In a year of unprecedented events, doctors look forward to another historic weekend.
OMA Council, the governing body for 42,000 doctors in Ontario, meets to debate the first ever vote of non-confidence in the Executive Committee of the Ontario Medical Association.
Six motions follow: one for each member of the Exec asking that each one resigns immediately.
First ever. Unprecedented. Unheard of.
Speakers at the OMA often quote Einstein,“The definition of insanity is doing the same thing over and over again but expecting different results.” Will OMA Council do something new?
Special Council Meeting
Council meets to debate the performance of the Executive Committee.
But people will twist it into a debate about individuals and personal integrity. Others will shame their colleagues for being divisive and petty. Still others will focus on forensics designed to assign blame.
Council needs to focus on one thing: Based on performance to date, do the doctors of Ontario believe that the leaders of the OMA can effectively serve the membership?
After dozens of council meetings, I expect the following:
A. The Board will anesthetize council with long speeches and a detailed review of all the hard work done to date.
B. The Board will pre-emptively respond to all known and suspected grievances.
C. Members of the Exec will offer heartfelt apologies for past performance. They had the best intentions.
A few Exec members will speak with passion, defending their honour. They will get angry and demand a point of personal privilege that anyone dare impugn their character.
A few will get choked up and share personal details. Emotions are powerful: Most doctors are softies.
D. Movers of motions will get a rigid 2 minutes to speak. They will try to read a long list of grievances, while council struggles to follow along.
Genuine but nervous, they will have a tough time convincing council, slotted against Board members with media training and decades of practice.
E. The Board will invite every living past President to attend. These polished statesmen/women will call for stability in uncertain times.
They will rebuke the divisive and rebellious doctors who dare to question the personal integrity and character of the Board.
F. Those who speak against the motions will continue the theme and talk about individuals, integrity and character. They will dismiss results or performance as unavoidable, an Act of God given the evil government.
They will say, This kind of meeting is exactly what the government wants!
If we expel the Exec, government will cheer.
The government is the enemy, not the OMA.
A Rift in Council
One group will denounce the motions as divisive, disruptive and a nasty attack upon good people who were trying their best.
The No camp will use moral language to attack the wisdom and professionalism of the movers. The No camp will make a natural appeal to emotion while questioning the integrity of their opponents at the same time.
Those in favour of the motions will say that Exec members are really great people, but doctors expect good outcomes, not just good intentions.
The Yes camp will appeal to reason. Do they have any choice? It seems hard to deliver an effective appeal to emotion or morality without sounding insincere or mean.
Humans are not logical. Morality and emotion trump reason. If the Yes camp has only reason, it will fail.
Way Forward
Hopefully, the Board grasps the importance of this special council meeting. If it were legal, a huge majority of doctors would stop paying their mandatory dues.
There have never been so many groups organized against the OMA:
Concerned Ontario Doctors,
the Coalition of Ontario Doctors,
DoctorsOntario,
Doctors for Justice,
the group who organized the special council meeting.
The OMA must win the trust of members, and then win the respect of government, as soon as possible. Right now, the OMA has neither trust nor respect.
The OMA must do something really special, something outstanding, to demonstrate that it deserves trust and respect.
Maybe it could offer all the members their dues back?
Maybe the whole board could stand for re-election, immediately?
Maybe the Exec could resign?
Fancy moves like a Special Committee to protect the Board will not win trust or respect.
Council almost never goes against Board advice. If Council supports a vote of non-confidence in the Executive Committee, it will be a first. It will be something new. Whatever happens, let’s hope the Board pays attention and does something different really soon.
What is interesting to note is the complete radio silence on the result of the two surveys that were done assessing what the membership feels. There was one by an outside agency and one done by thought lounge. They were on the agenda when it was a leaders meeting and now they are seemingly swept aside.
Great comment, Ernest.
But just in the time it took to respond, my email inbox got new emails from the Exec and from the Academic Medicine Forum asking me to support the Exec. Funny how quickly these come out.
All of this could have been prevented. We knew – many of us know – that the tPSA would tear the profession apart. Risky moves that fail require significant counter measures to repair. The Board cannot think that this will all disappear. Even if the motions fail this weekend, the Board still has a tonne of work to do before members or government will trust/respect it.
Thanks for all you do!
Best regards,
Shawn
Got the same email from OMA Executive…waiting for robocalls to start.
Your outline of Sunday’s meeting is bang on. Unfortunately, Council members have to be there to vote.
Good Luck to all on the motions.
Ha! I sure hope no one is stupid enough to do robocalls anytime soon.
Thanks Monique!
Shawn:
Thanks for such a insightful run down on the situation.
Obviously the Exec. and the Board did not learn something from the defeat of tPSA.
I was hoping after the failed tPSA and the president’s apology that they would change direction and
change direction. But NO. It is the same. The apology was just lip service and the inaction precipitate this special council meeting. If OMA get defeated, they ask for it. As you said, even if OMA survive the no confidence vote, they better work hard to earn back any respect or trust. Doing the same and hope that the membership would sheepishly accept the status quo will be disastrous.
God help us this Sunday.
Michael
Well said, Michael!
That’s my biggest fear in all this: OMA won’t learn anything.
Hoping for the best!
Thanks for taking time to share a comment!
Your predictions and insights, seemingly made with your experiences in mind, make for fascinating reading. The word “awesome” is thrown about too loosely but not this time. Awesome piece, Shawn. I will send it along to the other critic in my family. She will love it.
You are too kind, Gerry! I appreciate your encouragement even more because I know you feel free to also tell me what I need to improve. That’s more than any writer can hope for.
I cringe at the opportunity put before council. I sure hope council realizes that it’s doing the Board a favour by making a tough decision that the Board could not make on its own. If council does not, it leaves an even harder decision for the Board: How to rebuild trust.
I sure appreciate you reading and sharing a comment!
Thanks Shawn.
Now I don’t need to go.
I owe you a Sunday.
Too funny!
You always make me smile, John.
Enjoy your weekend. 😉
I see how you predict the OMA will respond, but what is it that you are wanting and needing where is that in your message? your page says – offering solutions… I see no good alternative other than posturing. I see a group of doctors worried about income and not to the functioning of the system so you don’t speak for me.
I work in both Quebec and Ontario and the system in Quebec is and has been significantly more draconian. If you expect more from your government and representation you certainly have a right to speak up, but discuss actual points in your message other than frustration or your representation will be equivalent to an angry mob but without a reasonable plan (a la Trump). Some in Quebec have compared ROME with COD but I disagree. ROME- Regroupement des medecins Omnipratitien pour une medecine engage- a group that emerged with our Loi 20- unilaterally imposed quotas and hours on Family doctors and pay cuts with a negotiated delay til Jan 1/18, they have particular points they want from goverment and union representation http://www.romequebec.org , show me that you want a better functioning system and are working for this I will consider your candidature for my representation.
Hello Gael,
Thank you for taking time to read and share a comment! You ask some good questions.
1. You ask for solutions and say that you “…see no good alternative other than posturing.” There are almost 300 posts on this site that offer quite a few solutions, in addition to over 2,000 comments that include solutions, too. This post, the one you commented on, is a list of predictions about what will happen at council. I offer it in the hope that I am proved wrong. I also offer it with the hope that people will prepare based on what I’ve said will likely happen. In other words, get ready for people to twist the discussion into a debate about individuals, etc.
2. I can only imagine what you experience in Quebec! Bills 10 and 20 sounded terrible. I talked with a number of younger docs from Quebec in August. They told stories to make us cringe! You pivoted on the Que experience to ask why I’m critiquing leadership. I critique leadership in this blog because that’s the topic of the blog post and Special Meeting of Council…
3. “…discuss actual points in your message…” I made a 3 concrete suggestions for the Board to consider. I have made many concrete suggestions over the past 6-10 blog posts. Did you read any of those?
4. “…show me that you want a better functioning system and are working for this…” Again, nearly 300 posts on this topic over 3 years, 15 years in elected leadership, 6.5 years on the Board of the OMA, and many more areas of service to system improvement should demonstrate my passion to improve the system. I’ve also written a book on wait times (No More Lethal Waits – 10 Steps to Transform Canada’s Emergency Departments), served on provincial and national committees… I could go on, but I’m not sure what more you expect me to do to ‘show you’.
5. “…I will consider your candidature for my representation.” Too late for that. I am not running to represent you any longer. Unless you are a doc at my local hospital, I do not seek to represent you at all.
Again, thanks for sharing such an interesting comment. I’m sorry to have somehow given you the impressions that led to your note.
Kind regards,
Shawn
I regret that I am unfamiliar with your site prior to today- and let my reading of your post to be only the posturing and propaganda I heard in August with no substance from COD and the OMA. Dues back is a bit ridiculous, but resignation and re-election a great idea- I wish the FMOQ had more responsiveness to its members as the OMA seems to with special meetings and votes on tPSAs…
I will look more at your site, but I hope that those that want to expel the board have something to stand for and not just against as I have no time for the complaining that isn’t backed up with a vision. The Bills 10 and 20 are now laws 10, 20, 130, etc… they are just not all fully applied in the case of 20 and 130.
All good, Gael!
I appreciate you feeling open enough to offer a challenge. I love that!
The OMA is nothing without members’ support. They forget that.
I look forward to hearing what you think about some of the other posts.
Cheers
Shawn
Shawn, you type faster than I do but as I wrote this already and make a few other points than you do, forgive me for the redundancies.–Gerry
You appear to be new to Shawn’s posts and ideas. His blogs have been around for quite a while and those who follow him here and elsewhere regularly know the answers to your questions and points.
Re: “but what is it that you are wanting and needing where is that in your message?”
This blog piece was not meant to answer that question. The answer to that lies in the litany of posts, actions, history of medical politics in Ontario that have been going on for years.
re: “I see no good alternative other than posturing.”
If all you are reading is this one blog piece then you may not be aware of the alternatives that have been discussed by many physicians including Shawn. With regard to “good alternative”, I say again that there are no good alternatives with regard to health care in Ontario and Canada. The status quo is no longer an option. If you are talking about “good alternative” to the present functioning of the OMA, there may be no “good alternative” but there certainly are better alternatives.
You may see “a group of doctors worried about income and not to the functioning of the system”, but either you have not been following what many doctors in Ontario are saying or you are choosing to be selective on what you hear.
Many, if not most, physicians in Ontario are “angry” and working for a “better functioning system” as well as for what we consider a fee structure that allows us to continue to give top-quality care to our patients and, yes, an income that, just as everyone else strives for,WE feel is appropriate for US.
You are entitled to your opinion but if by“reasonable plan” you mean a plan that YOU consider “reasonable”, that does not define what I consider “reasonable”.
If by “mob” you mean a group of people that is fighting back against authority and the old way of doing things, then we are certainly that. If by “mob”you mean a group of people that is rioting in the streets, then you should look elsewhere.
I know most of my colleagues will not agree with the way I phrase the following, but from my perspective this is what I believe. If you are using “à la Trump” as a group of people who are a bunch of DEPLORABLES (for not believing as you do) and who are “mad as hell and not going to take it anymore”, then you are correct. That is what we are like.
The duly elected representatives of the voters created this health care system. The physicians of Ontario are not responsible for it, but just doing the best we can. This is how I see the world is currently evolving: first Brexit in the UK, then Trump in the US and now DRexit in Ontario.
Gerry, thank you, thank you, Thank You!!
I should have waited for your brilliant answer. It’s SO much better when someone else responds to these kinds of comments!
I sure appreciate you taking time to do it!
Warm regards,
Shawn
I respectfully disagree, I feel that Shawn your comments were more substantive and reflective and Gerry’s continue to be argumentative and not supported by any vision or facts.
We need to get away from the Alternative facts and analogies to populist movements. Ontario MDs make the most (on average) in the country and although representation is not ideal- where are the MDs Drexiting to…? Many of Quebec’s doctors are leaving for Ontario, and across the country. Run for office if you aren’t happy with your representation, and convince your collegues to vote in elections, and for what you want the OMA to address.
Actually, Ontario doctors have fallen to 9th place in incomes. We have sustained over 30% cuts to our net incomes when we factor in inflation since cuts started in 2012.
I appreciate you bristling at the anger from Ontario doctors. But it is really bad here. I understand it might be worse in Quebec. That doesn’t warrant anger here.
I’ve already served 15 years in elected office with 6.5 years on the Board. I finally had to resign from the Board when I could not, in good conscience, stay any longer. Gerry served as an elected rep to OMA council for years and as a leader in his section, too.
I understand that you are coming to the discussion late. Thanks for showing interest!
Cheers
Shawn
Tiny correction, Shawn. I was never served on Council. I was on my section’s council many years ago. Nevertheless, I have been a physician since 1972 and an active observer of Ontario Medical Politics even before I graduated.
I am definitely arguing with you. You are entitled to your opinions. But opinions are opinions, just as mine are. They are not necessarily absolute truths, either way.
From what I have seen in the U.S., we cannot get away from Alternative Facts. I believe you are using the CNN definition of Alternative Facts and not that which I have taken from Kelly-Ann Conway’s use of the term. Fake Facts to me are different than Alternative Facts. Fake Facts are totally dishonest made up things and not alternative opinions and views. As I see it, Ms Conway’s point was that there are different angles from which to look at situations. She was offering a different angle of the situations that had been reported on already.
One example of Alternative Facts is the pictures of the crowds at Trump’s Inauguration. The one you probably saw in some media like the Toronto Star showed a sparse crowd. This was shown by many others in the media including CNN. There is another view of the Inauguration crowd that was taken by CNN as well that showed a YUGE crowd. Both pictures were real. Why the Alternative Facts? Because the first was taken before the full crowd had gathered and the second was taken after the full crowd had gathered. Here are some links with pictures showing that the various Alternative Facts have some validity:
http://www.motherjones.com/politics/2017/01/trump-inauguration-vs-obama
http://edition.cnn.com/interactive/2017/01/politics/trump-inauguration-gigapixel/
https://www.sott.net/article/340388-MSM-caught-faking-inauguration-crowd-size-as-CNNs-president-warns-Trump-his-network-will-deliberately-discredit-him
https://www.psychologytoday.com/blog/logical-take/201701/trump-inauguration-crowd-size-matters-so-whos-lying
https://www.sott.net/article/340388-MSM-caught-faking-inauguration-crowd-size-as-CNNs-president-warns-Trump-his-network-will-deliberately-discredit-him
I don’t see why I should not use an analogy that I personally think is appropriate. By the way, the opposite of Populist is Elitist.
https://www.powerthesaurus.org/populist/antonyms
Here is an Alternative Fact that is different from the one you have stated. I am not saying that you made it up. You have heard this from many sources and I am sure that you did not know this: the Ontario fee schedule in 2014 was the second lowest in Canada. There have been several cuts to the Ontario fee schedule since then so the relative fees are almost certainly worse for Ontario Doctors.
https://app.box.com/s/2rey1s4gtwlqq89bshfelxgf3zcxp56y
With regard to your point that the representation of doctors’ interests by the OMA are not “ideal”, I believe that most Ontario physicians would call that understatement, sarcasm and even comedy. These are some examples of “not ideal”:
“-When the GST was implemented the OMA did not get a fee increase to cover this increase in expenses for physicians.
– OMA dues have increased faster than the OHIP fee schedule that the OMA negotiated on behalf of physicians.
– Since the 1970’s the fees negotiated by the OMA have not kept up with inflation.
– In about 1985 the OMA negotiated a zero per cent increase as inflation soared to 10%.
– In the 1980’s the OHIP fee schedule was 90% of the OMA fee schedule. Now it is only 50%!
http://healthydebate.ca/opinions/is-the-oma-an-appropriate-vehicle-for-negotiating-doctors-fees”
Doctors of Ontario have been leaving Ontario for Western Canada and the United States. Others have been effectively leaving Ontario practice, retirement, changing scope of practice.
I used the term DRexit to describe a moving in a different direction than the status quo with regard to politics.
New grassroots have already run for office and won. That is where the recent petition to remove the OMA Exectutive has come from. 25 OMA Councillors brought this petition forward. The change has been happening for a while and is continuing.
Gael, I am not using the word Alternative Facts in a disparaging way. Some of your facts are different from mine. That is because of the different sources and angles that you have been presented with. I have changed my mind on many issues over the years when I have been presented with new information. I also view all information with skepticism.
Thanks for sharing this, Gerry. You put a tonne of work into it!!
It’s no surprise that neither the OMA nor the various coalitions of the disaffected can force the Minister to role over and give in to demands he is not prepared to agree to, namely binding arbitration. Is it not time to give up on a hopeless position? Maybe the tPSA was not such a bad agreement after all.
Oh Frederick, please don’t say it!
The tPSA had the following problems:
1. The process was terrible
2. It pitted section against section. It was destined to tear apart the profession and the OMA.
3. There was nothing in it for doctors. It offered a hard cap and more cuts.
4. But the MOST egregious part of the tPSA was this: It offered doctors a small bonus for cutting services! Government offered doctors $80 million to keep growth to 2.5% max. Growth has been up to 7% in some years, often over 5%, and on average 3.1%. Just look at the temper tantrums Hoskins had when the feds only offered 3% growth in funding. “But that wouldn’t even meet our historic growth!” he complained. I could not look at my patients, who’ve been waiting for 2 years for hip replacement, and know that I was getting a bonus for providing even LESS service.
I understand where your comments come from. We wouldn’t be in this mess if the Premier Kathleen Wynne hadn’t insisted on paying for her activist agenda on the backs of doctors and patients.
But please, oh please, do not wish that we had that terrible, no-good, rotten tPSA. We should respect the majority of doctors who voted No despite enormous pressure, and money, spent on the Yes campaign.
We must never give up hope, when truth is on our side. Cuts to doctors’ fees mean cuts to patient service. Period. I cannot give the same amount of time to my patients if my fee has been cut. I have to pay for my office overhead. I am not living a luxurious lifestyle where I can just cut fees without changing my care. I’m trimmed to the bone already. Cuts to fees = cuts to care. We must not waver. (As a side note, maybe you are in a specialty which could sustain fee cuts and not even notice anything. Fine. That’s not the case for many of us.)
Thanks so much for sharing your comment! I’m sure other doctors are feeling the same…
Cheers
Shawn
Shawn: thanks for your thoughtful reply. I’m not convinced we are better off with no agreement than the “terrible” tPSA, which at least got us to the table, prevented further unilateral cuts, and provided a forum for physicians and gov’t to find ways to reduce unnecessary health care expenditures, and after 45 yrs. in family practice, I have seen lots of waste. Granted the hard cap is an irritant but we can all play a role in reducing costs if we are motivated. As a tax payer, I am sometimes sympathetic towards our politicians who struggle with the health care budget overwhelming other departments, not withstanding the foolish wastage the liberals have engaged in the last few years. Re your side note, I have been fortunate to have enjoyed reasonable funding in a capitated and family health team practice for many years, negotiated by the OMA. I may feel different about the present conflict if I had been struggling in a fee for service practice.
Don’t despair, Fred. I understand your feelings but there has never been a rebellion like this in Ontario Medical History against government and the OMA. I have seen it evolve since the 1960’s. This time the physicians of Ontario will change how things run.
I see that this is getting to you emotionally and you want the current fight to just be over so you can just go back to treating patients and the rest of your life. You are not alone. Take a break from medical politics for a few days or weeks or even months if that is what it takes to get over the burnout etc. that you are suffering from. We all get drained from this type of situation. I have myself been there in the past and let it seriously affect me. We don’t want to you lose you, my colleague. Take a break and come back when are strong enough.
Brilliant advice, Gerry!
Gerry: thanks for your empathic reply, except it doesn’t describe me at all. I feel no despair at the current impass between the gov’t & the OMA, just somewhat bewildered at the vicious attacks toward the OMA and the minister. I thought the tPSA was a better option than the present lack of an agreement and it is not clear to me how new leadership could move a determined minister who holds all the cards. As has been pointed out elsewhere, physicians in Ontario have no stomach for a strike, the only measure that may frighten the gov’t off their present position. Fortunately, after 45 years I have retired from family practice and work in long term care part time, so burnout is not my experience.
I am sorry for misinterpreting your comment. I have heard and seen young physicians in the situation I alluded to. I am glad you are not one of them.
If there are any in the situation i described, I do hope my comment helps them. Thanks for explaining and I did notice and appreciate that you used the word “empathetic”.
Sent to District 4 delegates at the following email address set up for this purpose D4delegates@gmail.com
Sirs:
In response to your request for direction as district 4 representatives to OMA council, I provide the following.
Note – it is transmitted in full to the OntarioNeurology email list. For the benefit of my colleagues in Neurology, the original request lies below. On January 29 the dissatisfaction of my colleagues and I will no doubt also be expressed by our section Chair (Dr. Meloff).
The meeting calls for a vote on a motion seeking the resignation of the OMA board members who have failed to meet the expectations of the memebership. I support this motion.
The section on Neurology has to my personal knowledge has been unable to work within the OMA to address the significant shortcoming manifest in relativity. Inadequate technical fees have been recognized by the now defunct CTC and never realigned. The fees stand now where they were in 1988.
At every turn our concerns have been sacrificed at negotiations in order to obtain a PSA that meets with majority acceptance and reaffirms the OMA representation rights. I have personally campaigned as section chair to obtain support for the OMA through ultimately unsatisfactory negotiation outcomes extending back to Dr Rapin’s tenure.
This must stop.
Minority interests such as the section on Neurology no longer see the OMA as active on our behalf. If it takes a new broom to sweep the deck, it is better to do so now. It is not a comment on current individuals that this should be needed. It is a comment on the OMA.
Ed Klimek
Past Chair Section on Neurology
Thanks so much for sharing your letter here, too, Ed.
Well done. We need meaningful change. It seems extremely hard to stay focussed on members in the current funding and governance structure at the OMA.
Let’s hope council has courage to encourage change.
Thanks again!
Shawn
Shawn has insight into the machinations of the OMA Board that are rather unique….he was within the very heart of the beast…was repelled by what he saw and heard and then had the courage to resign from it to alert his preoccupied government mugged colleagues.
The OMA will try to “anaesthetize” the attendees as Shawn mentioned, and then will ‘rend their clothes, gnash their teeth, raise their hands to the heavens, verbally flagellate themselves’ to emotionally manipulate the softies ( we are by nature softies) into giving them yet another chance….they are in fact nothing more than collaborative wolves in penitents clothes.
A victory for the present OMA Board would be a victory for Hoskins.
An OMA defeat would throw fat into the fire….the whole name of the game is to neuter the profession before the next Provincial election , likely on the 7th., of June 2018….Hoskins and Wynne want to go into it perceived as the slayers of the ” most powerful union in Ontario” — we are , of course not an Union and we are certainly not powerful enough to make the government’s knees shake as does the Ontario Teachers Union which the government protects with a passion.
Thanks Andris!
I especially like your insight: “…slayers of the ‘most powerful union in Ontario’…” Very ironic that an activist Premier elected by the unions rules with a truncheon on the back of doctors. Maybe she sees us as far less than a union than others do?
Exciting times.
Thanks for taking time to share your thoughts!!
Best,
Shawn