There are two kinds of homeowners. The first kind would never change faucets and doorknobs. They buy a house, tear it down and start over.
Other people keep what they can tolerate. They cannot afford to be radical.
No matter the approach, everyone agrees: The point of renovation is to rebuild.
Like an old house, the OMA sprawls with additions, legacy rooms and dark closets unfit for visitors. It’s tired and dysfunctional. Most people finally admit it.
The OMA was never built to service 42,000 members. It was not designed to command a battle with an activist, majority government in the trenches of social media.
Crisis can bring out the best in people. It often brings out the worst in organizations. The OMA crisis exposed problems that no one talked about when times were good. Crisis forces organizations to face dysfunction. Dysfunction invites scrutiny, and scrutiny demands change.
If organizations do not respond on their own, or do not convince members/shareholders that they take a crisis seriously, members attack. They fire the Board, sue the organization and otherwise do anything they can to force change.
Teardown to Rebuild
Doctors in Ontario have forced the OMA to change. Now doctors debate what that change should look like.
Most doctors seem to want a renovation that leaves some structure, but they want everything updated and improved. Others want everything demolished.
We are near the point where the OMA renovation must switch from teardown to rebuild. No doubt, the OMA still needs more demolition, and some of the demolition will involve tearing out new committees that have just been struck. But we cannot focus on demolition forever.
If this were a renovation show on HGTV, it would be near the point where the homeowners start to fight. Their satisfied glow of accomplishment has faded. Reality sinks in. They stand knee-deep in debris staring at an immovable obstacle: a load bearing wall or a plumbing stack.
Some things at the OMA will be hard to change, maybe even harder to change than to work around. Renovation will not be perfect; nothing ever is.
We should aim for perfection but accept reality. We cannot restart a campaign to demolish the OMA when change does not go exactly as we want.
Committees will need to be sunset, and time-limited task forces struck. The end result will still be a large organization, but hopefully a less bureaucratic one.
Hopefully, more like Starbucks and less like Service Ontario.
Time to Rebuild the OMA
Government forced the OMA to the brink of collapse. Government stretched the OMA beyond what it could bear—exposed embarrassing weaknesses. But the OMA will turn out stronger, more member-focused and better able to fight for itself.
Some people have spent decades calling for change at the OMA. They say the OMA is in bed with government. They accuse the OMA of corruption, secrecy and dysfunction. They feel vindicated by the OMA’s turmoil.
There comes a point when even the harshest critics of the OMA must shift gears. We all need to give the OMA time to reform. It will be messy and painful for many months, and there will be tradeoffs on what we can accomplish. But we must transition from demolition to rebuilding.
Of course, doctors need to stay vigilant and involved. We need to watch what the Board tries to change before the new Board members take office.
In all of the mess associated with renovation, doctors need to start thinking about the new structure. What comes next? What do we need from our organization?
Focusing on missteps and fumbles uses up time and energy that we need for the next phase. It’s time to rebuild the OMA.
Photo credit: dailymail.co.uk
I wholeheartedly agree with your comments. The first order of business should be to address fee disparities. This is the elephant in the room and should be addressed first. A timeline should be set. Alberta is finally addressing this and so should we.
Agree. We need to address our biggest differences to rebuild unity. A superficial unity that only points to us all being MDs and ‘all in this together’ will not work. Pretending differences do not exist will deepen divisions. I have a blog planned on how to address our differences…
Thanks Bill!
The ONLY way to address fee disparities is to let the market decide what a service is worth.We need choice in a public or private system (like every other OECD country)where natural competitive forces will determine fees.
Dr R Saplys
Only the forces of a free market can achieve true value.
All prices, wages , incomes and profits in a free market are determined by the laws of supply and demand.
In a free market all citizens trade their goods and services by mutual consent to mutual advantage according to their own judgement—citizens can only grow rich by offering better value, better products, better services at a lower price than their competitors.
Instead we have central planners overseeing a monopolistic monopsonic health care system where wages, fees are determined by the arbitrary whim of parasitic politicians who are more concerned by their own reelection than the health and wellbeing of their citizens and a self serving bureaucracy that panders to them and enables them.
Andris,
Of course, you are correct in a perfect market. I’d love to hear your thoughts about market failure and whether or not healthcare can overcome market failure. I offer this only because it’s the standard retort to comments like you just made.
Looking forward to hearing your response!
Cheers
Monopolies and monopsonies lead to inefficiencies which lead to market failures .
Natural disasters can lead to market failure, but barring that, you’ll find the government’s invisible hob nailed boots as the primary cause of market failure as is occuring in present day socialist Venezuela.
Free markets and property rights ensure efficient transactions
Government policies that are designed to prevent market failure don’t— the market always wins in the end although Keynes believed that we shouldn’t worry about the eventual consequences of government interference —after all ” in the long tun we are all dead”.
Bill, I have seen many discussions on the OMA’s dealing with Fee Relativity. If you have not seen many such discussions then your opinion about Fee Relativity might make some sense. Having seen many discussions on relativity and having given the issue a lot of thought, I believe if the OMA pursues relativity aggressively as its major first goal then the OMA will disappear as a useful bargaining tool for Ontario physicians.
As Shawn has been saying: governance and mission redefinition are the priorities.
Agree that fee relativity should be the priority. Has to be settled once and for all. I propose to include it in the redefined mission statement of the OMA.
Great comments everyone.
Relativity remains the one great division that continues to embarrass the OMA. We need an approach, but I believe it needs to start from a different spot that all the attempts to date. Sounds like this might be worth a blog post….
Thanks to all of you for taking time to share your thoughts!
is there a point to this? no specific ideas or anything, just repeating the same platitudes over and over? Lazy!
Thanks for posting a comment, Jim.
The point of the post was this: At some point we must stop pointing out problems and turn our focus to rebuilding.
Specific suggestions about how to rebuild have been laid out in dozens of other posts and will be offered in more posts in the future, too.
Trying to not be lazy,
Shawn
😉
Wonderful analogy…please consider running for President!
Thanks Karima! 🙂
The metal is hot and malleable at the moment. If we want change, and we do, we have to strike while the iron is hot. We have seen delaying tactics from the old guard and attempts to push us into premature negotiations without a clear set of goals and must haves. Now is not the time to settle down and admire the handywork. We have torn down some – got the building permit really. Now comes the sledge hammers and saws but we still dont have the blueprints yet! Now is not the time to negotiate with government. Now is the time to refocus and re-energize the OMA and make it what we need it to be, not to reconstruct the old OMA with new paint.
Well said, Ernest. Well said indeed.
That’s exactly what I am saying: “Now is the time to refocus and re-energize the OMA and make it what we need it to be, not to reconstruct the old OMA with new paint.” There seems to be a magnetic pull to get bogged down in business as usual, but with a twist. We need to rebuild with intention. Refashion the Board governance. Get rid of all the committees. Revision the role of council. Divest the power concentration that currently sits in the Board. Set the Board on board work, not management work. etc etc
We should have other associations coming to us to find out how the OMA is run so well. When people think of the ideal association, they should think of the OMA. No one thinks that now.
Thanks again for taking time to share your thoughts!
Shawn
Could be the OMA has been mortally stricken.
Getting back on `track`, no matter what the new policies and new format for election of executive etc. might take, it is likely never going to please all the membership.
And it may be that, binding arbitration distractions aside, we may never even recover enough to achieve the base payment budget for physician services that we had in 2010 let alone the continuous COLA losses!
That is, of course, unless we stop pointing guns at each other and focus on the Provincial Government.
It`s somewhat analogous to Humpty Dumpty who, having received a mortal head injury, could not be put together` by all the kings army and all the kings men` – no matter how hard they all tried.
I feel somewhat like Oliver Twist as I now return to the fray of the OMA board with my empty plate thrust before me meekly asking, “Please Sir, could I have some more SOLUTIONS please?”
Here`s what happens when physicians stand firm and demand fair trade for services rendered –and refuse to accept the paltry handouts from overbearing politicians
http://www.dailymail.co.uk/health/article-4410344/Locum-doctors-paid-3-600-single-NHS-shift.html
Excellent points, John!
I find it jarring to have people ask us about solutions, saving and efficiency after we’ve been cut every year since 2012. Maybe that should be fixed, first?
I think the OMA needs to think about its approach to negotiations vis a vis the role of the Board.
Looking forward to what you deliver up from the Humpty Dumpty omelette, when you get to the Board! 🙂
Talk soon,
Shawn
Perhaps we need a motion, something like;
The OMA will not negotiate and will not accept any PSA based on relativity. The OMA will negotiate on the basis of actual value of all services.
This is a ‘must have’
Great motion. [See comments below for more nuance.] We cannot pretend to solve a problem that has vexed doctors for 30 years in one, short contract.
SO DO YOU WANT TO DRAFT IT UP AND WE PROPOSE AND SECOND IT? BTW I TRIED A FORMULA ON ODDF. WHAT DO YOU THINK?
I believe the time to submit motions has passed.
I would love to see this debated and to get a commitment that the negotiations committee won’t try to force a grand solution. Having said that, I generally disagree with micromanaging how the negotiations committee does its work. So, I’m torn. Ideally, the OMA should have refreshed its mandate before going into negotiations. I do not understand how it can negotiate on our behalf without a mandate refresh. Maybe they DID refresh the mandate and I missed it. The process used to take the better part of a year.
I’m not sure what you mean by ‘tried a formula’…
Thanks again for sharing a comment! Enjoy your weekend…
The deadline is the 19th
So, I’ve been thinking more about this motion…
I think we both know what it means: We do not want the OMA to pretend to fix relativity in one large swoop in a tentative contract. But that does not mean that we want the NC to completely ignore relativity!
Almost all MDs want relativity addressed in every contract, just not in the clumsy fashion of the the failed tPSA last summer. So, I agree with the NC paying attention to relativity. I believe council approved an approach that ensures relativity never gets ignored in negotiations.
Having said that, we do not want negotiations to ‘fix’ relativity once and for all in the negotiations process.
So, on second thought, I find this motion difficult to move. We need more clarity.
The frustrating thing is that we shouldn’t even have to think about such motions if we had trust that the process would roll out well.
Thanks so much for making me think! And on a blurry Saturday morning no less.
Enjoy your weekend.
Relativity is based on the ‘zero sum assumption’ . That the government is only willing to pay a fixed amount and we are fight amongst ourselves for our share. This assumption favours small highly cohesive specialties where group action is feasible.
Well said!
My main concern is that the government has a certain ” influence” within the OMA, steering our own colleagues , OMA employees and those “experts” who advise them to rebuild the OMA in a government approved manner—and when it comes time to vote on the matter, to shepherd members of Council in the government approved direction to the detriment of our profession as a whole and individual members in particular..
Our organization is composed of individual sovereign medical practitioners who wish to live their lives as each sees fit — they are not interchangable widgets as the government likes to perceive them ( see Bill 41) , members of a self sacrificing self flagellation collective whose lives are owned the government of value only so far as they serve the needs and whims of the government.
You make some good points about people working to guide Council, and not always with doctor/patient benefit in mind. I guess that’s why we have a large group at council. Hopefully, we can get enough regular working doctors on Council, who pay rent and staff salaries, so that we aren’t lead astray by financially independent utopians and those who’ve never run an office before.
As an aside, I’m not sure everyone can see past some of the hyperbole you put into your comments. Having chatted in person, I can see the twinkle in your eye and your cheeky smile as you make outrageous comments. However, those who do not know you might find comments like “self flagellation collective” as too much. I’m just saying…
Thanks for taking time to share comments!
Enjoy your Easter weekend.
Extravagant perhaps but not an exaggeration.
One wonders what happened to the kind of people who became flagellating religious zealots in medieval times, attempting to seek atonement for their sins?
In the modern era , it seems that many found their way into medicine.
Seeking redemption, medieval flagellants carried out extreme acts of penance, enthusiastically flagellating themselves and others , so do their modern versions in Medicine although they go lightly in self flagellation and more in flagellating.
The moment a modern day Canadian medical student finishes his or her training, he or she becomes sinful in the eyes of the government and media—through study and the passing of exams developing the modern version of original sin—in contrast, a student that morphs into a teacher or nurse become instantaneously virtuous.
Atonement for the sin of graduating as a medical doctor is a complex process — volunteering to work in the third world with MSF etc., seems to work for some ( I must confess that I did work in refugee camps when young) , returning to Canada and metaphorically beating up their sinful colleagues works as well.
It is particularly useful if one wishes to enter politics and climb that greasy pole.
This is the best description of the current and past failures of the OMA that I have ever read. Well said. Every OMA member needs to read this statement and think long and hard about how the OMA’s role and position in health care politics in Ontario has evolved and devolved into an arms length branch of the government as opposed to a real advocate of the professional working physicians of Ontario. Too many OMA motions and decisions are merely rehashing of the goals and directives of the government. It is anger towards this kowtowing that has driven the grass roots (COD, etc) to rise up and organize to hopefully reform the OMA. As a recently elected Delegate I look forward to being a part of this renewal.
Oh please. The not all at once, itty bitty approach to equitable fee and income for all doctors has been the only solution from the OMA for decades. If it were to work we would not be repeating the same discussions. And no one can on the low end of the relativity scale believes the OMA really gives a ….. anymore.
“There is a widespread feeling that the current processes of fee bargaining, internal allocation of fee changes and adjustments for changes in the costs of practice do not provide incomes that are reasonable and equitable within the medical profession.”
M. L. Barer and G. L. Stoddart Toward integrated medical resource policies for Canada: 1. Background, process and perceived problems CMAJ February 1, 1992 146:347-351
If, in fact, relativity is to be applied in negative allocations as approved by OMA council, the fee cuts needed would be forthcoming and the number one priority of any negototiation. The reality is the measures that have been implementred that have most effectively addressed pay inequity are those unilaterally imposed by the Minister of Health. Sadly our colleagues on the high end of the earning scale are all supportive, as long as it does not affect them.
Ed Klimk
Past chair section Neurology
I hear you. Just cutting the top earners to fix relativity might look like a quick solution. We could just use the power of government to get it done. I disagree with this approach for 2 reasons:
1. I abhor the use of force. Asking government to force a solution to relativity will do more harm than good.
2. I believe that we will end up at a much better spot if we work at getting buy-in before we create a solution (I will write a post on this and look forward to your comments on it.)
3. Doctors are stronger together, if we can agree on what we hold in common. Using a blunt solution to ‘fix’ relativity would fracture the profession even more.
4. High paying specialties have enough members now to negotiate on their own. I would not be surprised if they might elect to work out their own side deals (like many of the academic docs) in return for solving some vexing problems for government.
Thanks for sharing a stimulating comment!
Time to stop “abhoring” and time to decide if there is any solution not already tried to a problem for over 25 years. “Doctors stronger together” is what got 42,000 members associated involuntarily with little more in common than 4 years of medical school (neglecting for the moment those still in medical school that sit in on the discussion). And here,we are, stronger together without PSA for 3 years and rolled back 6.9% every invoice for service submitted to OHIP.
Here’s my solution, make the OMA responsible to its membership for adhering to their direction or let those who can meaningfully associate amongst themselves freely assemble and direct their own futures. Yes, the advantages of wealth will accrue to those able to buy influence. They may not be grateful that with my support they got there, but at last then my involuntary contribution to their representation by the OMA will be spent elsewhere.
There are, by my rough calculation, at least 4,000 members to benefit from effectively addressing relativity. That $8 million plus dollars could be spent pursuing a more effective representation. If the OMA felt the least inkling of financial concern relativity would be job one.
Ed Klimek
Past chair section of Neurology
Could it be that the government is quite happy to see the OMA and the medical profession in a perpetual state of chaos?
Aggravating the chaos by sowing discord between members and sections, the government has managed to avoid signing any contract with the profession even as it imposes its will, restructuring the Ontario health care system ( in a non evidence based manner) , as per Bill 41 etc., on the disorganized and demoralized profession.
The government will help in tearing down the OMA now that it is no longer a dependable vassal organization as it was in the days when it had a career MOHLTC bureaucrat as its chief strategist and CEO ( what was the Board smoking?) —it will do its best to prevent a viable and effective representative OMA to be built in its place.
The OMA Annual General Meeting looms, let’s see if the profession can get its act together or will it reemerge as an unstable ineffective jerry rigged structure unable and unwilling to stand up to the government?
“government will help in tearing down the OMA now that it is no longer a dependable vassal organization ”
There is no down side for government to keeping the OMA as it is. Involuntary OMA dues became a cost of doing business in Ontario much like emission testing or tire recycling fees became a cost of car ownership. An ineffective representative OMA can totter along while government appears to participate in negotiations.
Discontinuing the involuntary dues ( RAND) frees up money for doctors so inclined to assemble their own lobby group. Why would government want that?
Let’s all be clear…
It’s the OMA that continues RANDING physicians in Ontario … not gov’t.They could simply not submit a list of doctors that have not paid dues.