stop dividing the OMAs attention and try to keep a close, narrow focus on a deal that it fair, understandable and sustainable. If the OMA does that it is relevant and then can build to other things. If it can’t, either fix it or put it in the bin. I think we still try to fix it but I get the bin idea as well. I just don’t know how you would really replace it. I worry we’d end up with something much worse at least for a while.

    1. Thanks Dan! Long comment but really helps people understand the complexities of the schedule of benefits.

       Agree, we need OMA to stay focused on a fair, sustainable deal.

    2. “But we won’t let it die because a small group cling to a free market ideal that the model with its lower levels of external control will allow them to better manage their own practices. ”

       The free market is the best arbiter of what something is worth. Maybe I am taking this wrong but that sentence sounds quite condescending.

       1. The free market dictates the incomes of plumbers and electricians…in such a market all prices, wages and profits are determined by the laws of supply and demand…not by the arbitrary whims of bureaucrats , bean counters and governments.

          Individuals in a free society can only grow rich if they offer better value at a lower price than others can offer…wealth being achieved by the free “ vote” of the customers.

          It used to be that doctors, for example, prospered via the three A’s…Ability, Amiability and Availability….no longer, it now depends on which government approved group/ gang one belongs to.

          When there is a shortage of something, let’s say , Avocados …the price goes up…if there is a glut of something , widgets, the price goes down.

          In the medical field there is a shortage of a variety of medical professionals, with long line ups and long waiting lists…their incomes are going down contrary to market forces.

          There is a glut of government civil servants with salaries that never diminish , benefits and pensions ; hospitals are top heavy with such bureaucrats , the MOHLTC top heavy with bloated unproductive drones, government subsidized health clinics are also fat with unproductive personnel ….their incomes are going up contrary to market forces.

          Civil servants have to work 35 years to get full pensions, MPs 6 years…FFS MDs can work all their lived…no golden handshakes for them …unappreciated and pensionless a third of Canadian doctors work full time after the age of 65 , work being their pension plan…what did the CMA do , in particular having been subsidized by the same doctors for decades? Nothing …selling MD management for $ 2. 6 Billion and spending the proceeds on woke feel good projects…what does OMA do? Nothing, not even collecting relevant data, it is concentrating its efforts on questionable minutiae.

16. Not being able to give the thumbs up to Dr Milliken’s comment in Medical Post regarding the CMA and the sale of MD Management , the heisting of the $ 2.6 Billion value was a finger in the eye of all those MDs who generated it during their professional lives…frankly the CMA and MDM bureaucrats pilfered the monies to the detriment of the profession as a whole.

Comments are closed.