Physician Activism: Is It Worth It?

In the last two or three months, I have gotten fed up with waiting for “something to happen” in the Cold War between the Ontario Medical Association (OMA) and the Ministry of Health and Long Term Care in Ontario. I know perfectly well that this is a marathon and not a sprint, but in endurance challenges of any kind it is usual to check your position and “test the endurance” of other players and so I, personally, have begun to do this.

One of my actions was to develop three motions for the Emerging Issues debate at last month’s Canadian Medical Association General Council in Halifax. These were the motions:

  1. The Canadian Medical Association insists that provincial/territorial governments should fund all necessary health care.
  2. The Canadian Medical Association stands against governments undertaking unilateral action in lieu of a negotiated agreement with physicians.
  3. The Canadian Medical Association supports the Ontario Medical Association’s request for the inclusion of a binding dispute resolution mechanism in its contract negotiations with the Government of Ontario.

Here is a link to the CMA coverage of the motions.

These motions had very strong support and I tweeted out the news which caused several to ask: What difference does this make? What can CMA do?

It’s fair to ask this question but the answer takes more than 140 characters to answer.

The first difference it makes is that these motions establish a national policy at the Canadian Medical Association that provincial and territorial governments should fund all necessary growth in health care and not pass off their responsibility under the Canada Health Act. I have written about this previously several months ago: https://drgailbeck.com/2015/04/19/getting-blood-from-a-stone/ Governments are now being asked to fund pharmacare and psychotherapy at a time when they are already not meeting their responsibilities for funding hospitals and physicians. This first motion establishes the policy for our national association that governments should meet their existing responsibilities.

The second motion means that the Canadian Medical Association will stand against any government abandoning negotiated agreements with physicians in favour of unilateral action. We are in difficulty because of such action in Ontario, but our Quebec colleagues are facing an even worse fate from their physician health minister. http://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-20-41-1.html

In addition, since most jurisdictions and physician bargaining units in Canada already have access to a binding dispute resolution mechanism, the final motion confirms the need for Ontario doctors to have this as well.

As well as setting CMA policy, these motions did also provide an opportunity to highlight Ontario’s doctors’ situation and Dr. Toth, OMA President, had a number of media calls in response to the motions.

These are small pieces of work, to be sure, but in working on these motions, I was doing something. To use the marathon analogy, I tested the field and the interest and have finally had some people get in touch with me about the OMA’s situation and the impact the cuts are having. Maybe if I keep pushing, a few others will also begin to push and maybe we’ll start to build some momentum. I am not the only person pushing. In fact, most members of the OMA Board and a few others as well are using every means at their disposal to bring attention to the impact of the government’s cuts on healthcare. The OMA itself continues with a media campaign that also seems to be going unnoticed, but it is there. These days, it feels as though we are a very small group, unable to garner much attention, but we are committed and all of us believe that change is possible.

I am doing what I can in other ways also. I am going to continue to meet with doctors, meet with MPP’s, bring motions and write about these cuts. Maybe it is all useless, but I will continue with these actions until enough people begin to notice. I welcome anyone who wants to help. Leave me a message here and I’ll get in touch.

Is anyone out there?

“Never doubt that a small group of thoughtful, committed people can change the world. Indeed it is the only thing that ever has.” Margaret Mead

13 thoughts on “Physician Activism: Is It Worth It?

  1. Hi Gail
    I’m coming to your blog a little late …. mea culpa.
    But, since the Quebec Superior Court decision which you cite imposed an obligation on doctors to keep appointments made or pay a fine …. would this not impose a similar quid pro quo on Ontario.
    What I’m referring to is the recent Ontario MOHLTC notice published Sept 14 2015 that they are further reducing payments beginning October 1 2015.
    That seems very inadequate time of notice. Most Specialists I know are booking appointments several months in the future for elective matters, and many GPs are scheduling pre-ops and non urgent “physicals” on similar timelines.
    Surely the sauce for the goose (this would be us …. horrible analogy) is the same sauce for a big powerful gander like Dr Eric?
    Looks like you’re keeping your chin up.
    Best
    Mike Goodwin

    PS To Mark B …. I’m not a lawyer, but smart lawyers I know think doctors more closely resemble dependent contractors than the independent kind … and that is an important distinction.

  2. Dear Mark and Monique,

    The OMA website does not outline a detailed plan such as Monique hopes to see because the plan is not fixed, it is fluid and it is dependent on how the Ministry responds to each step. As she noted, we are waiting for the result of the PSC. Before we can move with a next step, this one has to be completed. You will likely recall that there was a similar process for Facilitation and Conciliation.

    OMA Board and Council members have urged that as much information as can be shared be easy to find. I look at the website as often as I can and this is improving, but I can understand your concerns that it is not as good as it could be. Thank you for telling me. I’m no expert with websites, which is why I need things to be easy so I will find out if I am looking in all the places where information could be found and let you know.

    It may take me awhile to get back to you as I am on call and in Toronto for much of the week, and I apologize for not being as prompt as I’d like to be. Thank you both very much for being so interested in this. All the best.

    • Sorry, Gail, but the comment “the plan is not fixed, it is fluid and it is dependent on how the Ministry responds to each step” is not acceptable. Physicians are trained to develop guidelines to manage problems, and most of these include algorithms for decision making and action plans. If one waits for the response to an action before formulating an action plan to anticipated responses, one will be slow to respond or miss the opportunity to respond altogether. Surely, the OMA has contingency plans in anticipation of government responses to entreaties?
      As a paying member of the OMA, I deserve better than access in the members’ section to publicly accessible and known information. The rank and file need to be respected by its leaders. In primary care, we live by “if you fail to plan, you plan to fail”.

  3. I support your actions and your views. Where I may differ, and with all due respect to OMA Board members, is my belief that the OMA must rise up and tell the MOHLTC that we will not wait any longer for them to join us in negotiations or binding arbitration. It is time for the OMA to lead us in this inevitable confrontation with the MOHLTC. It will be too late after the clawbacks are imposed in a few months. It is time for job action. I have already implemented my exit strategy from family practice by advertising for a replacement physician but I will not stay on until that comes to pass, if ever. I do want to contribute to the improvement of physicians’ status in Ontario as my daughter wants to join our ranks some day.

    • There are 2 potential concerns with work action. The first is that we must operate within CPSO guidelines. This is reinforced by the recent decision of the Quebec Superior Court which has asked the Quebec Federation of Specialists to reimburse patients who whose appointments were cancelled because of their series of one-day strikes.
      The second barrier would seem to be apathy. In a survey the OMA sent on behalf of the Physician Activities Working Group(the work action committee), doctors responded that, for the most part, they would likely not support work action. It makes planning such actions difficult. Can you think of actions that doctors could take that would not affect patient care? The OMA website makes it easy to send a message to one’s MPP and most doctors have not even taken that step. Suggestions would be welcomed.

      • Physicians are involved in a variety of activities that are not directly patient care; think of all the meetings with LHINs and so on. I can reduce my work hours and that will not result in patients having their appointments cancelled. It does reduce my billings which will still be clawed back next year.
        Why hasn’t the OMA begun a legal challenge to the MOHLTC in regards to current issues? My understanding is that the OMA was waiting for the MOHLTC to agree to binding arbitration. Now that the deadline has passed, the OMA has not shared with members what if any next steps it is planning since the request has gone unacknowledged. As the MOHLTC has all the power on its side, including the threat that any work action could result in CPSO action against individual physicians, it has no reason to even consider responding to OMA requests. As they say, the proof is in the pudding… no response from MOHLTC to the OMA request.
        By being perceived to be powerless and not actively challenging the MOHLTC, the OMA is perhaps inadvertently encouraging sections/specialties to come up with their own action plans. I hear a group of GPs have considered legal action against the MOHLTC and have been waiting for action from the OMA.
        As for the survey you mention, it is unfortunate that I was not part of the sample surveyed.

  4. Great post, Gail. It is abominable what the Government of Ontario is doing to our health care. Who says we don’t have a two-tier system in Ontario? We certainly do. There are so many investigative tests, services/treatments and medications that low income earners, persons on disability/welfare and seniors simply cannot access because they do not have the money to pay for them. Even many of us who have extended health care coverage can’t afford the 20% co-pay required in order to access services. For instance, my federal government retiree health care coverage only pays 80% of $375 every two years for lenses; however, I usually require new lenses every year and my lenses alone usually cost over $475. Frustrating to say the least!

  5. Hello Gail, I’ve followed your very thoughtful posts/twitter comments for some time (along with Scott Wooder). I too practice speciality medicine in Ontario. I’ve realized that thoughtful, forward thinking and moral comments continue to go unnoticed. The OMA has certainly lost the media campaign…the teachers have won. I’m not quite sure why our campaign is so poorly adopted. In terms of your motions, they will go unnoticed. There is no incentive for a majority government to act on opinion, motions etc. The only mechanism that could possibly work is a legal challenge/litigation. If physicians in Ontario have the right to assemble, collectively bargain and have the right to arbitration, then we have a legal challenge. The issue is, do we have the right to all of those things (as unions do)? If we do not, then we must vote with our time and leverage this. At some point, the government will get the picture but patients will certainly suffer. At this point, the government can theoretically decide to pay physicians zero dollars for an infinite number of years. What is the legal mechanism that allows us to say no? Do we have one? How many people will just quit? These are loaded questions. I know for a fact (after anecdotally reviewing potential litigation with a friend) that the OMA should file a legal challenge. I’m just not sure why they haven’t done this yet. Thank you again for your thoughtful comments. I just hope the OMA deals with these issues soon (I suspect individual sections will be colluding to bring their own legal challenges).

    • Thanks, Mark, for writing. I hope Monique who responded above will read this but the OMA private members’ website does contain more information on what the OMA is doing with respect to this motion passed at the May 2015 Council Meeting: “That the Ontario Medical Association demand the Representation Rights Agreement be amended to add a binding dispute resolution mechanism.” This motion, brought during the Board Report, is a main motion and binding on the OMA. The members’ website does outline the actions being undertaken.

      • Hello Gail,

        Yes, I am reading the comments to your blog. I visited the OMA website before formulating this comment.
        There is a post dated August 13th, 2015 indicating that the OMA had met with the MOHLTC to discuss the request for amendments to the RRA, and an agreement could not be reached. This matter has been referred to the bilateral PSC for consideration with an expected turn around time of 30 days. Today is September 11th…I will patiently wait until next week to learn of the outcome.
        I did look under every heading of the member’s section and I could not find any detailed action plan that the OMA Board has developed vis-a-vis the MOHLTC’s intransigence.

        Monique Moreau

      • Thank you for your response. I note that Monique has read the response. I too looked for the detailed information but could not find it in the OMA private members’ area. I suspect the OMA is intentionally keeping things private…perhaps there is some discussion with the MOH that we are unaware of. The issues with the Representation Rights Agreement is that there are few mechanisms to enforce it. We can demand all we want with agreements etc, but at the end of the day, only something entrenched in law will have teeth. If we are not considered to be a union, there the Rights Agreement is meaningless. There are certainly many aspects of the OMA that suggest that we are a union and should be treated as such…one aspect is that we cannot strike. If we are considered an essential service, this implies that we have representation, are employed (in some way) and as such are entitled to arbitration. Physicians cannot strike but we can just close offices (in an appropriate manner) and just decide to work less. There is nothing that says we cannot take vacation or work less than we do. This is obviously a horrible thing to do to people and we would never do that. This is precisely why the MOH has a significant advantage over us…we are independent contractors (kind of like the people that fix the roads/bridges) with professional and moral code. We will never truly win unless we are considered a true union (with rights). Look what happened in the 1990’s. I’m surprised the government wasn’t sued successfully by the OMA/individual sections.

  6. Great piece Kiddo.  Proud of you. Can you get this off to every member of OMA in eastern Ontario?  If only, eh?  Send a copy to the  DS who are running in this election if possible?  Just thoughts.  

    Sent from Yahoo Mail on Android

    From:”Dr. Gail Beck” Date:Thu, Sep 10, 2015 at 9:06 AM Subject:[New post] Physician Activism: Is It Worth It?

    drgailbeck posted: “In the last two or three months, I have gotten fed up with waiting for “something to happen” in the Cold War between the Ontario Medical Association (OMA) and the Ministry of Health and Long Term Care in Ontario. I know perfectly well that this is a marat”

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s