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Ontario Health-Care Cuts Are History Repeating Itself

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Back in the mid-1990s, the Ontario Provincial Government found itself in a bitter dispute with Ontario physicians. Back then, the government tried to frame the dispute as one that was solely based on physician compensation. Physicians of course, took the stand that the dispute was actually about how health care was funded, cuts to patient services, and that, in the long run, it would be the people of Ontario that suffered.

The Ontario Medical Association (OMA) of the day, the body that is supposed to represent all physicians, was felt to be sorely lacking in this regard by a significant number of it's members. They felt the OMA was not doing enough to represent their interests or to protect patient care. Family physicians felt particularly disheartened about the lack of respect they were being allotted by the government of the day, and were frustrated by the perceived inability of the OMA to advocate on their behalf.

As a result, two young female physicians, Dr. Sharla Lichtman and Dr. Rochelle Schwartz, founded the Coalition of Family Physicians (COFP). This breakaway group started to do things that the OMA either couldn't or wouldn't.

Both were young, full of energy and passionate about providing high-quality patient care. Recognizing that government cutbacks would ultimately hurt patients the most and unfettered by what appeared by many to be an "old boys club" at the OMA, they proceeded to launch a public campaign, using the media of the day.

By highlighting the flaws of the health-care system and, in particular, how family physicians were being singled out by the government as being solely responsible for the ills of a growing and ageing population, their passion resonated with many of Ontario's front-line physicians.

I'm unable to link to the cached web pages, but if you click on Dr. Lichtman's profile above, you can click on the COFP letters to read just how different tonally the response from the COFP was to anything that comes out of the OMA.

They were rapidly able to grow their organization to almost 4,000 members (about half of all family physicians!) within three years. They were able to get numerous new stories published in newspapers highlighting how the system was failing, and how the number of patients without a family physician was approaching three million.

From a political perspective, they were able to get numerous members of their group elected to senior positions in the OMA (one, Dr. Suzanne Strasberg, even became OMA president) and this resulted in a much more strident tone in the OMA's dealing with the government.

It certainly could not have been reassuring for the OMA to have another group be referred to as representing the interests of a segment of its members. At the end of the day, however, the combination of a more strident OMA and a "breakaway" group that was willing to say what the OMA would not succeeded in forcing the government to implement Primary Care Reform (PCR) in 2001.

PCR lead to a seismic shift in how family physicians practiced. The result? Now about 45 per cent of medical school graduates in Canada choose family medicine as their specialty (and yes, it is a specialty) as opposed to as little as 18 per cent eight years ago.

Fast forward to 2016. The government of the day finds itself, you guessed it, embroiled in a bitter dispute with Ontario physicians. The government portrays this as, you guessed it again, a dispute based on physician compensation.

Physicians are once again pointing out that vulnerable patients will suffer and, once again, a significant number of physicians feel that the OMA is not doing enough.

Unbeknownst to most of the general public however, a breakaway group of physicians, spearheaded by, you guessed it yet again, two young, highly energetic female physicians, Dr. Nadia Alam and Dr. Kulvinder Gill, have spoken out vigorously against the cuts to health care.

The co-leaders of the group Concerned Ontario Doctors (COD) have (here we go again) taken a number of steps that the OMA either can't or won't do.

Using the power of social media, they have managed to get over 11,000 physicians to come together on a secret Facebook page and email lists, to speak privately about how health-care cuts are affecting the general population. They have actively promoted a Twitter campaign via their Twitter handle (Your Ontario Doctors -- @OnCall4ON) that rebuts just about every tweet that Eric Hoskins and Kathleen Wynne make about health care. They've created a public Facebook page called We are Your Ontario Doctors (WAYOD), that list stories of how physicians continue to serve the population, despite being marginalized by Eric Hoskins and the Liberals.

Did you know that there was an orthopaedic crisis in London, Ontario?

Did you know that Dr. Emily Queenan, who the media strongly feted in the fall for being a doctor who moved here from the United States (opposite of what many physicians were considering doing), now feels as if she is being driven out because of the mess that is health care in Ontario?

Did you know that despite spending $51 billion a year in health care, we still have an Alzheimer's patient sleeping on the floor of an emergency department for eight days?

I wouldn't have known about these stories if it wasn't for the WAYOD page. All of their media releases are also archived on their Care Not Cuts page. For whatever reason the OMA refuses to promote this, but the stories are being widely circulated by COD. They also clearly use a much more aggressive tone.

On January 30, Drs. Alam and Gill organized a protest rally against cuts to health care in front of Liberal candidate Elizabeth Roy, in the by election of Whitby-Oshawa.

As a result it's widely been reported that while the Liberals didn't speak about health care before the protest, they did after. How much of a role the protest had in the stunning and overwhelming defeat of the Liberals in that riding is for political pundits to speculate on. But suffice it to say that it clearly didn't help the Liberal cause.

On Saturday April 23, Drs. Gill and Alam are going to up the political ante. They have organized a public rally at Queens Park for 12 p.m. The idea is to have everyone who is concerned about health care, whether physician, nurse, allied health-care provider or patient, have a peaceful march protesting against the cuts to meet a patient services.

If even three or 400 people are willing to show up, the event will be a big success considering how few resources they have at their disposal to publicize the event. (And yes, I plan to be there and yes, you are invited, too -- just click here to join).

Moving forward, there have already been numerous OMA elections that have resulted in members of the COD gaining various positions in the OMA bureaucracy. Many of these physicians are taking a much more strident tone that the current OMA leaders. As a result, the longer Hoskins and Wynne wait to go back to fair negotiation process with Ontario doctors, the more difficult they will find it to reach a deal.

George Santayana is famous for saying that those who cannot remember the past are determined to repeat it. In medical politics, this clearly seems to be the case.

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