The seven months of turmoil at the Ontario Medical Association (OMA) is enough to make anyone's head spin. Doctors and patients in Ontario have been inundated with competing narratives about what is happening in an endless stream of emails, blog posts, tweets and news articles. One thing has become increasingly clear though: the moderate voices at the OMA have been silenced and the push now is for physicians to take job action.
The doctors pushing for job action continually draw a link between a new physician contract and improved patient care, a link that is tenuous at best and a sly marketing tool at worst. A physician contract is about physician income. If doctors take job action, it will be to increase the amount they are paid by tax payers. Additionally, patients will likely view any job action negatively as physicians' average take-home income exceeds that of 95 per cent of Canadians.
What might job action look like?
1. User fees
There have been increasing calls on various social media platforms to institute user fees or increase those in place. This is the thin edge of the wedge. Carefully crafted to not be in contravention of the Canada Health Act, they supplement physician income. There is no question that insured services need significant review. However, unfettered, these fees disproportionately impact those who can least afford to pay and will keep those who need care from seeking it in the first place.
2. "Emergency services-only" days
Services such as non-urgent, clinic-based patient care and elective surgeries would not be offered on specific days -- for example, "Furlough Fridays." The irony is that those pushing for job action insist that wait times and standing-room only emergency waiting rooms are part of the problem -- a problem that this type of job action would exacerbate. With no alternative, patients whose family doctors' offices are closed would flock to the nearest emergency department.
There is no question that the health-care system is struggling
3. Abandonment of teaching responsibilities
Doctors train in an apprenticeship model, with physicians in training working under supervision for up to eight years. Abdicating this responsibility would ransom the future of medical students and residents, meaning they might miss critical learning required for them to care for their future patients.
4. Slower diagnostic services
Doctors with primarily diagnostic practices are uniquely positioned to gum up the gears of health care. Rather than read X-rays on arrival or look at pathology specimens, non-urgent studies could be put off for several days before reports are issued, again slowing patients' journeys through the health-care system, delaying their care and potentially putting them at risk.
5. Decreased participation in planning and committee work
Rather than provide physician input at the local level, some physicians argue they should not participate at all. This, despite their contention that physician input is critical to system and patient care improvements. In this setting, government will simply look to those who will say what it wants rather than face the reality of what is needed, while doctors are excluded, looking left out and out of touch with patient needs.
Health Minister Dr. Eric Hoskins. (Photo: CP)
Perilous course for the OMA
There is no question that the health-care system is struggling, with its obligations to provide care outstripping the province's ability to pay for it. Physician payments make up approximately 20 per cent of the health-care budget and, with an already unpopular government focused on eliminating the deficit before the next election, Minister Eric Hoskins and Premier Kathleen Wynne see little or no upside to caving to the demands of high-earning doctors. In fact, they are likely to use the megaphone of Queen's Park to amplify the impact of job action on patients and the earning power that physicians already have.
Well-funded doctors' groups, as well as grassroots groups, have established a no-holds-barred, take-no-prisoners approach to bargaining. They point blank refuse to allow the OMA to go back to the bargaining table without first getting binding arbitration -- using lawsuits and threats of general members' meetings to bully the OMA leadership. This, despite the knowledge that this government and future governments are unlikely to grant arbitration unless terms are negotiated at the bargaining table or through a court order that the OMA is already pursuing.
Each side will need to compromise on some things to achieve their broader goals.
This strategy is a mistake.
A way forward
The right strategy is to step back from the brink and find a way forward that achieves our goals without harming our patients. Most doctors want to provide excellent care for their patients and to be compensated fairly. To this end, a group of physicians came together after the failed contract vote last year to identify positive and solutions-focused principles to move the profession forward.
- A unified voice for the medical profession at the bargaining table
- A fair and binding arbitration process to resolve compensation disputes
- A medical profession engaged in system stewardship
- A commitment to addressing inequities in physician compensation
- A restatement of our commitment to the principle of equity
Added to this, it is essential that physician leaders, both within and outside the OMA, begin to separate negotiations of physician compensation from the broader health-system reforms that are essential to its sustainability.
Physicians, like all groups that collectively bargain, need a fair and equitable agreement with the government. The best way to achieve this is at the bargaining table where, as in all negotiations, each side will need to compromise on some things to achieve their broader goals.
Abandoning our patients through job action, in the hopes that an intransigent government will suddenly deliver more money for doctors and binding arbitration, is a fool's errand. Doctors will look greedy, government will have ready-made advertising to show they are holding the line on spending, and our patients will continue to wait, helpless to intervene.
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