On Sunday, August 14, 2016, the Ontario Medical Association (OMA) held an extraordinary general meeting (the first since 1991) to vote on the Tentative Physician Services Agreement (tPSA) negotiated in secret by the OMA Executive, and presented to shocked physicians on July 11th.
The General Meeting was the result of extremely tenacious activism on the part of the Concerned Ontario Doctors (COD) group, co-led by Dr. Nadia Alam and Dr. Kulvinder Gill. Nicknamed "The Mighty Mites" by other members of the group, in recognition of their small physical stature, but fierce determination to protect health care for patients, the Mites delivered spirited, vocal, passionate opposition to the tPSA, while smartly creating alliances with a number of other medical subspecialties.
The OMA executive had countered by using high profile PR firm Navigator, at a rumoured cost of $3 million of its own members' money to push the tPSA onto physicians. However, the Goliath that is the OMA corporation, couldn't hold off the relatively sparsely funded Mighty Mites, and in an epic piece of medical history, could barely garner 37 per cent of the vote of the membership in favour of their proposed agreement. Even with that, many of those voting in favour of the agreement did so begrudgingly, recognizing its imperfections.
But how did it come to this? More importantly, what does it mean for the future of Health Care in Ontario? What will the Minister of Health Eric Hoskins do now? Let's take a look.
The OMA Executive embarked on what I feel is an extraordinarily one-sided campaign to promote this agreement.
First, despite a promise by OMA president Virginia Walley that there would be no return to the negotiation process unless there would be binding arbitration agreed to by the government, the OMA executive backtracked and cut a deal with the Ministry of Health without arbitration in place. What's worse, it's been alleged by more than one person that the OMA executive failed to follow its own due process for negotiations and did not appropriately notify the Negotiations Advisory Committee about the tPSA prior to agreeing to it.
Second, the deal itself had many controversial components. A hard cap on physicians' services (what happens if patient need is more than what the government is willing to pay for?). A "bonus payment" that seemingly rewarded doctors for turning away patients (regardless of need). A Physicians Human Resource Committee to look at needed number of physicians, when it's alleged that there is an "oversupply" of physicians (what happens to the nearly one million residents without a family doctor?). Promises of modernization of the Physicians Schedule of Benefits (but reading deeper revealed it was really cutting more fees).
The OMA Executive embarked on what I feel is an extraordinarily one-sided campaign to promote this agreement. Senior Management teams criss-crossed the province, met with groups of physicians and OMA sections. They implored the membership to vote yes, because, well, they're the executive, and they said the deal was best for the membership.
However, in their hubris, they completely minimized not only the COD but by extension, the Mighty Mites as well. While the Facebook page for COD has almost 11,000 members, the reality is that only a few dozen frequently post (but MANY read). Taking that to mean that most of the members were NOT following the lead of the Mites, the OMA simply ignored attempts to balance their presentation on the tPSA.
The mainstream media, taking the OMA's lead, also minimized the group. Variously referred to in the media as dissident, protecting high-paying specialties (Dr. Alam's a family doctor, and Dr. Gill's a pediatric allergist -- one of the lowest paid specialties), the media generally took a dismissive tone toward them, and portrayed them as only wanting people to resign. Missteps made by the Mites (there were a couple) were magnified to indicate these were radical doctors.
The most ridiculous comment was from Bob Hepburn in the Toronto Star, who likened the Mites to Donald Trump supporters. Because, of course, the first thing you think when you see two young, brown, ( and in one case Muslim) women is -- "Gee, they must support Donald Trump!"
In response, the Mighty Mites joined forces with many OMA sections and launched a series of court challenges. And they won. First, they forced the OMA to release its membership list to them so that they could disseminate an opposing viewpoint to the tPSA (the OMA felt it was already disseminating a balanced view -- something the Superior Court Judge clearly didn't agree to). Then, the forced the OMA to re-write the question on the ballots. On this occasion, the Judge went so far as to call the OMA's wording of the ballots sneaky, and potentially leading to a governance breakdown. Finally, I understand the OMA was NOT prepared to allow the Mites to present an opposing viewpoint to the tPSA at the general meeting but was again forced to do so by a judge.
As a result, the OMA Executive was seen to be at best incompetent, and at worst manipulative by the membership. While some suggested that the Mites would simply do anything, including legal means to get "their way," the fact that a Superior Court judge sided with them, proved to the membership that there was some basis for concern. The result was a historic repudiation of the OMA executive, the likes of which I have never seen in my 24 years of practice.
So what happens now?
The OMA is on record as saying that they want to return to negotiations. Eric Hoskins, appeared to be so stunned by this that he decided to lie to the public and state that this was the first time physicians would have had a "seat at the table." Where has he been the past 20 years?!? Will he return to the bargaining table? My sense is that he may very well try to simply impose more cuts on physicians like he has been doing these past two years.
The problem with that however, is that there are three by-elections coming up, and in the last one, you guessed it, the Mites were involved in organizing a protest in front of the Liberal candidate's offices, which contributed to their overwhelming defeat.
Does Eric Hoskins risk further antagonizing the Mighty Mites? He perhaps should have a quiet conversation about underestimating them with the OMA Executive. The consequences of not taking them seriously for his party will be severe.
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