Dear Dr. Hoskins,
I had the opportunity recently to attend the 25-year reunion of my medical school graduation class. It was a happy occasion, and it was wonderful to catch up with many of my old friends and colleagues from the Class of 1990. To quote one of my classmates excellent blogs, "The last quarter century has taken 250 people in different directions. Careers have been built; families have been established and nurtured." It was exciting to see what directions my colleagues took in their lives.
As it turns out, while the reunion was, itself, a grand event, it was somewhat bittersweet to see where so many of my classmates went. Simon, who I always thought of as the type who would be Chief of Surgery somewhere, did, in fact become a Chief...in Kamloops. Martin, Dianne and Patrice who I thought would be awesome family doctors, are awesome family docs...in British Columbia. But at least they are helping, nurturing and supporting other Canadians.
But what about David, who I also thought would be an awesome family doctor? He is...in Boston. How about Howard and Blake, who aspired to be top notch gastroenterologists? They are, in Texas and South Dakota. How about the "Z", who was probably one of the two funniest "Patch Adams" types in the class? He now works as a family doctor and has a whimsical set of Youtube videos to help patients understand their illnesses...in Texas. Humeira, the internal medicine star? One of Seattle's top cardiologists. Stan, who shone at endocrinology? Helping to care of diabetics in an impoverished area of California. Lisa, who broke stereotypes by wanting to be an orthopaedic surgeon? She is one...in Rochester. The list goes on. In short, its appears over 30 per cent of the graduates of my class are no longer in Ontario. These are good, smart, hard working people who's primary focus is making the lives of their patients better.
You may not know this, but it was shortly after we graduated that the Bear-Stoddart report came out, and it suggested that there were too many doctors in Ontario, and the size of medical schools was decreased. Also at this time, many residency positions were eliminated. I trust this situation will sound familiar to you.
Additionally, the government of the day, Bob Rae's New Democrats, eventually entered into an agreement with the physicians whereby a hard cap was put on physicians income, in return for some savings the government was allegedly going to find. Once found, those savings were to be reinvested and the physicians were to get a raise in their income. Again, I trust this situation sounds familiar. The government never was able to find those savings yet still insisted the physicians keep up their end of the bargain, and accept ongoing clawbacks.
It may (though it should not) surprise you to learn that physicians were quite perturbed by all of this in the 1990s. If you make an agreement in good faith, the expectation is that the other side will follow through on their commitments. Since that didn't happen, it created a situation where the government of the day simply dictated to physicians how the health care system would be run, as opposed to working collaboratively with them.
Dr. Hoskins, you in particular have been very fortunate to have worked in many positions where you could be in charge, and set you own terms. While you clearly understand the hard work, dedication and passion it takes to get through medical school and residency, I don't think you appreciate the frustration that comes when, after all that, your voice is not accepted when you advocate for your patients. Or the anger that comes with the simple knowledge that when you make a rational, constructive argument in favour of improving health care, you are told that "it's all about money." Or the despair that comes with realizing that there is not a fair process for addressing your concerns.
Dr. Hoskins you are actually one in a very long line of Ontario Health Ministers to state that Ontario has the "best paid" physicians in the country. Your predecessors with the NDP and Conservative governments all said the same thing. Yet a third of my class (and perhaps more) left the province anyway. Because the reality is that end of the day, physicians want to advocate for their patients, and want their voices heard. From working in Ontario for many years, they know what is necessary to provide high quality patient care, and they know when they are being obstructed from doing so. They also know when they are not appreciated, and will move to areas where their opinion are appreciated (which curiously happen to be many of the areas you and other Ontario Health Ministers claimed had lower incomes).
I've been told your are a very well-read individual. No doubt you are familiar then with George Santayana's famous quote, "Those who cannot remember the past are condemned to repeat it." Dr. Hoskins, my patients, and the people of Ontario cannot afford to repeat the same mistakes of the past. We cannot return to a system where there are three million or more people without a family doctor, or wait times to see specialists (already too long in my area) get prohibitively longer. I urge you and Ms. Wynne to stop acting in a draconian manner and reverse your cuts. Return to fair negotiation process that values your physicians. If not, prepare for the next "crisis" in medicine, in about three years. Say, isn't that when the next election is?
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