Dean On Campus Blog

The OMA in crisis; a sad day for the profession

Yesterday the OMA executive resigned.

In my personal view, this is a sad day for the profession and one that leaves physicians in a fractured and disadvantageous position. It may well be true that it is the only way that we can move forward at this point. But that notwithstanding, we should never have been here in the first place.

The OMA’s relationship with the government is in terrible shape. The anti-government rhetoric emanating on a daily basis from OMA communications cannot be healthy. At some point, sooner than later, the inexorable goal of both parties must be that we get back to the table.

Groups such as the Concerned Ontario Doctors and the Coalition of Ontario Doctors have been effective in their advocacy and have expressed major concern in the OMA leadership. Ultimately, the leaders have resigned.  While it may be true that there is a lot to have been critical about with respect to the successes (or lack thereof) of the OMA in recent years, what has transpired cannot be good for the profession.

The Coalition of Ontario Doctors in their communications have indicated that their principal motivation is with respect to patient care: “this is really a fight about creating and funding a fair and stable system that let’s us provide better healthcare, the kind of healthcare you deserve.”1

I’m not so sure. It’s my observation that their movement is predicated on two essential perspectives. The first is that Ontario doctors have been hard done by financially, and that that needs to be reconciled. The second is a more elusive construct, but akin to the Trump/Brexit movements and other anti-establishment actions of the day.

It is certainly understandable how physician groups have become increasingly frustrated with government over the last few years. Unilateral decision-making, especially negative decisions that seem to be unfairly targeted at physicians, is problematic. But there will be only one vehicle in resolving this issue. And that vehicle is getting back to the table. This is why I personally have written in support of the TPSA (tentative physician services agreement) and was so disappointed to see it defeated this past summer.

One can only hope that sane minds will prevail and positive steps will be taken to rebuild the OMA. This will not be easy given the antics of the last year, however, my own view is that we need to search for some specific qualities in the next leadership group at the OMA. First and foremost, this includes a strong desire to find any means to get back to the table. Second, we must find leadership who would be adamantly opposed to any kind of job action. Third, we need reasoned leadership that can take a balanced perspective with respect to the issue of physician compensation, advocating appropriately for the profession, but working with government in acknowledgement of the fiscal reality that they are faced with. It really doesn’t matter why the government is in such bad financial shape, the fact is they are. Negotiations for the medical profession will have to take that as a given.

Yesterday was not a good day. I’m confident that if leadership emanates from groups that hold extreme views, at this juncture in time, the medical profession will take a great step backwards.

We absolutely must proceed with calm, moderate views, reason and most of all with a fanatical focus on what’s best for the patient as opposed to a preoccupation with the financial interests of physicians.

Please share your thoughts by commenting on the blog, or better yet, drop by the Macklem House…my door is always open.

 

  1. https://www.facebook.com/notes/we-are-your-ontario-doctors/welcome-we-need-your-help-to-save-our-healthcare/821822827951825

67 Responses to The OMA in crisis; a sad day for the profession

  1. Roxanne says:

    Unfortunately, you are in error. The non-confidence vote was not organized by concerned ontario doctors or the coalition. Please fact check.
    Also, please check the definition for a coup, a violent attack to seize power illegally.
    How did council violently attack the OMA? By following ontario corporations act by-laws?
    How did they illegally seize power?
    None of the council will be appointed to be the new executive, as that is not allowed as per by-laws.
    As the Dean of a leading medical school, I would expect for you to have a bit more background before publishing your views to a vulnerable audience, medical students at your mercy.

    • reznickr says:

      Roxanne,

      Thanks for your comment. You and others have pointed out to me the lack of involvement of the Concerned Doctors of Ontario and the Coalition in the recent vote of non-confidence. I appreciate the correction. That said, I still do have concerns for the series of events over the past six months or more that one can interpret as having been part of the lead-up to what happened yesterday.

      Richard

      • Roxanne says:

        Totally agree with you, that the actions of the executive since April unfortunately led to this vote of in-confidence.

        • Sandra says:

          100% true. This was a situation that post tPSA was avoidable with wisdom and consideration. Thank you Roxanne for your views.

  2. Brad White says:

    Neither of the two groups you mention had anything to do with the ousting of the exec. It was done by council. It was done by the rules. There was a VOTE. That sounds closer to democracy than a coup. You are in a very influential position and you need to respect that power by having your facts correct. I disagree with your opinion but you don’t get to make things up. I hope you can edit your post to reflect the truth.

    • reznickr says:

      Brad,

      I will respond by saying that i acknowledge your concerns about my referring to the two groups. What I said was

      Groups such as the Concerned Ontario Doctors and the Coalition of Ontario Doctors have been effective in their advocacy and have successfully overthrown the OMA leadership. While it may be true that there is a lot to have been critical about with respect to the successes (or lack thereof) of the OMA in recent years, a coup d’état, which is effectively what has happened, almost never translates into a good result.

      While it may not be entirely accurate that “they overthrew” the OMA executive, and I will correct the blog post, it is true that the actions of these two groups, and other events, have ultimately contributed to this situation. Thanks for your comments.

      Richard

  3. Mark Linder says:

    Dean. I am not a student of yours. I am a family physician working and living in Toronto. And I think this Dean on Campus Blog situation you have going on here is remarkable. I applaud you. I wonder if all Deans of medical schools are providing such a fantastic style of communication with their students.
    I agree with much of what you say, as do many of the province’s doctors. We have a hostile government, and relations have never been so poor. We are frustrated, yes indeed. And getting back to the table is certainly top of the agenda.
    Respectfully, however, I must take issue with some statements that you’ve made here that are presented as fact, but are far from it. Firstly and most importantly, this notion that COD and COOD overthrew the OMA leadership in a coup d’etat. No. That did not happen. 25 elected delegates. Not fanatics. Not radicals. Elected delegates. Many of whom have no association with COD or COOD, called for a Special Meeting of Council. This meeting was NOT initiated by either COD or COOD. Further, this is a normal corporate procedure–it is a normal and legal procedure in any democratically elected group. It is not even radical. And the result was…a meeting of council, which the majority of the OMA’s elected delegates attended. Let me say again: This was a meeting of the elected OMA delegates. The representative body of Ontario’s physicians. And a motion was debated all morning, and a vote of non-confidence in the executive of the board was passed. Not by 25 council members–by 55% of the delegates present that morning (more than 200 physicians). The motion passed. That is democracy. The will of council was clear. That is not a coup. That is not a secret group of grass roots extremists. That is the will of council and therefore the will of the majority of Ontario’s physicians.
    Clearly not yours of course.
    Many of those who voted have been part of the OMA for many years. The executive was spoken of with great respect at this meeting, and their work to date is still respected. However, the majority of Ontario’s physicians believe that it is time for new leadership.
    Please when reaching out to your future physicians, learn all the facts of the case before presenting opinion as fact.
    Sincerely,
    Mark Linder, MD

    • Richard says:

      Dear Mark,
      Thank you for your comments. Like you, others have corrected me about the exact facts that led to the vote of non-confidence. I have altered the blog accordingly.

      While it may not be entirely accurate that the two groups overthrew the executive, it is true that the actions of these two groups, and other events, have ultimately contributed to this situation.

      Sincerely yours,
      Richard

  4. Darren Cargill says:

    Dr. Trangmar is correct.

    COD and COOD did not file this petition. It was done by 25 Council members. Elected Council members.

    It was not a coup. This language is unnecessarily inflammatory. It followed established OMA by-laws. While many of us disagreed with the motion of non-confidence, there were many who agreed. This was a democratic process.

    Many front line physicians are struggling. These are the physicians with employees, overhead, equipment leases and other bills. These are physicians who do not have pensions, health insurance and other benefits afforded most public sector employees. The unilateral action and cuts are not insignificant and they threatened the health care infrastructure supported by Ontario’s 30,000 practicing doctors.

    Job action is only necessary because of government intransigence to provide binding arbitration to essential service, physicians. CPSO policy does not prohibit job action. Rather it says it must be considered as a last resort and must be done with patient care firmly in mind. Binding arbitration is available in 7 other provinces for physicians. It is the norm, not the exception.

    It matters why the government is in the financial situation they are in. Waster, scandal, lack of accountability and mismanagement matters when the health care system is used to balance a budget. The Auditor General has written clearly on this government’s track record.

    Many people have different perspectives on what happened yesterday. Some feel this was the only way forward, others do not. But even as give our opinions, it is important that we do so as accurately as possible.

    Respectfully,
    DC

    • Richard says:

      Dear Darren,

      Thank you for your comments. Like you, others have corrected me about the exact facts that led to the vote of non-confidence. I have altered the blog accordingly.

      While it may not be entirely accurate that the two groups overthrew the executive, it is true that the actions of these two groups, and other events, have ultimately contributed to this situation.

      You do bring up important considerations. Like you, I find the unilateral action of government-imposed cuts problematic. However, it’s my firm view that the negotiating table is the only appropriate vehicle for coming to a resolution.

      Thanks for your comment.
      Richard

      • Thank you for your reply.

        We both agree this needs to be settled at the negotiating table.

        Binding arbitration is a tool, not a result. It motivates both sides to find agreement and common ground. It would level the incredible power imbalance that currently exists between doctors and government.

        For example, if an arbitrator had selected the OMA’s “final offer” in 2014, it would have resulted in a three year freeze on fees.

        The rhetoric that arbitration would spiral health care costs out of control simply isn’t true.

        I hope you will agree and advocate that arbitration is a fair and reasonable way to settle an impasse entering it’s fourth year.

        Respectfully,

        DC

    • Sandra says:

      Darren

      Thank you once again for your astute fact correction. Always important to have the facts down pat.

  5. HI Dean Reznick. Thanks for your post. I enjoyed debating with you on the Agenda. I found that you had a lot of good factual information, and listening to your point of view was helpful in challenging me to make my point better.

    On this occasion however, you have made some factual mistakes. (You are certainly entitled to your opinion, but I feel that any facts you state, should be accurate).

    Firstly, Concerned Ontario Doctors and the Coalition of Ontario Doctors had ABSOLUTELY NOTHING to do with the motions of non-confidence. Zilch. Zero. Nada. (They certainly voiced their opinions, and continue to do so, but that is totally separate from actually contributing to the situation). In fact, at one point COD had some significant questions about whether the Special Council was even a good idea, and whether we shouldn’t just wait for the elections in March (imagine that, COD and COOD agreed with YOU).

    Twenty Five Members of OMA Council, ALL of whom were democratically elected, followed the OMA Bylaws, and called for a Special Council Meeting. The OMA lawyers reviewed the request and found that it was 100 percent COMPLIANT with OMA Bylaws. All Motions made were 100% COMPLIANT with OMA Bylaws.

    I’m not sure who the phrase coup d’etat applies when, you know, you actually follow the bylaws and due process.

    I share your call for calm reasonable actions. That’s why I’m personally prepared to vouch for each and every single physician who signed the petition. They are all calm reasonable types, who have NOT gone on wildcat strikes or taken job actions that would affect patients. What they did is simply to say that the Status Quo is not good enough anymore, and this is a legal, reasonable way to achieve that.

    You are, of course, entitled to your opinion that this was not a good move. So be it. But please get the facts right.

    • Richard says:

      Dear Sohail,

      Thanks for your comment. Like you, I enjoyed our interaction on The Agenda. And as I said on the program, I applaud you for your leadership and for getting others involved in the affairs of the medical profession.

      With respect to my blog today, you and others have corrected me about the exact facts that led to the vote of non-confidence. I have altered the blog accordingly.

      While it may not be entirely accurate that the two groups overthrew the executive, it is true that the actions of these two groups, and other events, have ultimately contributed to this situation.

      I feel strongly that whoever takes over in leadership positions at the OMA needs to find a way to unite the profession and get us back to the table.

      Once again, thanks for taking the time to comment on the blog.

      Richard

  6. Monique Moreau says:

    Good Afternoon, Dean Reznick. As the dean of a leading medical school, responsible for the education and training for a significant number of future physicians, it is indeed your responsibility to educate your students and your privilege to voice your opinions. You should be basing your opinions on fact and evidence, just like your students are taught evidence based medicine and practice. While we can all agree that yesterday was a sad day in Ontario medical politics, when the OMA executive had to resign in order to respect the will of the majority of the Council delegates in a vote of non confidence, after having been given many opportunities to realign their activities to support the will of the majority, it was also a good day for democracy. In your position as dean, you wield tremendous power and influence over your students and this is certainly communicated in your blog. However, I am confident that the accomplished young men and women under your tutelage are able to discern fact based opinions from ivory tower judgments, and develop their own view of Ontario medical politics. They will most certainly come to these realizations once they leave your ivory tower.

    • Richard says:

      Dear Monique,

      Thanks for your comments. Like you, others have corrected me about the exact facts that led to the vote of non-confidence. I have altered the blog accordingly.

      While it may not be entirely accurate that the two groups overthrew the executive, it is true that the actions of these two groups, and other events, have ultimately contributed to this situation.

      I do take my role as dean very seriously. I use the blog for a multitude of reasons, including from time to time, weighing in with my personal opinion about political events that are relevant to the medical profession.

      Once again thanks for taking the time to comment.

      Richard

  7. NAWAZ ARORA says:

    wow-we are compared to Trump-to me that is a whole new level of insult being thrown at doctors that are actually concerned for the future of health care.nobody signed up for charity but we treat and care for our patients much beyond the payment recieved-everyday-in every little thing that we do.now we are being stretched beyond comfort zones due to errors of the governing bodies-we are only trying to stand up and demand respect for ourselves and our patients.Liberalexit must pave the way for these reforms.our own association should be our advocate or get out of the way.

    • Richard says:

      Dear Nawaz,

      Thank you for your comment. My reference to Brexit referred to a general groundswell of “anti-establishmentism”. I have no doubt that doctors in Ontario care deeply about their patients. The unfortunate circumstance we find ourselves in must come to an end.

      Yours sincerely,
      Richard

  8. John Aquino MD says:

    Dear Dr. Reznick,
    As a physician working in the community, under the very real financial pressures of running a practice against continued cutbacks, with employees to pay, and no pension or sick time or paid holidays, I need to say that your blog exceedingly allows government to escape blame for the situation we all find ourselves in.
    With continued unilateral cuts, their failure to meet their obligation as payor, in this single payor system, is a form of job action on their part is it not?
    Regards,
    John Aquino MD

    • Richard says:

      Dear John,

      I completely agree with you that unilateral cuts are problematic and erode trust between government and physician representatives. I do understand that physicians in the community are under both work and financial pressures, but firmly believe that we ultimately need to get back to the negotiating table to resolve the physician compensation issue.

      Thank you for your comment,
      Richard

  9. A. says:

    Comparing this situation to Trump and the Brexit makes it seem like you don’t know anything about Trump or the Brexit

    • Richard says:

      My reference to Trump/Brexit was to allude to a growing feeling amongst certain sectors of disgruntlement with establishment, in this case, the government and the OMA.

      Thanks for your comment,
      Richard

      • Philip Hassard says:

        Well I am disgruntled. Patient care has deteriorated across the province. Hospitals are overflowing with the sick and the elderly, waitlists are ridiculous, home care is a mess, and doctors are blamed. We are without a contract for 3 years. The tPSA was terrible. Other groups such as teachers enjoy pay raises while we get cuts and vilified by this government. Those in the Ivory towers should come down from their walnut gilded offices and spend a day in a FFS family doc’s office.

        It is those who are not disgruntled that worry me.

      • Gerry Goldlist says:

        I absolutely agree with the “overthrow” of the OMA Establishment’s being analogous to Brexit and Trump’s election. Some Ontario physicians have actually used the word DRexit to describe the phenomenon of rebelling against the current order and status quo.

        Ontario doctors have been and still are mad as hell and not going to take this anymore. The status quo is no longer an option

  10. Paul Rosenbaum says:

    Those who have been critical of your post have focused on the use of the word coup and aspersions cast at two physician groups. I think it would be prudent to re-read and consider what I feel are the central issues that you raised. 1. Leadership that will quickly get back to the table. This will require swollowing some pride and demonstrating willingness to consider almost anything (“consider” but not accept). 2. No threatening of a government now in political trouble. 3. Recognition of the Province’s dire financial situation. I agree with these three points you raised. I would add further, recognition of the government’s needs and creativity in finding ways to satisfy these.

    • Richard says:

      Dear Paul,

      Thank you for your comment. I do believe that the other commenters did accurately point out that it wasn’t explicitly the two groups that directly resulted in the resignation of the executive. Like you, however, the focus of my blog post was on the three issues that you raised. As someone who has spent a lifetime working at the interface of physician compensation and government, your comments are much appreciated.

      Sincerely,
      Richard

  11. Hoshiar says:

    Thank Richard:
    It is true the Council had a no confidence in extra-ordinary session. The objective of the Council meeting was precisely to pressure the Board and Executive Committee of the Board of OMA to resign. I do see any good outcome of the current situation. I do no believe this Government or any future Government will come up with more favorable agreement with profession that what OMA negotiated last summer.

    • reznickr says:

      Hoshi,

      I agree with your comment. It is indeed a regrettable situation that has evolved. Appreciate your perspective.

      Richard

  12. Chris Sheasgreen says:

    It’s fallacious to think that resuming negotiations without a binding arbitration framework would be anything but a complete disaster. The government holds all the cards. They have only to dig in their heels on any given issue and then implement their will unilaterally. If you are completely against even job action (which can be done entirely ethically), then you have no bargaining chip with which to negotiate.

    It is not uncommon for people in established positions of power, like yourself, to dismiss new ways of thinking and less hierarchical movements like those that are popping up online. But recent events show the power of these types of movements.

    • reznickr says:

      Dear Chris,

      I do appreciate your comments, and hope I am not too ossified to deny or reject any new approaches or novel thinking. That said, my read of the political realities, and of public opinion, is that job action would hurt, not help the profession.

      Chris, thanks for your comment.

      Richard

      • Dear Dean Reznick,

        Job action certainly won’t make us more popular with the public, but that’s never the goal of job action. There simply is no other option at this point. There is no incentive for the government to try to make a fair deal without some pressure. You mention the anti-government statements from the OMA, yet you neglect to mention the disrespectful conduct of the government – making unilateral decisions, going to the media with proposed contracts before going to physicians, and trying to represent physicians as devious $6 million billing machines. Most physicians do not bill $6 million. Most physicians are finding it more difficult to do their work. There is certainly more pressure on the system. There have been unilateral cuts and the cost of overhead only goes up. Clinics have had to close because it is no longer financially feasible to keep them open. There is a lot of frustration among physicians because we see a lot of waste and we see a government too lazy to fix the problems. It is much easier to unilaterally make cuts to the physician fee schedule – after all, we don’t have a union to protect us, and there is little sympathy from the public given that our incomes are much higher than the average Ontarian’s. Like you, I am somewhat sheltered at an academic centre and I don’t have to deal with some of these realities. But I do see the problems and I empathise with my fellow physicians who are struggling out there trying to keep the system going.

        Best,
        Hooman

        • reznickr says:

          Dear Hooman,

          Thanks for your comment. I do agree that some of the government’s focus, particular when it focuses on the extremes of physician compensation, are ill-placed. I also agree with you that there have been many added pressures on physicians. That said, I do not belieeve that job action will accomplish much except to craete a further wedge between us and government, and I believe it will be counterproductive with respect to our relationship with the public.
          Thanks for responding to the blog.

          Richard

      • Chris Sheasgreen says:

        Thanks for your response. I remain concerned, though. You wish to avoid job action, but you want an agreement. Without binding arbitration as a precondition, why do you think getting back to the bargaining table would result in anything but the same outcome as this summer? The government still wants a cap and cuts, and the membership still finds those ideas abhorrent. Failure to come to an agreement will result in unilateral actions by the givers again.

        You don’t want job action, but the membership won’t accept what the government is offering. So what’s your solution? (I’m open to hearing from anyone who holds similar views–even med students!)

  13. vskapoor says:

    Dear Dean Reznick;

    You are right. This is about physician income. Why is that a bad thing, though?

    There is something called employment and labour rights. Why is that a “bad” thing when dealing with physicians, but a “good” thing when dealing with the WSIB and workers rights in a manufacturing setting?

    Occupational medicine and public health medicine teaches us about workers rights, but somehow this is ignored for physicians? Why? Workers rights are enshrined in legislation. Are you advocating ignoring physicians’ working conditions and workers’ rights to help the government control its debt?

    Why is it bad to not talk about physician working conditions, physician incomes and physician rights. After all a healthy physician at work makes for healthy patients.

    To accept this agreement would have accepted the principle that physicians are responsible for the increasing public utilization of health care systems, and penalizes physicians for increasing demand. Analagous to this is, if firefighters have to deal with more fires, and work overtime, they get the same or diminishing compensation. In other words, as there is more demand for physician services, physicians get less income or work increasingly harder to get the same income.

    Take for example, an individual physician who works 49 weeks of the year 60 hours a week. The government wants to limit increases of the physician services budget to 2.5% percent, but growth in services is predicted to grow 3.5%. Therefore, there is a percentage clawback monthly of what that individual physician earns. As you know, the history, and physical take the same amount of time and there are guidelines on good medicine as per the CPSO. To make up for this lost income, the physician has to work extra hours and see extra patients, or take in less income. Why does the physician have to do this? Tuition is increasing at Queens on a yearly basis and graduates come out with larger and larger debts. Overhead is increasing year by year in the office setting. There are demands by office staff to raise pay, or they leave for the public sector where pay is 13.4% higher.

    Every single group on the payroll of this Liberal government has seen pay increases, including nurses, CCAC nurses, corrections officers, teachers, government bureaucrats. Police and fire have seen pay increases municipally in the last 5 years. Why are only physicians shouldering cuts?

    Nurses take up well more than the 12 billion dollars of the physicians services budget, yet they are not being targeted for cuts. They have received raises.

    I understand that the government is in debt and deficit, but then why are they doling out raises to other groups? Why must physicians be the only group who are paid by government that must sustain cuts?

    Let us also consider government debt and deficit. If the debt and deficit get worse, how low an income would you accept for physicians? How can physicians pay office staff and overhead with such a low income? How will they pay off student debt and $25,000 plus tuition x 4 years at Queens alone. That is $100,000 alone in tuition not including living expenses, which surely must add another minimum of $100,000 for a total of $200,000 for medical school alone. What about undergrad? Then there is residency of 2-5 years. Are you willing to cut tuition fees to run Queens Medical School to help graduating physicians shoulder cuts?

    Furthermore, while I understand your students cannot talk about income at their medical school interviews, I am sure that is a consideration in choosing their stressful profession. What type of students will you attract when physicians are poorly paid and saddled with debt? Even students from rich families, which now dominate medical schools, will start to avoid medicine.

    Why is it that the only solution to increasing government debt and deficit is for physicians only to sustain cuts? Why can’t the Ontario health premium be raised. I can certainly understand that you may not want taxation to rise higher as it is already 53% above $200,000.

    Why can’t we permit other ways of raising funds? Surely you are aware that at the OECD, Commonwealth and a number of health system indicators, we do not have the best performing health care system. All the better ones permit some aspect of private pay or private sector involvement. Why are comparative health systems being ignored in this debate?

    Calm and moderate views will now be present at the table at the OMA with this change.

    The extremists are going away.

    It is actually extremist thinking to say that physicians cannot engage in any job action as per CPSO policy, cannot have binding arbitration, must shoulder the brunt of government debt and deficit, must sustain diminishing working conditions and income as demand for our services increases, and cannot be allowed to raise any other revenue outside of the government OHIP system. – THAT is an extremist perspective.

    We are taking great steps forwards.

    Scott

    • Richard Reznick says:

      Dear Scott,

      You are quite right, that there’s nothing wrong discussing physician income. And you make several important points in your comment that question why physicians are being treated differently from others in the public sector. I also agree we need to ultimately arrive at fair compensation levels that recognize marketplace issues. That said, there’s much work that can be done on the issue of relativity and modernization of the fee schedule.

      Thank you for your comments,
      Richard

  14. Lil@lark26 says:

    Dear Dr Reznick,
    Your salary and benefit package exceeds most “high biller” take home income. With no call and possibly a pension plan. We can’t all be administrators. There need to be front line docs who diagnose, treat and save lives. Those individuals should also get a raise maybe once every 6 years? What is happening here is the devaluation of our profession. No physician should support this.

    • Richard Reznick says:

      Dear colleague,
      Thank you for your comment. You are correct that I am currently the administrative leader of our Academic Health Science Faculty. It is of note that for 25 years I did work in the area of clinical medicine, and colorectal surgery where I had a robust clinical and academic practice. I do agree with you that our goal should be a fair settlement with which physician representatives agree.

      There is much that can be achieved if we collectively worked hard on issues of relativity and fee schedule modernization.
      Richard

      • Lil@lark26 says:

        I actually know that you had a clinical practice. A family member saw you for an issue many years ago and you were great. The point is that physician remuneration should not only place value on administrative skill which seems to be where the emphasis is at present. Clinicians in active practice need to be paid fairly. While CEOs get raises, the people struggling to keep this underfunded system together are being vilified. We even label them high billers when really they are hard workers struggling to meet ever increasing demand often in underserviced regions of our province. Yes we can talk about relativity and modernization but we also need to compare ourselves to colleagues in other provinces. Look at the auditor general report. The base fee for many high billers range in 20-30 dollars. It’s the enormous volume that is pushing them into that territory. To place increased utilization at their feet and blame them is simply wrong. That was the most objectionable thing about the tpsa. We are our own worst enemies. We continue to put targets on each other’s back. We need to stop that and ask to be treated fairly. 6 years of cuts is enough don’t you think? It’s our profession, we should fight for it. To attract the best and the brightest, you are going to have to pay them well. That’s the way it works. I think the patient waiting 18 months for her hip replacement would agree with me.

        • Lil@lark26 says:

          FYI I too am an academic with a busy tertiary practice. I couldn’t survive without my front line colleagues. We are being treated unfairly and we should support each other more.

  15. Sandra says:

    Richard.

    It is interesting how our views on this fundamentally differ. I find it sad that it came to a situation that the Executive of the OMA became so woefully out of touch with the thousands of physicians (and surgeons) that they represent. My reaction was the opposite of yours as it gave me (and many others) hope of a cataclysmic rebirth of what has been a stagnant situation. I am of your “genre” hopefully as well not ossified. The time came to move bravely and the 25 OMA delegates did just that. I think that assessing the facts with care and having the wisdom of flexibility is key to success in this situation. A better day is coming and my wonderful colleagues and students need that day. Please provide now some sage and non ossified opinions and advice.

    All the best

    Sandra

    • Richard Reznick says:

      Dear Sandra,

      Thanks so much for your views. I appreciate that you and many others viewed the resignations in a positive light. As you understand, I don’t share that opinion, but certainly respect the fact that the OMA has been besieged with problems which ultimately resulted in this event.

      Thank you for expressing your opinion,

      Richard

  16. Does Queen’s University have any provincial funding?

    • Richard Reznick says:

      Hi Merrilee,

      Like all institutions of higher learning in Canada, Queen’s University receives funding through student tuition, government grants and several other sources. I would proffer to add, that like all organizations whose principal funding comes from the public sector, universities in Canada, collectively, face ongoing financial challenges.

      Richard

  17. Medical Student says:

    Dr. Reznick,

    I read your post with great interest and the comments with great sadness.

    You are certainly not the only person to use the analogy of the Trump/Brexit anti-establishment movements to describe these physician groups. I have heard this many times and think this comparison is very apt.

    The responses here read like many of the threats made by members of these physician groups to the medical students who advocated for the tPSA. At least none of these posters have threatened to ruin your career.

    I should make it clear that I am not in favour of cuts to physician salary. I just consider myself a realist.

    The reality I have come to accept is that physicians are going to make less money in the upcoming years than the have in the past.

    The reason is not a lack of binding arbitration or lack of OMA leadership. Simply, the taxpayers of Ontario have no empathy for the plight of the physician. Physicians are not and will never be a group that inspires sympathy. When average taxpayers are struggling to find meaningful work they don’t have any time for physicians who are advocating for more compensation, albeit thinly veiled under the guise of patient care.

    Any sort of job action would be a disaster for the profession. It would not result in physicians getting more money and would certainly erode the relationship we have with our patients.

    As a medical student I have been told many times that my opinion on this matter is not valid. Despite having attended numerous OMA meetings, and met with leaders of COD, COOD, and the MOHLTC, I have been told that I am uninformed.

    Be that what it is, I hold out hope, as you mentioned, that the two sides find a way back to the bargaining table. But more than that I hope that the new leaders of the OMA resolve this issue without destroying the relationships I will someday have with my patients.

    Thank you for your thoughts on this important issue. I couldn’t agree with you more. I hope leaders within the medical profession, such as yourself, continue to advocate for a resolution that is, as you said, best for the patient.

    • reznickr says:

      Dear Medical Student,

      Thanks so much for your comment. Not only do I feel that medical students have and important place in this discussion, I fundamentally believe they have the most important place. It Is your future we are talking about. Like you, I have been extremely distressed by reports of intimidation of medical students and residents during what are supposed to be collegial discussions about these issues. I also agree with your perspective on the issue of current public opinion about physician compensation. That is not to say we shouldn’t advocate appropriately for fair compensation that reflects, importantly, a North American marketplace. And indeed, as well, one that addresses the extreme inequities in our fee schedule with respect to relativity.

      I am very glad you have commented on the blog, and I hope you and your colleague medical students remain active in this discussion.

      Richard

      • Vic says:

        Dr. Reznick,
        I am such a resident – a PGY5 surgical resident, that is staring down an underfunded health care system, where I see my staff physicians losing OR time due to the continued cutbacks and underfunding. Between 3 staff, on only 1 round of cuts, they had 80 hours of ONCOLOGIC OR time slashed that already been scheduled. That is a lot of Oncologic surgery to reschedule. This is only the tip of the iceberg, which also includes summer OR cuts, Christmas OR cuts, etc.

        I am staring down a Canadian job situation that is therefore bleak exactly because even the existing surgeons are operating way below their maximum capacity due to lack of resource allocation by the government and subsequently the hospitals.

        The tPSA would have worsened this situation by continuing to underfund, while compounding it with a hard cap that would have resulted in funding allocation well below the combination of projected increased utilization and inflation. This even omits the discussions regarding the limitation/managed entry of incoming medical students and physicians that was to occur in the province under the tPSA and further compound the job situation for new grads.

        You state that you want to hear the perspective of the new grads and med students as it is our future. Continuing down the road you suggest makes that future very bleak.

        • Richard Reznick says:

          Thanks for your comments, Vic.

          Like I said in response to the medical student who commented on the blog, voices like yours, a graduating surgical resident, are critical. I agree wholeheartedly that the current financial situation has led to tremendous stress not just in the area of physician compensation, but in the #1 healthcare spend, hospital funding. Being on the boards of several hospitals I can attest that financial pressures have challenged the ongoing delivery of both volume and quality of care. That said, spending for healthcare is the largest single budget line in our province, and the treasury equation is a zero sum game. That is why the profession needs to take leadership in finding ways to create efficiencies and preserve volumes. That’s going to take some fairly radical thinking if it’s going to be sustainable, because currently, I would argue, we have just been working at the edges of the problem.

          Once again thanks for your comments.

          Richard

          • Vic says:

            Dr. Reznick,
            I agree with you that new ideas regarding sustainability must be explored and agree that physicians need to involved in creating inefficiencies. I would argue that when it came to the tPSA that that burden was set up to be born in large part on the backs of front line physicians, This is especially inappropriate in the context that per CIHI data, on a per fee basis, Ontario physicians are the second lowest paid in Canada, next only to Newfoundland (https://secure.cihi.ca/estore/productFamily.htm?pf=PFC3266&lang=en&media=0). This is obviously fee for service only and excludes salaried physicians and family physicians in FHOs/FHTs, however these funding models are now difficult for new family grads to enter due to managed entry by the government. This places a huge burden on new grads in family medicine who are experiencing record debt loads upon graduation.

            There have been many recorded clinic closures already due to the financial pressure placed by the current funding climate. Obviously, as you know, physicians create a significant portion of the infrastructure necessary to deliver care to Ontarians. If these cuts continue patient wait times and care will continue to deteriorate. The tPSA made our profession complicit in that reality.

            The solution may well be alternative means of health care delivery that includes private payment if the government can no longer support a completely publicly funded system. I would further argue that the government does not appear to be placing a priority on streamlining the system however, as evidenced by the addition of expensive additional layers of bureaucracy as done with Bill 41. The LHIN expansion compounds rather than improves the situation though, considering the poor performance record of the LHINs. Their refusal to engage with the profession in a constructive manner on this legislation seriously undermines the trust necessary to engage them in meaningful discussion regarding further health care reform.

            Regardless, the fall out from all of this is that physicians and patient care are both currently suffering in large part due to global lack of health funding from this government. I don’t believe that further borrowing from physicians to finance the system is a reasonable way forward.

    • Queen's med alumni says:

      Dear Medical Student, Where are the “threats” you allude to in the above comments? From what I’ve read, most, if not all, of the commenters above have been respectful. They may have disagreed with Dean Reznick or challenged his statements in his post, but I don’t see any threats? Please don’t mistake passion for threats. Yes, many doctors are passionate about this topic. Many feel undervalued and taken for granted. Doesn’t mean they are threatening anyone. It seems to me to be a respectful discussion of a topic that affects/will affect us all–practicing MDs and trainees alike. Please don’t make this into something it’s not.

      • Richard Reznick says:

        Dear meds alumni,
        You are right, the comments to my blog have been for the most part respectful discussion. However, I believe the medical student is referring to something else. During the debate around the tPSA, there have been allegations that medical students and residents have been threatened. I stress that they are allegations, because I have not heard these firsthand. Nonetheless, deans in the province have discussed this issue, and I believe that is what the medical student is referring to.
        Richard

  18. Roxanne says:

    Dear medical student,

    Thank you for your insight. It is great that along with learning the basics of pathology you are also interested in medical politics. It is too bad that your career was threatened.
    Certainly one of the pillars of the CanMEDs roles is advocacy, it is also one of our roles as per CPSO.

    When I was a student I also felt like a realist, but looking back, I was an idealist. Actually it was only during my residency that I truly learned the issues and gaps in care of our health care system.

    As a newer doc, the tpsa was a def NO for me, not due to cuts, but due to the ridiculous imposition of hard cap below predicted growth, with an unethical reward if we kept physician services down, essentially rationed care. The financial reward for restricting patient access to healthcare nauseated me. As a family doctor, I am already a “gate-keeper” and I already follow the choosing wisely recommendations. I could not stomach the hardcap, would the wait times then be due to lack of funding as it is now? Or orchestrated by us physicians to reduce services and then get our bonus? This does not sit well. If the government had been prepared to match growth predicted by their own data, then i might have voted yes.

    As he old saying goes, “if a person is not a liberal when he is twenty, he has no heart; if he is not a conservative when he is forty, he has no head.”

    Good luck to you in the future. I hope you continue to be involved and always remember, one of our roles is to be an Advocate. We advocate for patients, and we want an Association who advocates for us.

    • Richard Reznick says:

      Roxanne,

      While it may be true that a person’s “political leanings” change over time, my interpretation of our medical student’s comments is that they are neither liberal nor conservative; just an accurate reflection of today’s current reality.
      Richard

  19. Greg says:

    Great line going. I take a couple of objections, as a long time OMA member. First of all, do you not think that as professional negotiators, the government hears the objection to job action, and it effects the aggressiveness of their stand. It sure would effect me if I was negotiating for them, as I would consider them an unarmed foe, and I simply have a job to do. The point is that I believe we have paid for that position for several years. Secondly, I read recurrent objections to the unilateral cuts that are often tempered by the inevitable conciliation to the poor fiscal position of the government. Are we paying a price for that public stand as well as during the time that we have been without a contract, offering to work for no fee increase, we watch high school teachers, primary teachers, and nurses all get pay increases. Yesterday, it was reported that the government offered 4% to the catholic teacher’s union. Could it be that we have made ourselves victims. As physicians, we well know that playing the victim role is never healthy. Thanks and keep up the dialogue.

  20. Bill Moore Meds ''62 says:

    Richard, you seem to have hit an all-time record for replies on your blog, which is good for stimulating thinking about complex medical and now political issues. Thanks to all who commented and for your replies. As you know, I am not a physician/student/resident in Ontario, only a long-time supporter of Queen’s Medicine.

    Your blog posting and the replies make me think about the growing influence on Medicine of government and reaction to it, whether in Canada or elsewhere.

    My concern is that Medicine is now becoming viewed more as a Business and less as a Profession, This can lead to talented students questioning their motivations to be providers of needed healthcare and physicians who are caught in the midst of political-financial changes and challenges. Some will choose other Professions but hopefully most will continue their service aspirations and providing essential healthcare.

    Medical-political issues in the U.S. seem to be in flux, too. Where they are leading or will stabilize is anyone’s guess. Given that reality, I hope people needing healthcare will get it and continue to get it in Ontario, all of Canada, and the U.S.

    All the best, Bill…

    • Richard says:

      Dear Bill,
      Thanks for your comments. I agree with them; in particular I agree with the issue that we should think of ourselves first as medical professionals. However, I do agree with all of those who are concerned that physicians should be fairly compensated and in the single-payer system, this mandate, good bilateral and respectful relationships with government, something we don’t currently enjoy.
      As always, thanks for your comments.
      Richard

  21. Greg says:

    Thank you Dean for engaging in conversation. That is important. As long time OMA member I do not disagree that settlement will come at the table. However, I do have a couple of thoughts. If I were a professional negotiator for the government, I would have singular purpose, and it would make me more aggressive and confident when I keep hearing doctors say that we must have representatives that do not believe in job action. As a negotiator, who wins and loses financially, I would never cave to an opponent who consistently and publicly announces that they have no weapons. Secondly, I am tiring of doctors who object to the concept and reality of unilateral cuts, yet immediately frame their objection in the context of sympathy for government who is in a “tough fiscal reality.” This self pity becomes more noxious as we watch primary school teachers, high school teachers, police (?) and nurses all get raises during our 4 year tenure of having no deal and making offers of 0% increases. Either the cophers are closed or they are not. If they are not we are just political pawns and deserve was we ask for. No increase and no respect. Other working groups will get what they negotiate. Did the Globe and Mail just report yesterday that the Catholic Teachers just got 4%??? How does that make you feel as we work more hours than ever?

    Greg

    • Richard says:

      Dear Greg,
      Thanks for your comments. And you absolutely bring up some appropriate considerations. With respect to potential job action, I understand your viewpoint, but I am personally of the view that the negative results of job action in our profession would outweigh any positives. I agree with you that as physicians who continue to work hard and deal with inflationary pressures and increasing costs of practice that there needs to be an appropriate negotiation and recognition of these realities to the medical profession. That is why I so firmly believe that we need to get back to the table. In doing so, I would however argue that there are opportunities for us in the fee schedule to look at critically and this could be part of the solution as we go forward.
      Thanks for your perspective,
      Richard

  22. Chris Sheasgreen says:

    Why is it up to physicians to bear the burden of a system that costs too much to support? Let’s imagine that the current financial situation had nothing to do with government mismanagement, but was simply a function of how expensive it is to provide universal health care. Why is it up to physicians to accept less remuneration than they’re worth to keep the system afloat? There’s evidence that Ontario physicians are already the most efficient and low-cost in Canada.

    I am currently a Fellow in Gastroenterology (essentially PGY6). Looking at future actual employment, I see my fellow gastroenterologists forced to pay for their own endoscopy clinics in order to care for patients who would otherwise overwhelm our underfunded hospitals. And yet the cuts keep coming, to the point where the endoscopy clinic in Barrie had to shut down because they couldn’t afford to keep it open.

    That’s why I despair when I hear fellow physicians advocating that we take on more of the financial responsibility for this bloated and inefficient system. We’re already propping up this system but the support beams are bending under the pressure. I would submit to you that, while many physicians are well-off, many are actually not. Many are struggling to keep their clinics open and their patients cared for. I agree that the province’s financial situation is dire, but until there’s a province-wide agreement that cuts should be made across the board, I don’t think we should be offering to fix it ourselves when so many of us are already suffering. It’s time for improvements to the system, not more dumping on physicians.

    • Richard says:

      Dear Chris,

      Thank you for your thoughtful comment. You do bring up many valuable points, and an important perspective. I would argue that it’s absolutely not only the physicians’ responsibility to deal with financial pressures of the system, but that’s a responsibility of the entire system. In thinking about this, it is important to recognize that healthcare is the single largest expenditure in the provincial budget and that growth of healthcare expenditures will ultimately come at a cost from reductions in other social services. That is for sure a difficult choice for governments to make.
      With respect to looking for sources of efficiencies in the cost of delivering health in our province, it is of note that the two largest costs are hospitals and physicians. Being involved with hospitals as I am, there’s not question that they, like the physician sector, have been under tremendous strain in the last decade. I would suggest that it is not only for the physician group that financial austerity is part of the reality; I believe that extends across much of the public sector.
      I do want to thank you for your thoughtful comments, and I appreciate your perspective.
      Richard

  23. Dear Richard

    Thanks for your honest, heartfelt opinions. You do speak for many Ontario physicians, including me. People of good faith can have opposite opinions and must be free to express them in a respectful manner. Debate is a part of our heritage of freedom.

    Your patience and grace in answering every criticism should be a lesson for everyone who expresses a public opinion.

    Thank you, Scott

    • Richard says:

      Dear Scott,
      Thank you so much for your comments. This is especially meaningful to me coming from someone who is a great Ontarian and a great physician leader.
      Richard

  24. Victor Stollar says:

    Dear Dean Reznick,
    I am an alumnus of long ago (1956) and have lived in the United States most of the time since my graduation. However, I was not engaged in clinical medicine, rather I was involved in laboratory research and teaching. I read your blogs almost every week, but never have I seen such a reaction and an outpouring of complaints and dissatisfaction. I was not aware of the situation in Ontario, and wonder if there are similar problems in the other provinces. Although I did know that there were some problems with the health system in Canada, for years I have spoken proudly to my American friends of the many positive features of the Canadian health system. Must I now eat my words?
    By the way I wonder if any of your readers saw the two hour debate on CNN this week between Senator Bernie Sanders and Senator Ted Cruz on health care. Reading the responses above would certainly have given much fodder to Senator Cruz.
    with best wishes and congratulations for the wonderful work you are doing as Dean.

    • reznickr says:

      Dear Victor, thanks so much for reaching out. I’m so glad that you have continued to defend the Canadian healthcare system. Although there are certainly stresses in a publicly funded system, and this current discord between the province of Ontario and its doctors is one example, I am still a passionate advocate for our system, especially after watching a program like the CNN debate between Sanders and Cruz. I am confident that we will be able to prevail and an reach an agreement with our government. Thanks so much for reaching out and all my best.

      Richard

    • Gerald Goldlist says:

      Dear Victor,

      There is currently a lawsuit in the BC by patients who have been waiting for treatment and want the right to get private care. One of the plaintiffs has died while waiting for the court case to continue moving forward. Another has become partially paraplegic. http://www.ctvnews.ca/health/b-c-lawsuit-potentially-a-disaster-for-universal-health-care-doctors-group-1.3060143

      Under funding by the Ontario government has being going on for so long now that our health care is becoming a disaster. This is not a recent phenomenon but is getting worse and worse. Almost 1 million Ontarians do not have a family doctor.

      Wait lists for nonlethal conditions are unconscionable. People can wait in pain suffering quality-of-life issues and not being able to work while waiting for consultations and treatment. A specific example that I know about is cataract surgery. In Ontario the guideline and goal set by the government is a six months wait for cataract surgery. At first glance this may not seem so bad but being unable to drive at night or even during the day can mean that people are unable to work. The situation with cataract surgery in Ontario is actually much worse than the measured wait times that we read about. The wait times we read about are measured from the time the surgeon and the patient decide to go ahead with the surgery. These wait times do not include waiting to see the consultant. Hospitals sometimes ask physicians to not put the patient on the waiting list until it gets closer to the OR time and so the hospital statistics look better. Also, when a patient has to wait one year for bilateral cataract extractions, this is often averaged to two 6 months waits! I am sure other specialties have their own artificially shortened wait figures.

      Those who need urgent care usually get it. Things like heart attacks and appendicitis are treated promptly. Unfortunately I have recently heard from physicians of patients waiting for diagnostics to go from possibly treatable cancer to palliative care while waiting. I just saw this post from an Ontario colleague: “Mother went to 2 emergs to get an mri that found large abdominal abscess. Waitlisted at 1st one. Died in severe pain.”

      These are only a few things that I know of. Whistleblowers are afraid. Victor, it is way way worse. Do not look to Canada for your American healthcare system. You must have a safety net for people who get sick but look to the European systems for how to do it better.

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