The OMA failed in 2016-17. Doctors will talk about it for decades. If the OMA were a country, it would build a memorial.
The crisis forced the OMA to do what consultants had been telling it to do for decades.
The OMA changed course, rebuilt, and is better now. But the change is new and precarious. Without holding to a deep, direction-changing understanding of why it failed, the OMA could fail again.
1st Reason the OMA Failed
“The OMA forgot to represent members.”
But what does that mean? As the OMA was sinking, everyone thought they were representing members. Everyone believed they had doctors’ best interests in mind. Good intentions and better knowledge guaranteed great outcomes.
Just because we know more does not mean we know best. The OMA knows many things. But it had lost sight of the one thing a membership organization must know.
Service organizations survive on a paradox: The customer knows best. Even junior service reps at Apple know more about computers than most customers.
Superior knowledge must never usurp the mandate to serve. Service means an unshakable belief that the customer knows best.
No One’s Smart Enough
A group of really smart service reps will never know all that individual customers know about their own needs and preferences.
Even if we could capture everything that individuals know, no humans exist who are smart enough to use the data to allocate resources on behalf of individuals as well as individuals do on their own. No one can buy shoes that will fit you as well as the ones you choose yourself.
Central planning means bulk decisions with limited information on behalf of large groups of people. Central planning is the opposite of service.
The service paradox requires humility. Individual members may be ignorant about medical politics, but they still know more about their own practice and preferences than any board, organization, or staff.
2nd Reason the OMA Failed
The old OMA elevated one paradigm above all other ideas. It dismissed challengers as misinformed or just silly. The OMA tried to figure out what government wanted and then worked to convince doctors to go along. That’s not service. It’s coercion.
Like finding a great partner in a three-legged race, the OMA wanted partnership with government more than anything. Questioning this plan guaranteed smirks, eye rolling, or outright laughter.
Private initiative, innovation, and hard work were passé. We needed clear policies, strict guidelines, and more oversight. Doctors should receive payment for following rules, not for creativity or effort. Any doctor who works harder than 90% of his peers should be investigated; he must be up to something.
Pandering and Planning
The OMA was forced to change direction, reorganize, and adopt new ideas. But the OMA is still fragile. It could relearn old ways: survival means avoiding controversy; never doubt the power of government to fix medical problems; never ask whether government knows best.
Of course the OMA needs to work with government, but it must not pander.
Policy is downstream from culture, and culture is downstream from ideas. If the OMA assumes that central planning works and that we need more of it, then it will create a culture that aims to figure out how to be part of the planning in order to shape the best policies.
To plan or not to plan is not the question. Everyone wants to plan. The question is whether people want someone else to plan their lives, or whether people want to plan their lives themselves. Click To TweetIf the latter, then the OMA must learn to help doctors plan and not assume to plan for them.
Prevention
The OMA must embody the service paradox. This is hard given that the OMA gets paid even if it does not serve well. Hard but not impossible.
Second, the OMA must believe that there is nothing suspicious about getting paid for hard work. The OMA must allow this self-evident truth to animate all policy. If the OMA assumes popular labels of hard working doctors, e.g., “high volume practices”, access to care will suffer.
Managerialism, rationalism, and radical levelling work to crush initiative and output. They decrease health care costs, but they do not help patients. Clock watchers are not more virtuous, nor do they necessarily deliver better care.
The OMA is doing well. It has a great CEO, staff, and board. But the OMA is just people. It must remember. Every member organization, like every free society, is only one generation from failure and serfdom. Monuments are not just decoration.
Photo credit: Nationalpost.com
Interesting take as always, with the year of Pres to look back on.
Enjoyed working with you on that “old” Board, Shawn.
The key phrase is”OMA is just people”, moreso, you can do all the governance review/changes you want, shrink Council by 90%, shrink Board by 90%, but if the right people aren’t found to fill those positions, the OMA can and will fail again.
I would say also that “reason 3” would be to stop being reactive and be more proactive. That means modernization of reaching more Ontario docs one at a time in a more personal, 2 way flow of communication. It means strategic planning that is dynamic and not static. Without ongoing grassroots input into strategic planning, you will remain out of touch and out of minds of practicing doctors.
Does AWG touch on reason number 2? That book is yet to be written, because the harder decisions are still coming with bigger “savings” needed to be found and we shall see what is decided with that process.
Great comments, Hiro! I like “reason 3”.
Thanks so much for all your work helping to make lives better for patients and doctors.
Well said Shawn.. I am also worried, – If we forget that we are here to serve the members we are doomed to repeat the past..
Thanks Jim.
You can see how easy it would be to slip sideways. It takes energy to resist the momentum all around us. The default position is to assume anything that goes against a cookie-cutter, by the hour approach is wrong. We need people to push back. Thousands of docs are working day and night to help our most vulnerable citizens. We need our organization to have the backs of those docs.
Thanks for all you do! The OMA is really fortunate to have you there.
Hope you are well,
Shawn
Hiro, our current system is unsustainable. The sooner you realize this, the quicker we can dismantle this antiquated mess and get on to building a different system. We don’t need bigger savings. We can’t save more without cutting additional services. And all this leads to, is rationing and longer lines. Think USSR. Let’s age the population curve by 10 years but keep the health care budget the same… You tell me how that’s going to work out.
Shawn, I don’t think this is an interesting take, but I think you hit the nail on the head here once again. The OMA is either directed by its membership, or it’s directed by government which might as well make it another CPSO. And one of the things the membership has been asking for, for years, is proactive representation of member interests. I think we’re heading in the right direction but of course there’s always room for improvement.
I think we do need to step out of our comfort zone a bit though and start commenting on issues that affect us but may not be in our wheelhouse. The erosion of our value as physicians and the rise of responsibilities of Allied Health Providers lead to inequities and inconsistencies in compensation for provided services. Equal pay for work of equal value should apply to Physicians, midwives, nurse practitioners and pharmacists. And of course if work is of higher value, it should be paid accordingly. I wonder if much of our distress that I’ve heard voiced from Physicians about Allied Health comes from the perceived inequities in compensation models rather than the work that’s actually being provided. We were more than happy to talk about what was and wasn’t fair with unilateral government action. We should also describe fairness in terms of appropriate allocation of resources across a number of professionals for services provided.
Powerful comments, Rob.
I hope readers don’t miss this: “The OMA is either directed by its membership, or it’s directed by government which might as well make it another CPSO.”
The BC government is currently advertising for NPs and GPs for their primary care networks. They propose to pay NPs more per patient than GPs. I hope to blog about it soon. If the OMA is holding back because it assumes that it still possesses some noblesse oblige, those days are long gone. It’s a fit for a corner of a fixed pie. Either you demonstrate why you deserve a bigger piece, or someone else gets it. Docs are not used to proving why they add value. They better get used to it…everyone else has had a few decades to polish their presentation.
Thanks again for posting. I hope you are doing well!
It is only a couple of years ago that the grassroots members of the OMA fought and defeated the tPSA that was pushed on its members by the OMA executive. This occurred after Brexit in the UK and the election of Donald Trump in the US. At the time I was thinking that all of these events were early examples of push back against Elitism. I use the definition of Populism as meaning the opposite of Elitism (noblesse oblige) and since then I have seen Populism continue to sweep across Europe and the rest of the world. On reading this blog, Shawn, and in retrospect I believe that my analysis as Populism vs Elitism was correct.
“The OMA forgot to represent members.”
Great comment, Gerry. You captured the idea exactly. Thanks!
Good points as always Shawn. One thing I might add is that reform of structure and improved transparency are one thing but they aren’t the whole thing. Half measures such as the half assed pick your 10 favourite codes to negotiate for, die at the outset. Leaving the government the option to rob Peter to pay Paul will just end in loss of service. It is the entire Schedule that has to be tackled, not just bits of it. I know the task is daunting but that’s exactly why it needs to be done and done properly. This is a multi-year project and pecking away by cherry picking codes isn’t going to get us anywhere. Our leadership needs to be courageous and not co-opted by governments whining that it is too big or too complicated.
You are SO right, Ernest.
The SOB is a patched up flag from pre-medicare days. It needs a rewrite. However, even just saying that gives me hives. The Schedule is a mammoth project in price fixing, so I believe it will fail no matter what we come up with. But to your point, better is still probably less failure than we have now.
Thanks!
Nobody seems to want to talk about the elephant in the room.
As long as the OMA forces it’s members to pay dues,goes along with gov’t in preventing docs from opting out of OHIP,and does not work to allow physicians to work privately in Ontario,it will NEVER have credibility with a large swath of membership.
The OMA is NOT serving it’s members,and it cannot … due to membership diversity of interests.The tragedy is that the OMA is not serving the public of Ontario either,as it tries to work with gov’t to save a non-system that has a huge revenue problem,yet attempts to control costs by rationing care.
The only way the OMA will survive is if it LETS ITS PEOPLE GO … and derand our once noble profession.
Ramunas,
You have a particular skill at walking up and slapping the bull right on the rear end! I agree with you and feel torn at the same time. The reason we need a pseudo union is to fight the concentration of power in the government monopoly (they aren’t just a monopsony anymore — they want to run things and not just buy things as a monopsony implies).
Having said that, I always favour freedom in a toss up.
Thanks again!
The Ontario Medical Association is a professional association . A membership organization that is supposedly to represent the political, clinical and economic interests of Ontario’s Physicians and surgeons…it is not an union with the accompanying legal rights and privileges…it is, essentially a corporation, its Board members owe their allegiance to the OMA as a corporation as opposed to the membership of the OMA.
If the interests of the OMA clash with the interests of the membership, the corporation’s interests come first.
When I voluntarily joined the OMA decades ago the payment of the fee was voluntary…the OMA Board of the period got the OMA corporation into financial difficulties ( real estate mal venture being aa major factor) …the Ontario government “ rescued “ it by RANDIng the membership, the payment of fees became compulsory , thus the OMA was saved as its coffers filled …without the compulsory RAND the the increasingly bloating OMA would be bankrupted overnight.
The OMA owes its survival to the Ontario government and dances to its tune …there is no partnership , it is a vassal organization…the government holds the OMA’s gonads firmly in its grip ensuring that the OMA’s hearts and minds follow.
The membership has been reduced to that of public servant widgets without the rights and privileges of actual unionized public servants ( with their job security no matter the state of the economy , with pensions and benefits) while, at the same time , time bearing the trials, tribulations and responsibilities of independent practitioners facing market forces.
As it is the Council has been whittled and reshaped into the form of a compliant social justice snowflake (as its decisions increasingly reveal).
Either the OMA breaks away from the government shackles by de RANDing and earning its membership’s support….or the membership should create a new representative organization which fights tooth and nail, no holds barred, for its membership’s interests .
Solid comments, as usual, Andris.
Do you have any thoughts on the increased power of government in jurisdictions where doctors are more divided — like in Que?
Speaking of the OMA being improved (Shawn) and real estate (Andris), lets have an answer to one simple question: why does the OMA need to rent office space in Yorkville rather than 100 other places it could find for half the price, paid with our money?
The rot persists no matter who the CEO is. The system is on fire as the OMA works with the government to alot even less water to a growing blaze. The problem is , and always will be (as Ram keeps pointing out with every essay)) the pseudo-Randing of its members (we are not a union). Nothing changes until that does.
Great question, Ksy11
Actually, we looked into the real estate question. The lease that OMA holds is far under market such that it can sublease for much more. Furthermore, there are some savings being close to Queen’s Park.
Having said that, could the OMA save on rental costs by locating near Pearson, or even further away? I believe so. But the overall business case has not shown that to be a big savings. This is worth raising during the finance committee report again.
Thanks!
Ksy11…the real estate theory is that the OMA should be close to the government and health ministry power base so to better its ability to influence them…instead it is closer in order to be influenced by its masters.
The geographic centre of Ontario is Hornepayne, a township in Algoma district with a population of 980….there must be a Tim’s close by where the OMA’s hierarchy could hold its meetings with that of the Health ministry and the government officials.
I agree with Dr. Matangi’s response to this article in the Medical Post where he states that the OMA sees itself as the “ righteous protector of Medicare “ rather than of the medical profession and its members.