To my physician colleagues: The tPSA is not a good deal, but I'm voting yes and you should too.
Lets be honest. The tentative Physician Services Agreement negotiated between the OMA and the Ministry is not a good deal. Anyone with any experience in negotiation, law, or with any common sense can realize that this barely qualifies as a contract. But I'm voting yes, and I strongly encourage my colleagues to do the same.
The Ministry has been three steps ahead from the beginning, has all of the leverage, money, power and public opinion on their side. In 2012, they negotiated a deal without binding arbitration. When they needed to find funds in the health-care budget, they cut our fees. We can't take job action -- if we do, we lose our license. We try to show the public how things really work, but it's complicated, and the Ministry's version is simple. We make it about patient care and warn that this will suffer, but most patients don't notice any difference. We scream from the rooftops that we need to be involved in reforming the system, not have unilateral action imposed on us, but no one listens. The Ministry keeps cutting our fees, and is now trying to pass legislation to put the LHINs in charge of overseeing our practices, destroying our autonomy.
Now, the OMA, almost miraculously, is able to come to an agreement that keeps us in charge of our own practices, promises a seat at the table, and gives us predictability, even if that predictability is more cuts. But to preserve the Charter Challenge, negotiations happen in secret. Since the second reading of Bill 210 is in September, and our changes need to be included and included fast, few details are worked out in the agreement and the timeline to ratify is short.
If we think that saying no now will buy us a better position to bargain from, we are mistaken.
There is no binding arbitration, even though we were told not to accept a deal without it. The deal is "leaked" to the media before members find out. The already shaky relationship between the OMA and many members, especially those in COD, breaks down. Who stands to gain the most from dividing our members and putting the allegiances of our representatives in question?
The public system is not sustainable in its current form. No matter what cuts we agree to now, co-pay/private pay and patient accountability need to be addressed. These are wildly unpopular ideas, and won't be discussed without us pushing for it. This deal gives us no guarantee, and we have essentially no faith that the Ministry will follow through on any promises or implement our suggestions. But by ratifying the agreement, we have a chance.
Here's the situation if we don't. We have minimal public support, no voice in managing the system, a track record of not holding ourselves accountable from a resource management standpoint (case in point -- the slow uptake of things like Choosing Wisely), and no ability to take job action. If we think that saying no now will buy us a better position to bargain from, we are mistaken.
Our charter challenge will take at least two years to work its way through the courts, and more unilateral cuts will be made in the meantime. Based on recent legal precedence, the court will not reverse any of the fee cuts, and is not even guaranteed to rule in our favour and give us binding arbitration. If we secure binding arbitration, it may not result in a better deal than the one we have in front of us today.
I want our fantastic ideas about reforming the system to be heard.
While the Liberals would like to have health care wrapped up with a nice bow for the election, they are still going to proceed with their budget. If we don't ratify, will it hurt their bid for re-election in two years? Maybe. Is it a dealbreaker? Absolutely not. Their public ratings will likely stay the same. They've weathered much worse already. And they know it.
This is the decision in front of us: take the deal, know what cuts are coming, have a say in how they happen and where they come from, stop some of Bill 210, get a seat at the table, and work on getting a better deal in four years. Or reject the deal, the government spins it and makes us look even worse in the public eye, continues with unilateral cuts, allows the LHINs to oversee our practices, and continues to shut us out of discussions around system reform. We hold our breath that the Charter Challenge fixes everything, knowing full well it will not.
Vote yes -- we have a chance, not a guarantee, but at least a chance to have some control over what happens to us, and make positive changes. Cooperation between us and the Ministry shouldn't be a bargaining chip, but it is. Vote no -- we get to be angry, "stand up" to the Ministry, protest, make our point, stomp our feet, and stand by while indiscriminate fee cuts rain down on us.
I want a chance. I want a seat at the table.
I want our fantastic ideas about reforming the system to be heard. I want to make rational decisions about where to cut funds. I don't want the LHIN inspectors with no experience doing my job telling me how to run my practice. The tPSA is not a good deal. But the alternative is much worse. I'm voting yes.
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