“I know you guys needed to act tough recently.
I get that.
But when are you going to start supporting government again?“
“You know, you get more done when you work with government than against it.”
I could fill pages with these comments.
Experts and establishment insiders insist that doctors should always try to support whatever position seems popular with government.
They believe that funding requires relationship, and relationship must come before principles or position.
You only Get to Yes when you abandon positions for interests.
Working with government was never in question. Doctors in Ontario have begged for a working relationship since 2012.
Even when medical leadership had deep ties to the ruling Liberals, doctors were shut out of decision making, shunned from consultations and heckled in the legislature.
Medical leaders had tea in private clubs with the Premier, at the same time that the Premier was unilaterally cutting doctors’ fees.
Did this relationship help doctors, patients or healthcare in general?
Everyone benefits when doctors and government work together. No one disputes that. Problems get fixed, crises averted and both parties look smart.
But what do we do when government pursues an activist agenda and uses the girth of its majority to ram through drastic healthcare redesign?
Do we stay silent in the face of sub-inflationary funding for hospitals and cuts to doctors and nurses?
How do you trust a government that has 5 police investigations (1, 2, 3, 4, 5), brags about tripling the provincial debt and has a leader with the lowest voter support in recent history?
Impossible questions. Regardless, doctors might have to try to work with this party, if they win, or worse (Rae Days). The provincial election brings no guarantees, even if your favourite wins. Docs have been beaten up by all major parties at some point.
No, there was never any doubt. Doctors have to find a way to work with government. The issue is how.
Relationship Nonsense
Fear of consequence underpins healthy relationships. Freedom in relationship rests on knowing that there are real consequences if we abuse that freedom.
If we behave poorly, we lose intimacy and perhaps the whole relationship. Without limits, one party becomes a pet or worse.
It takes two to fight. We cannot blame one party. It also takes two to get along. One party giving in all the time is not relationship. It is slavery.
“You know, at some point, you must start working with government. You need to stop being combative.”
Why must doctors always stop being combative? Doctors are by nature averse to fighting. They complain, but they rarely fight. Docs must reach a point of burnout, breakdown or boiling over before they mount a concerted attack.
How should a reasonable person respond to heckling in the legislature, slander in the media and being ignored completely for multiple pieces of legislation?
Should we beg to be heard? Should we flatter and applaud?
Or should we stand and demand respect?
Smiling politicians stand up in the legislature and say:
- Ontario docs are the highest paid in Canada (not true), and
- Doctors only want healthcare to be a priority in the election because they want a better position in arbitration (also not true, and in fact, impossible)
Healthy working relationships start with respect and fear of consequences. If we were all angels, working relationships could stand on trust in other people. In real life, we need boundaries.
We need to know that there are laws, regulations or some authority to punish us, if we abuse a relationship.
What boundaries limit government?
What holds politicians back from directing bureaucrats to design a new scheme for healthcare, make it law and then force it on doctors, without any consultation with the doctors themselves?
Nothing.
They have the legal authority to cut and legislate and change whatever they want without any consultation at all.
The only thing that makes politicians hesitate is wondering whether doctors will make a public outcry, and whether the public will care.
Doctors must regularly demonstrate to government that we know how to fight, that we will never ignore abuse.
Working together starts with respect.
Respect requires limits.
Limits mean nothing without consequences.
So to all the well-meaning experts, so full of advice and good will, please stop telling doctors to just get along with government.
Ontario needs a working relationship between government and doctors. True relationships contain limits and consequences. Relationships cannot function when one party has all the power and no fear of misbehaving.
Relationship nonsense is still nonsense even when an expert says it.
Photo credit: TechWhirl.com
In a dysfunctional relationship, sometimes divorce is the best option.
There are many places in the world that would appreciate the expertise of a Canadian physician.
You raise a fair point, Pradesh. Too many of us have deep roots that keep us here. But brain drain starts quietly. We are already losing many of the new grads who can settle elsewhere.
Divorce, in this case, tends to happen slowly over time. Hopefully, people wake up to it soon.
Thanks for your comment!
Cheers
Complacency and the role of the victim a’la Stockholm syndrome. No one can remember not being subjugated by the Canada Health Act. No one even sees the denial of rights to physicians in the CHA. They say ‘of course the government can deny me the right to work for someone else or for myself’ or God forbid work compensation commensurate with your training and responsibility. We have become a profession of victims grateful for the odd crust from our masters. Worthless in the eyes of society where medical care is “free” and unlimited.
You make a great point, Ernest.
We have never known anything else. How can we advocate for colour when we’ve only lived in black and white?
But you also raise an important point about the worth of ‘free’ services. People celebrate ‘free’ services until they forget that they were never ‘free’ before. Once a gift becomes an entitlement, people see no need for gratitude. When services are cut, celebration transforms into suspicion that maybe they aren’t getting all that they are entitled to.
Having said all this, we still have to find a way to stand tall in the current state of affairs. Even if we lack the stomach to do it for ourselves, perhaps we can do it for our patients.
Thanks again for taking time to share!
So when are we going to stand and demand respect?
With the election coming up there is no plan to march up and down University Ave and demand attention. Demand that the public understand the cuts.
Fair negotiations happen when there is respect for the other side. We have never been respected. We are weak, we agree to ‘no increases’ settlements, we dont participate, we are small in numbers and we are not vocal. Until doctors want to get involved nothing will happen. We can complain about the government but how loud is our voice? With negotiations in arbitration we need to say what are the key things to achieve in this election and make it loud. With the surveys that you have done , what do doctors care about??
Thanks Pat.
I agree with some of your comments. For example, getting involved in the election is key. We’ve been very active. I hope you checked out the OMA platform and clicked “Take Action” on the Not a Second Longer website to send a letter to your local candidates NotaSecondLonger.ca Many docs have taken action, but we need more doctors to take action. The OMA cannot do it all alone.
As for demanding respect, I believe we have done so this year…although we can always do more. We achieved a binding arbitration framework, we pushed the federal government back on their tax changes, we are in arbitration now, and we have an election campaign that says “It’s the government’s fault”…just to name a few things.
I look forward to seeing you at council. I can’t remember how you are currently serving in the OMA, but we need more passionate people like you helping to create the organization doctors want.
Thanks so much for taking time to share a comment!
Cheers
It would seem that the most damage done to the profession occurred when it worked with the government from a subservient position.
The medical profession is not negotiating with the government as an equal partner…there is an inequality between them…of resources , of power and frankly , of will and of intelligence ( both cognitive and of the military kind as per Sun Tsu) .
The government has its sympathizers ( Quislings/ spies) within the medical profession relaying confidential inside information to the government …there are no sympathizers ( we have no agents/ spies) within the ranks of the government’s negotiating team…it is not a chess game…it is a game of poker where the government has its agents looking over the medical profession’s shoulder even as it holds marked cards cards up its sleeve.
We are trying to negotiate with a party that states that “ what is mine is mine and it’s only what’s yours that s negotiable”…the voices that are agitating for “ working with the government” are the voices of the government’s ideological sympathizers, agents and of useful idiots.
The government does not treat the medical profession with respect …it understands the profession all too well, it knows it’s weakness and is willing to go for the jugular…the medical profession knows the government’s weakness but declines to attack it as it should be doing between now and the 7 th. of June 2018 Provincial election.
The government treats the medical profession with scorn and contempt…and, having witnessed the negotiations between the profession and the government over the last 30 years, and their consequences on the health care system and on the medical profession, the contempt has been well earned.
At present the OMA has not earned the respect of either the government nor of its own membership….and judging by its present docile deferential behaviour , doesn’t deserve it.
Dr Whately provided the membership with a glimmer of hope, a flicker of light… there is a rising minority penetrating the upper reaches of the corporation that may well spark a fire that may well earn the respect of the membership and that of whatever government is in power…the present government’s agents will, of course , try to extinguish it as they have managed to do in the past….one hopes that they fail and get their fingers burned.
nicely put. So do you want to speak at the next rally??
Thanks Andris,
Very eloquent as always!
My favourite line in your comment is: “We are trying to negotiate with a party that states that “ what is mine is mine and it’s only what’s yours that s negotiable” ” Brilliant.
I strongly disagree with you when you say, “…judging by its present docile deferential behaviour…” I wonder if you’ve had the chance to listen to even a few of the dozens of interviews I’ve done? We have relentlessly highlighted the dysfunction in healthcare. We have placed the blame where it belongs: on government. Why else would people be begging us to stop?
At some point, we have to start supporting our organization and working to make it more of what we want. We can’t criticize without doing our part to improve.
As always, I love your comments! Thanks so much for sharing them. I can’t possibly respond to them in the fullness they deserve, but please know that the readers enjoy your thoughts.
Thanks again,
Shawn you have spoken very well…many Presidents before you have also spoken well…the OMA itself has made some wonderful declarations over the years…however I’m a behaviourist in my training and approach and perceive people as being “bilingual” …when verbal language and behavioural language run in parallel OK, but when the verbal language says one thing and the actual behaviour says another I regard the behaviour as being the more authentic.
The government, for example, is deliberately bilingual ” saying nice doggie, nice doggie ” as it strokes the head of the medical profession “dog” with one hand whilst its other hand is reaching out for a stick or rock, anything to beat it with….and it is.
A wise dog would take any governmental stroking with skepticism and keep the eyes focused on the other hand….the government has passed a series of bills ( rocks) that it has piled up ready for the day that it will hurl them…and it will if given half a chance.
The OMA verbally ( and in writing) stated ( over a decade ago? ) that it would go to court, to the highest level, to fight vigorously for the rights of the extremely wronged profession …but as far as the grass roots membership is concerned , the ” going to the court” bit has been glacial…deliberately glacial perhaps …certainly the beating of the legal war drums have not been audible to the masses, so sapping their morale and their faith in the leadership even more.
Unfortunately I suffer from hysterical aphonia in public meetings.
My I suggest approaching Professor Jordan Peterson as a speaker…his excellent book the ‘ 12 Rules of Life ‘ touches on many of our profession’s deficiencies…for example , we need to learn how to stand up straight as a profession with our shoulders back…
We must keep electing members to council,directors and presidents that speak truth to power,and are willing to engage in the process of fundamentally changing the OMA and its relationship with gov’t…..the problem is that the process is extremely time consuming,and the only docs willing are those with special interests such as idealogues(eg quebec docs that wanted their raise reversed),insiders(docs that would rather sit in 9hr board mtgs and get paid $1400),and those who enjoy the ‘sport’ of medical politics.Things have become bad enough that the grass roots realizes it must stop the ‘gravy train’…. I hope it lasts.The hard cap in this arbitration is the key .. if we lose that,the profession is done in Ontario.If we win,the system will crumble,as it unsustainable(despite what the medical reform group types say)in providing high quality care in a timely fashion.Then physicians will have a CHOICE as to what system(private or public or both)they work in,will have respect and leverage with the power of the services they provide.Until then …… good luck.
I love what you said here, Ramunas: “We must keep electing members to council,directors and presidents that speak truth to power,and are willing to engage in the process of fundamentally changing the OMA and its relationship with gov’t…” Excellent!
And I also agree, “…the process is extremely time consuming…”
Serving requires time, energy and sacrifice. That is the problem. The $1400 for a one day board meeting says nothing of the 2 days of preparation and innumerable emails, phone calls and conversations that are NOT compensated. Trust me, you will make much more money just seeing patients. Please do not serve to make money…you will be disappointed.
You make some very interesting points about what a ‘hard cap’ on physician services might mean if it is brought in, or not. I agree, choice is good: It drives quality.
Thanks so much for taking time to share and for your well wishes!
Cheers
I find it perplexing when professionals (like Ontario’s doctors) who have a significant vested interest in costly public programs that depend on progressive taxation dig into the archives of Ontario’s political history to bemoan the NDP (your jab about ‘Rae Days’), but have some sort of (?convenient) amnesia about the plight of health care under the more recent Mike Harris PCs. Deep health care cuts, hospital closures, some 6000 nursing jobs slashed… How can we reasonably expect an increase in the Physician Services Budget and more health care dollars from a PC government that is pledging tax cuts?
I agree, Andrea.
That’s why I said, “Docs have been beaten up by all major parties at some point.” If Harris had done something eponymous such as “Harris Heydays”or “Harris Happy Days”, I would have mentioned it in brackets, too.
I cannot predict what any new government will do. Ford has promised no more cuts to doctors and nurses. Will he live up to that promise? Hard to know. We can be certain of more cuts from Wynne. Ms. Horvath would need a huge pile of other people’s money to finance her utopian dreams.
So again, I agree. We would be wise to be skeptical of all centralized controllers of any nationalized industry, regardless of who forms government.
Thanks so much for taking time to share a comment!
Cheers
The medical profession has been forced by law to have a “ vested interest in costly public programs that depend on progressive taxation”…the medical profession did not conceive this monopolistic monopsonic health behemoth , top heavy with overcompensated health care bureaucrats that cannot deliver what the goods that the conceivers promised…the medical profession did not build it and certainly do not manage it.
The medical profession has as much interest in the present costly ineffective inefficient health care program / system as did the surviving private farmers in the USSR who were forced to work in the behemoth Soviet collective farms that led to mass hunger and starvation. …a collectivized system that eventually collapsed under its own weight.
Many would prefer to work in a world class hybrid public/ private health care system …systems proven to be more effective and efficient in the delivery of care…the introduction of which would be much in the interest of both patients and those who provide health care at the coal face…but not , of course, in the interests of the health care bureaucrats of which we have a glut in Canada and Ontario…only one in 15 of whom would be employable in Germany for example ( we have 15 for every 1 German health care bureaucrat).
It is perplexing that there is no evident interest in introducing an evidence based world class health care system into Ontario / Canada.
In the mean time career politicians should be changed regularly like diapers and for the same reason….6 more weeks before this soiled provincial provincial diaper gets dumped into the pail.
Dr Lielmanis’s rebuttal of the comments supporting socialist health politics/systems is outstanding,and speaks truth to perception.
There are MANY/dare I say the majority,of OMA members who feel the same.
Bravo !!!
Hi Shawn,
From my perspective, I can see the problems on both sides. The OMA needs to come up with a specific plan of action which we all agree to. Unfortunately we don’t have our shit together as a multifaceted group. Relativity and all the different payment systems and fees, and the huge change in our work methods since computerisation changed the way we work and cell phones and emails have changed the way we communicate. Until we sort ourselves out internally, we are not fit to negotiate with government, because we don’t know exactly what we want and therefore cannot come up with the defined action that we can take to government.
We also have to decide if the Lhin in its present form is something that we can work with and if not, can we suggest modifications that would help. The coordinator for patient referrals is a big step in the right direction. The next big step is getting seniors placed in the correct living accommodation with or without acute or chronic illness, married or single.
Both excellent comments, Chris.
This round of negotiation built on massive input from all the sections. We can be certain that we’ve heard from doctors. The challenge is getting the government to listen. Government spends time setting its own agenda, but almost no time listening to needs on the front lines of clinical care.
Your comment about the computerization of medicine is interesting too… I must think more about it.
Thanks for taking time to share a comment!
Cheers