Most observers were surprised to hear that the Ontario Medical Association (OMA) and the Ministry of Health (MOH) had reached an agreement in early July. The Tentative Physician Services Agreement (TPSA), while not perfect, has benefits to both sides.
For Physicians:
- No further unilateral cuts to fee codes
- Better funding for the growing and aging population and physician supply
- Equal seat at the table to manage ongoing spending and updating the Schedule of Benefits (fee codes) with third party facilitation*
- Ability to continue charter challenge seeking binding arbitration
* Facilitator recommendations are binding
For Government:
- Four years of predictable physician spending
- Targeted fee cuts
- Labour peace with physicians prior to the election
- Demonstrated cost savings
- No negotiated binding arbitration
This is how negotiations work. Each side brought their priorities, neither got everything they wanted, and both walked away able to claim success for their side.
Since its release, the OMA, the Professional Association of Residents of Ontario (PARO)* and the Ontario Medical Students' Association (OMSA)* have come out in favour, with the OMA and OMSA encouraging their memberships to vote in favour of the Agreement.
*OMSA represents approximately 3600 medical students and PARO represents more than 5000 resident physicians, most of whom are OMA members.
The TPSA was to be put to a non-binding referendum, which would inform the OMA Council who would have the final say. While the referendum was non-binding, the elected OMA council has not previously gone against the will of the membership.
Enter Concerned Ontario Doctors
After the unilateral cuts in 2015 a Facebook Group was formed, now known as Concerned Ontario Doctors (COD). Their early impressive numbers, almost 9000 members, were achieved as people could be added to the group without their permission. The leaders began organizing small protests, meeting the opposition and writing opinion pieces criticizing the government. The media provided significant coverage to this sensational internecine fight.
When the TPSA was announced, COD was incensed. How dare the OMA negotiate a deal without consulting with us first?
They sought help, and help was readily available.
The Coalition was Born
COD partnered with the Ontario Association of Radiologists (OAR) and Doctors Ontario, both of whom have long disagreed with the OMA. Joined by some OMA Section Executives, largely from high billing specialties, they call themselves the Coalition of Ontario Doctors.
The Coalition brought COD two very important things: money and lawyers.
Not content with the non-binding referendum and wishing for increased participation from rank-and-file physicians the Coalition organized a petition. When 5% of OMA members signed they forced a general meeting that gave all members (about 40000 physicians) a binding vote; however, they neglected to do their homework.
General meetings for corporations have specific requirements, including either physical presence or proxies to vote. It also had to be organized within three weeks and the meeting, simply for practical travel and venue choices, would have to be in Toronto.
Rather than enhancing physicians' voices, the general meeting has stifled them. It will necessarily favour voices from Toronto and those who have the means to travel. Talk about the law of unintended consequences.
Ontario physicians should read the TPSA for themselves, ask questions and read multiple points of view.
The Coalition now accuses the OMA of "rigging" the proxy system and has had it invalidated by the courts (a new proxy form was issued on August 3). They demand resignations from the OMA President, OMA Board, Minister Hoskins and Premier Wynne, accusing them of being a "government-OMA cabal." Aghast that the OMA is recommending the TPSA to physicians, they sued the OMA for its membership list and are sending unsolicited e-mails to Ontario physicians.
Why Do We Support the TPSA?
It is important to know that neither of us is on OMA Council or Board. Both of us have significant experience on the PARO Board and, in our respective times, were PARO Presidents.
There has been an incredible amount of misinformation, hyperbole and emotion presented to physicians by COD and the Coalition. They have played on physicians' anger and frustration in, as Andre Picard put it, a very Trump like fashion.
Ontario physicians should read the TPSA for themselves, ask questions and read multiple points of view. They should make the decision based on facts.
This is why we are voting in favour:
1. Stability: This is the most important reason we are in support. The last four years have seen unilateral, across the board cuts arbitrarily imposed by the MOH. This agreement specifically precludes unilateral action by government.
2. Schedule of benefits changes: There is broad agreement amongst most physicians that this needs to happen. This agreement guarantees the OMA an equal seat at the table to ensure that physicians are represented as changes are made and that we hold ourselves accountable. There is a third party facilitator at the table whose recommendations are binding in case of disagreement.
3. Charter Challenge continues: This will not impact the OMA's ability to continue pursuing the Charter Challenge to try and secure binding arbitration for physicians in Ontario, which will take years.
4. Reversal of restrictions on primary care: Programs that have been implemented by the MOH that specifically target new in practice family physicians and primary care practitioners are being rescinded and two of the most contentious provisions in Bill 210 are being revisited by the OMA and MOH.
5. Funding for new programs or unexpected events: The Government has committed to providing additional funding for new programs (e.g. IVF) and unexpected events (e.g. SARS).
6. PARO and OMSA: Both groups have both been given written assurance by government that the changes will not target new physicians and, further, have been given seats at the table as health human resource challenges are addressed.
These are challenging times for physicians, governments and patients. We need to have peace and we need to rebuild trust in order to improve the health system in Ontario and the health of our patients. After 18 months of scorched earth tactics we are open to trying something different.
We are voting yes, and we hope you are too.
Dr. Kaif Pardhan
Dr. Alim Pardhan
Neither of their views reflect the organizations for which they work.
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