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Navigating Uncertainty In The New Ontario Physicians Deal

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Tension is mounting as physicians around the province count down the days to the binding vote on the proposed doctor deal. Those firmly in the Yes camp and No camp have submitted votes by proxy. What remains are the Undecided.

Hour by hour, more drama unfolds as the OMA ramps up its hard sell: multiple daily emails exhorting docs to just say "yes." Multiple social media ads clutter news-feeds advocating "yes." Multiple daily OMA telemarketing calls push docs to vote "yes." To a lesser extent, the Coalition that represents the No camp is also sending daily emails and holding Tele-Townhalls.

Doctors argue amongst themselves to figure out the best way forward. Many are trying to ignore the blatant manipulation and make a decision by weighing the pros and cons of the tentative Physician Services Agreement (TPSA).

The problem is that nobody has really provided that. I know because various medical students, residents and doctors have asked me to create one.

For those who feel that because I'm voting No, I could not author a balanced pro-con list, I have two things to say:
  1. Read the list. It's factual and unbiased. In fact, Dr Darren Cargill, a friend who is voting Yes, contributed because he believes in an informed vote as much as I do.
  2. Every day, as doctors, we weigh risks and benefits of proposed treatments before making a recommendation. Our opinions are not biased, they're evidence-based. Do yourself the courtesy of realizing that your opinion on the TPSA is valid because on some level you too have weighed the risks and benefits of this "treatment." Your endorsement means as much as the OMA Board because in the end, you too are a critically-thinking physician. Recommending a side does not mean that you can't fairly articulate the pros and cons.

Merits and failings of the contract aside, many wonder about the aftermath of this vote. Ratify the contract and what -- ration care and pinch pennies? Reject the contract and what -- face a vengeful government's unilateral cuts? The uncertainty inherent in the contract is mirrored by the uncertainty of the unilateral actions that we have weathered for the past 18 months.

This debate boils down to the level of uncertainty one is willing to accept.

And like others note, doctors do not deal well with unpredictability. After all, advances in medical knowledge and technology are all aimed at plumbing the depths of body and disease. Physicians are part scientist, part artist, part humanitarian and part statistician. Medicine is as much about hard evidence as it is about navigating the unknown. And there are a lot of unknowns with or without the contract. In defence, many try to drown out the silence of the unknown with noise.

The OMA's not-so-subtle message: reject this contract and physicians have failed. Punishment will ensue.

My message: reject or ratify, we simply don't know and cannot predict the outcome.

This debate boils down to the level of uncertainty one is willing to accept. How optimistic are you that the government will play fair? How convinced are you that the co-management that this contract hinges on will succeed? On the flip-side, how certain are you that the government will save political face, avoid more cuts and re-negotiate a second (potentially fairer) offer? How convinced are you that the government will fear physician influence in the fall by-elections and the 2018 provincial elections?

And the elephant in the room: what will become of the OMA? Will it evolve into an organization more responsive and reflective of all members -- not just the ones who toe its line? Will it encourage decentralization of power? Will it release its jealously-guarded Old Power hierarchy and accept the free-flowing, open current of New Power?

For me, I've already survived the uncertainty of unilateral actions. If the government imposes more cuts, they will hurt. But at least, I'll still be free to criticize them for their bad decisions. If I accept this contract, all advocacy will be effectively muzzled because I will be complicit with the cuts: I will have made my bed and will have to lie in it. I asked my patients what I should do. They replied, "Vote No; we want a doctor unafraid to speak up for us."

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