INDEPENDENT OPINION ON THE OMA’s APPROACH TAKEN TO THE CHARTER CHALLENGE

Members have asked for an independent opinion on the OMA’s approach taken to the Charter Challenge. Attached is an opinion from Mr. Andrew Lokan, one of Canada’s senior and most experienced constitutional lawyers. We hope doctors will find this opinion to be both helpful and informative.

The Coalition engaged Mr. Lokan to provide an independent opinion in response as a follow-up to information contained in Dr. Walley’s September 26th letter in which she made a number of assertions about the OMA’s handling of the Charter Challenge.

Mr. Lokan’s response includes a number of comments that members should be aware of. Notable among them are:

  • The OMA’s timeframe of a projected hearing date is “unusually long”. 18-20 months is the norm
  • Affidavits are normally part of the public record especially in Charter challenges due to their public policy nature
  • Walley neglected to mention that the involvement of the OMA lawyers in other constitutional challenges was on behalf of government interveners who were opposing the union’s case. The Supreme Court judgment ruled in favour of the union

Sincerely,

Coalition of Ontario Doctors

Attach.

Click on this link to read the full letter or by clicking on the images below:

COALITION RESPONSE TO OMA SEPT 30-2016

Our members have asked for very basic information but the OMA seems intent on maintaining secrecy in order, one presumes, to prevent members from obtaining the full picture. It is time for members to have a direct say in these issues. Read the full text of the letter is below, or you can download PDF copy of the letter.


September 30, 2016

Virginia Walley, MD, FRCPC
President
Ontario Medical Association
150 Bloor St. West, Suite 900
Toronto, Ontario
M5S 3C1

Dear Dr. Walley,

Thank you for your response to the Coalition’s letter of last week. The OMA would better serve its members’ interests if it formally recognized that the Coalition and Concerned Ontario Doctors represent thousands of Ontario doctors who are deeply concerned about our ability to provide timely and adequate care for our patients. The concerns we raise and the principles we are fighting for are of great importance to all physicians, our patients and the broader public.

The Coalition is glad to see that affidavits in support of the Charter Challenge were delivered to the Ontario government at the end of April so that at least the first step has been taken to advance the case. However, members are very concerned that it took six (6) months to deliver these and that a further five (5) months have passed with no response from the government and no timetable set for one.  We will not further debate the timelines for this kind of case other than to say we have it on very good legal authority that taking more than a year to complete the first round of evidence is well outside the norm. The estimate of three years to obtain a ruling from the court is also well outside the norm of 18 months for a case of this type. And, contrary to what you say in your letter, case management judges are not appointed at the end of the process but rather at the beginning in order to ensure that a case proceeds smoothly and expeditiously through the system to a hearing on the merits. The Coalition’s proceedings commenced this past summer in response to the OMA’s efforts to push through the 2016 tPSA. That incident provides an excellent example of how quickly a hearing can be obtained and conducted if a party wishes to advance a case efficiently and promptly.  In the tPSA proceeding, the judge was appointed at the very outset to ensure the case moved quickly. Similar efforts to ensure the expeditious progress of the Charter Challenge should have been, but were regrettably not, taken by the OMA or its counsel. The reason for this unnecessary delay and why it has not been explained or disclosed to OMA members remains an outstanding and vexing concern.

You are also incorrect to say that it is common for public interest litigation of this kind to be conducted in confidence with the record released just seven (7) days before the hearing.  It is highly unorthodox for evidence in a public interest case to be kept from the public and interested parties to prevent it being ‘dissected’, whatever that means.  Transparency is important. This is why the OMA rigorously, and appropriately, publicised its commencement of the Challenge in the media last year.  However, when it signed the April Agreement to resume negotiations in secret and abandon its insistence on binding arbitration, the OMA appears to have agreed with the government to keep the Charter Challenge ‘confidential’ as well.  We note that you have not responded to our request for disclosure of the April Agreement, and I would now ask that this document be provided without any further delay. Please confirm that you will provide this secret April agreement.

We did not agree with the tPSA being negotiated in secret and we do not agree with the Charter Challenge being conducted confidentially. Ontario’s doctors have nothing to fear or hide in our request for binding arbitration.  Members and the public understand our position and the importance of binding arbitration. You also admit that the evidence will be disclosed seven (7) days before the hearing at some unspecified date in 2018.  Members are tired of having information of great importance to them and their patients withheld and released on a need-to-know basis with limited time to understand and respond to it.  Members are tired of being told that openness and transparency are to be avoided. It is most unfortunate that the OMA and government appear to have decided to conduct this case in secret and disclose the evidence just days before the hearing. This secretive approach was the root cause of the divisive events of this past summer. Members are every bit as capable as the OMA leadership of absorbing, evaluating and understanding information critical to their livelihoods and professional responsibilities, and it is unacceptable that the OMA persists in its efforts to prevent its own members from having transparency.

You have, in your letter, dodged the issue of PWC’s independence by instead addressing the issue of conflict of interest. We have never alleged that PWC has a conflict of interest with the OMA. PWC has a very close business relationship with the OMA. The OMA is a longstanding client of PWC and, that being the case, PWC is not independent. It certainly isn’t going to publicly disagree in any material way with the conclusions and opinions of OMA legal department and management expressed in your letter of last week. As an example of OMA’s prior ties to PWC, we note that in April 2015, PWC was the sponsor of the OMA’s speech to the Economic Club of Canada; and was engaged to carry out a physician overhead costs study that failed to obtain a statistically reliable sample yet proceeded to produce a report that was viewed as being both an inaccurate and controversial document that was then knowingly used to produce other inaccurate reports and findings that negatively impacts thousands of doctors.

There remains a deep concern among physicians about the biased views that Mr. Falk, PWC’s most senior health consultant, harbours towards physicians and the impact of how those known views will impact the findings. Furthermore, and contrary to the suggestion in your letter, no special health expertise is required to review the OMA’s decision to negotiate in secret, exclude Section heads, drop the demand for binding arbitration, pursue the Yes campaign in the way it did and censor efforts by Section heads to communicate with members.  It seems the OMA intends to use PWC’s so-called “Independent Review” as a retrospective justification for its negotiation and support of the tPSA.  In this regard, we note that you have ignored the request to disclose the PWC terms of reference, which further reinforces our concerns about PWC’s lack of independence and the OMA’s lack of transparency with its own members. We are more concerned than ever that PWC’s report will be used to be nothing more than a whitewash of OMA actions and behaviour.

You have not indicated what the PWC Independent Reviewer will cost OMA members. We are requesting that the total cost of the PWC project be disclosed to the Coalition and OMA membership.

Finally, your refusal to disclose the cost of the Yes campaign is noted. Certainly, there was an amount paid to Navigator for advertising/robo-calls/social media campaign costs, Computershare, and the OMA’s legal advisors for the meeting and proxy process. These amounts are all readily identifiable and will have been the subject of invoices that are currently in your possession. There is no reason that the total amount spent cannot be promptly determined and disclosed. Members of the OMA whose dues were used to fund these expenditures are entitled to know the amounts that were spent on this unsuccessful campaign to influence OMA members to support the tPSA.

In summary, we view your September 26th letter as unfortunate and unproductive. We had hoped it would be constructive and harken a new and more open discussion. Our members have asked for very basic information but the OMA seems intent on maintaining secrecy in order, one presumes, to prevent members from obtaining the full picture. It is time for members to have a direct say in these issues.

Sincerely,

Charles Peniston MD               OMA Section on Cardio-Vascular Surgery

Jim Swan, MD                          OMA Section Cardiology & Ontario Assoc of Cardiology

Chris Giorshev, MD                  OMA Section Chronic Pain

Kulvinder Gill, MD                   Concerned Ontario Doctors

David Adam, MD,                     Dermatology Association of Ontario

David Jacobs, MD                     OMA Section Diagnostic Imaging

Doug Mark, MD                         DoctorsOntario

Sharad Rai, MD                         Doctors for Justice

Michael Murray, MD                OMA Section Emergency Medicine

Iain Murray, MD                      OMA Section Gastroenterology & Ontario Assoc of Gastroenterology

Christian Rabbat, MD              OMA Section Nephrology

Keith Meloff, MD                      OMA Section Neurology

Sean Symons, MD                    OMA Section Neuroradiology

Christopher O’Brien                  Ontario Association of Nuclear Medicine

Mark Prieditis, MD                    Ontario Association of Radiologists

Joan Charboneau, MD              Family Practice

LETTER TO DR. WALLEY: OMA ISSUES SEPT 21-2016

Today, the Coalition of Ontario Doctors issued a response to to Dr. Virginia Walley and the OMA Board about the Charter Challenge; regarding the communiqué released on Monday, September 19th; the appointment of PriceWaterhouseCoopers; and the cost to OMA membership of the tPSA campaign.

Read the full text of the letter is below, or you can download PDF copy of the letter.


September 21, 2016

Virginia Walley, MD, FRCPC
President
Ontario Medical Association
150 Bloor St. West, Suite 900
Toronto, Ontario
M5S 3C1

Dear Dr. Walley:

The Coalition of Ontario Doctors (Coalition) is writing to you and the OMA Board about the Charter Challenge; the communiqué you released on Monday, September 19th; the appointment of PriceWaterhouseCoopers; and the cost to OMA membership of the tPSA campaign. Please share this letter with the full OMA Board membership.

OMA Charter Challenge

Over the last two months (and again on Monday in its communiqué) the OMA has repeatedly invoked the Association’s Charter Challenge as justification for its decisions including its decision to negotiate the rejected tentative Physician Services Agreement (tPSA) in secret, to drop the demand for binding arbitration as a prerequisite for bilateral negotiations, and to provisionally agree in the tPSA to drop the significant financial damages suffered by Ontario physicians as a result of unilateral fee cuts made by the Health Minister.

This has caused many Coalition members to inquire about the status of the OMA’s Charter Challenge, the efforts the OMA has made to advance it towards a court hearing, the nature of the government’s response, and the next steps. To our knowledge, the OMA has not provided much by way of public updates or related documentation since the Challenge was started almost a year ago on October 29, 2015.

In looking at the OMA members’ website today, there is no meaningful information about the Charter Challenge. The only reference to a legal action is to the Coalition/OAR’s PSA Injunction application. To respond to Coalition member inquiries we have reviewed the Superior Court file in an effort to understand the status of the Challenge and the next steps.

The Coalition was very surprised to find that, according to the Court records, nothing has been done by the OMA to advance the Challenge since it was started last October.

The Notice of Application that started the Challenge last October says that it will be supported by affidavit evidence of Drs. Kapur and Tandan, and Messrs. Kantarovic and Roszuk. But, almost a year later, not a single affidavit has apparently been filed in support of the Challenge.

There are also no affidavits from the Ontario government. In fact, according to the court file, the Ontario government has not even responded to or acknowledged the Challenge by filing a Notice of Appearance. And it does not appear that the OMA has taken any steps to have the government respond to or acknowledge the Challenge.

It would also appear from the Court file that no steps have been taken by the OMA to ensure that the Challenge ever does advance, such as setting a schedule for the government to respond, filing of evidence, the appointment of a case management Judge and setting a timetable for the conduct of the challenge. This is in contrast to the legal proceedings this past July and August when the Coalition demonstrated how effective a case management Judge could be in managing court proceedings about the August 2016 PSA vote and general meeting.

It would appear that nothing has been done by the OMA on the Challenge since it was started eleven months ago, including getting the Ontario government to even acknowledge it. We understand that the rules of Court require the responding party (the government) to respond ‘forthwith’ and that the absence of any response or delivery of evidence is very unusual.

This is of great concern to the Coalition and to all Ontario doctors because of the importance of the Challenge to the profession and the extent to which it has been presented as a justification for the OMA’s recent decisions.

If for some reason, the Court file does not accurately reflect the steps that the OMA has taken to advance the Challenge, please let us know. We had presumed that any steps, including evidence in support of the Challenge and the Ministry’s response, would and should be part of the public record and shared with membership.

On behalf of our members we require a response to these questions:

  1. Has the OMA entered into any form of ‘standstill agreement’ or other agreement with the government to delay prosecuting the Challenge? If yes, why has the OMA not notified the membership?
  2. Has the Ontario government put in a Notice of Appearance confirming it will respond to the OMA Charter Challenge?
  3. What communications have there been with the Ontario government about the Charter Challenge and bringing it to a ruling from the Court?
  4. Have the affidavits of Drs. Kapur and Tandan, and Messrs. Kantarovic and Roszuk been completed and served on the government? If they have not, why have they not?  If they have, where can members see a copy?
  5. If affidavits have been submitted, has the Ontario government responded? If it has, why have copies of its responses not been provided to OMA members and made a part of the public record?
  6. What requests have been made of the government for judicial case management so that a timely schedule can be set for the hearing of the Challenge? Please provide a copy of a schedule if one has been set.
  7. What is the OMA’s schedule for the completion of the Challenge?
  8. Why is information about the Charter Challenge not more prominently displayed on the OMA website?
  9. To date, how much has the OMA spent on the Charter Challenge both in terms of external legal counsel and other related expert advice?
  10. What law firm(s) is the OMA using to represent the Association membership in the execution of this legal action?

OMA President Walley’s September 19th Communiqué

The Coalition has reviewed the OMA’s response, which was prepared by the OMA legal department to Mr. Lisus’ August 2016 report. We do not intend to engage in a debate but wish to make it clear we do not accept the rationalisations and justifications particularly the tap dancing around the still secret April agreement pursuant to which the OMA resumed negotiations without binding arbitration.

While we do not share the OMA Legal Department’s characterisation of Mr. Lisus’ report as ‘selective and adversarial’, we are not surprised that they would express this opinion given that a number of the legal steps taken during the course of the proceedings (including the form of proxy invalidated by the Court as sneaky, unfair and unbalanced, the finding that the OMA executive abused its authority, and the prohibition on the OMA receiving proxy tallies in advance of the meeting) were made or approved by the OMA’s legal department.

While the OMA is entitled to its views, we wish to convey our members’ concerns that, after promising an independent review, the OMA chose instead to conduct a self-review carried out by the very same individuals whose decisions are in issue. Specifically, we are referring to the detailed response/rebuttal to the Coalition’s report in August 2016, as well as the provision of explanations for the OMA’s conduct to-date (such as negotiating in secret and the refusal to disclose the April 2016 Agreement). The OMA has wholly accepted the conclusions of its own reviewers and publicly endorsed them in advance of its promised ‘independent’ review.

In these circumstances, our members find it very difficult to believe that PriceWaterhouseCoopers, or anyone else engaged, paid by and reporting to the OMA, will be prepared to differ in any material respect from the opinions and justifications that have been pre-emptively reached by the OMA legal department, endorsed by management and communicated to membership.

It is indeed regrettable that the promise of an independent review and an important opportunity for transparency, renewal and accountability has been so fundamentally compromised.

Appointment of PriceWaterhouseCoopers as Independent Reviewer

In addition to the above serious process concerns, members have raised questions about the appointment of PWC as reviewer. Last month we asked for input in the selection of an independent reviewer to ensure true transparency and accountability. Our requests were ignored. Without any input from membership, we learned yesterday that PWC has been engaged to conduct the independent review.

PWC is not independent. It has been engaged multiple times by the OMA to provide consulting services in the past resulting in reports that have been viewed by large segments of the medical population as being inaccurate and/or controversial. Some current PWC personnel have been involved in prior PSA negotiations on behalf of the Ministry (most recently in 2012), and who have authored reports, which members have strongly disagreed with. PWC’s current health group lead consultant has advocated for the reduction of physician fees and the tendering of physician services. The OMA is well aware of those physician concerns.

In addition, PWC has a consulting relationship with the Ontario government. PWC is not an independent reviewer. There is also a concern amongst doctors that the engagement of PWC is part of an after-the-fact effort to justify the OMA’s continuing commitment to the rejected tPSA, similar to Monday’s after-the-fact criticism of Professor Carr’s report.

  1. Please advise how much the OMA has allocated to spend on this “independent PWC review”?
  2. What kind of process did the OMA engage in to determine what constituted an independent review?
  3. What factors contributed to the selection of PWC as independent reviewer in light of its prior involvement?
  4. What is the mandate of PWC and why has it not been shared with the membership?

OMA’s Cost for the PSA Campaign

Members have expressed great concern about the zeal with which the OMA approached the tPSA Yes Campaign, its communications strategy and its refusal to share counter positions from Section leaders, the Coalition of Ontario Doctors and Concerned Ontario Doctors. The OMA’s Vote Yes activities, all funded by members’ Randed dues, were widely viewed as being the most extensive and expensive PSA campaign ever undertaken.

  1. Please disclose the total cost of the OMA’s Yes Campaign, including a breakdown of its use of external consulting firms and other resources, advertising and other related expenditures.
  2. Has the OMA Board considered Dr. James Swan’s written and verbal requests that consideration be given to cover some of the costs of the No Campaign, which, delivered important balance and ultimately expressed the views of the membership. Will any funding be provided?

We would be grateful if you would answer the questions in this letter by Wednesday, September 28th.

Yours sincerely,

Charles Peniston MD               OMA Section on Cardio-Vascular Surgery

Jim Swan, MD                         OMA Section Cardiology & Ontario Assoc of Cardiology

Chris Giorshev, MD                OMA Section Chronic Pain

Kulvinder Gill, MD                  Concerned Ontario Doctors

David Adam, MD,                    Dermatology Association of Ontario

David Jacobs, MD                    OMA Section Diagnostic Imaging

Doug Mark, MD                        DoctorsOntario

Sharad Rai, MD                       Doctors for Justice

Michael Murray, MD                OMA Section Emergency Medicine

Iain Murray, MD                       OMA Section Gastroenterology & Ontario Assoc of Gastroenterology

Christian Rabbat, MD              OMA Section Nephrology

Keith Meloff, MD                     OMA Section Neurology

Sean Symons, MD                   OMA Section Neuroradiology

Christopher O’Brien                Ontario Association of Nuclear Medicine

Mark Preditis, MD                    Ontario Association of Radiologists

Joan Charboneau, MD             Family Practice

 

“We urge your Ministry to reflect on the message Ontario’s doctors have sent” – Coalition’s new letter to Min. Hoskins

Today the Coalition of Ontario Doctors sent a new letter to Ontario’s Health Minister Eric Hoskins.

The letter explains that with August 14’s vote, Ontario’s doctors clearly told the Ontario Medical Association and the Government of Ontario that we are tired of the brinksmanship and bullyism that has been the hallmark of this government’s approach to physicians and patient care.

Read the full text of the letter is below, or you can download a PDF copy of the letter.


August 29, 2016

Hon. Dr. Eric Hoskins, MPP
Minister of Health and Long-Term Care
Hepburn Block, 10th Floor
80 Grosvenor Street
Toronto, Ontario
M7A 2C4

Dear Minister Hoskins,

Doctors across Ontario read with concern your letter of last Friday to Dr. Virginia Walley, President of the Ontario Medical Association.

We represent thousands of physicians, including family doctors and specialists, across Ontario, from tertiary care academic centres to the smallest rural clinics. Our members, and those who share our views, cast almost 15,000 (14,799) votes against the tentative Physicians Services Agreement which, as you point out, was negotiated ‘under a cloak of confidentiality’ and pressed on the profession in a campaign of misinformation. This was the largest number of votes ever cast in respect of a PSA, a notable event given that the agreement was disclosed without notice and a vote called in the middle of the summer. Shortly after the tentative PSA was disclosed, and in little over 24 hours, over 3,000 physicians from all practice areas across the province signed a petition to compel a general meeting to vote on the tentative PSA, an event that has happened only once before in the history of the OMA.  The doctors who rejected the PSA, and the manner in which it was negotiated were not, as you would like to suggest, high paid specialists. Very far from it, in fact.  They were a deep geographic and professional cross-section of the profession, including thousands of family physicians.  And they rejected it because it was a bad deal for patients and physicians alike.

On August 14, Ontario’s doctors told the Ontario Medical Association and the Government of Ontario that we are tired of the brinksmanship and bullyism that has been the hallmark of this government’s approach to physicians and patient care. We are tired of the relentless bureaucratization of practice, the escalating restriction of clinical autonomy and loss of professional independence embodied in Bill 210.  We are tired of the deliberate misinformation about ‘raises’ which ignore inflation, increasing care needs of an aging population and the demands of immigration. We are tired of being told we must ration the care of our patients to absorb the government’s lack of fiscal discipline.  As professionals who care deeply about the welfare of our patients and the sustainability of our health care system, we expect better from our politicians. While the events of the past six weeks have been difficult, and no one wishes to repeat them, they have also been clarifying.

We urge your Ministry to reflect on the message Ontario’s doctors have sent: we work tirelessly and at great personal sacrifice for the welfare of our patients. We do so under increasingly difficult conditions created by your government including public vilification and unilateral action. We do not wish to debate these issues here.  We would be pleased to have a principled, fact-based, rhetoric-free negotiation towards a fair deal for patients and their doctors cloaked in common sense and respect not confidentiality.

We will work openly and collaboratively as equal partners with the Ontario Medical Association to reach an agreement with the Ministry of Health and Long-Term Care that will fairly serve the patients and physicians of Ontario in pursuit of our common goal of providing the best medical care to the people of Ontario. We hope that you will too and we look forward to hearing from you.

Sincerely,

Dr. Kulvinder Gill                               Dr. Douglas Mark

Dr. David Jacobs                                 Dr. Sharad Rai

On behalf of the Coalition of Ontario Doctors

Letter to Dr. Walley: Coalition “must be directly involved” in meetings with government

The Coalition of Ontario Doctors has issued a response to Dr. Walley’s letter of August 24. The Coalition’s strong letter of response restates our position that, “the Coalition of Ontario Doctors, which represents thousands of family physicians and specialists across the province, must be directly involved in any meeting involving the OMA and the Ontario government.”

Click on the thumbnail or this link to read the full letter.

Released: Report on the OMA General Meeting and Vote on PSA

The Coalition of Ontario Doctors has published an August 25 letter by Jonathan Lisus and Eric Hoaken of our legal firm, Lax O’Sullivan Lisus Gottleib. The letter gives full accounting of the events leading up to the successful vote to defeat the PSA.

You can read the full PDF of the Coalition’s letter here, or by clicking on the image below:

Read it here: Coalition of Ontario Doctors’ letter to the OMA Board

Today the Coalition of Ontario Doctors sent a formal letter to the OMA’s Board of Directors.

The letter outlines a number of concerns (such as the still-undisclosed cost of the OMA’s “Yes” campaign) and explains that the Coalition “expects to fully participate in the review process.” You can click the image below to read the letter, or download your own PDF copy of the letter here

Statement: Time for Renewal at the OMA

Colleague,

The resounding rejection of the Physician Services Agreement—one which was vigorously championed by the leadership of the OMA at considerable cost—requires a change in the composition of the committees responsible for its negotiation. We are respectful of the actions of the OMA leadership to date, however, the results of the vote make it mandatory for new leadership to accomplish the goals of the membership.

To this end, the Coalition of Ontario Doctors today wrote to the Directors of the OMA to respectfully request that they initiate the dissolution of the Negotiations Committee and Negotiations Advisory Committee.

The Coalition expressed its concern that the OMA leadership continues to ignore the will of its members by advocating for a similar agreement, a similar relationship with government, and a similar vision for the future of the profession. The majority of OMA members on August 14, 2016, rejected these three items. The letter highlights concern with the OMA communications strategy which is unfair, unbalanced, and designed to support decisions made in secret by the Executive Committee. In some instances, these decisions appear to be withheld from the Directors of the OMA.

In addition to the negotiating committees, further governance changes within the OMA are needed immediately to restore the trust that has been lost between the membership and the leadership of the OMA. If successful, we will be able to preserve patient access to care and make the government responsible and accountable for the cost of delivering health care in Ontario while unifying and reenergizing the profession.

Sincerely,

The Coalition of Ontario Doctors

Victory for Doctors and Patients

Ontario doctors stood up for themselves and rejected a deeply flawed PSA, one that was vague, cut funding, and threatened our independence.

Ontario doctors stood up for their patients against a government that continues to undermine our already fragile health care system. The Coalition enthusiastically welcomes the result of yesterday’s vote as victory for physicians and patients, alike.

The Coalition—which campaigned hard, but respectfully for this outcome—thanks every doctor for their support. We are proud to have been your voice and advocate. We will continue to do so.

To those who supported the PSA, we extend a hand of collegial friendship. The OMA belongs to all of us, regardless of how we voted. United, we have the power to make a positive change for the future.

Doctors sent a message that should be heeded by the OMA leadership. The status quo is no longer acceptable.  Trust was missing and doctors demand better. The Coalition will determine its next steps over the coming days.

A letter to residents…

Dear fellow residents,

I know that we’ve been bombarded with emails about the Tentative Physician Services Agreement (TPSA). Many of us are likely well informed, as information and discussion has been all over social media. Others wonder why they should care as the TPSA covers a term when many won’t be in practice yet. Many wonder why they should even seek more information when the OMA fully endorses the TPSA.

However, there are three things to know about the deal that the I feel are critical to making an informed vote.

Promise of stability? All I see are Cuts!

The deal legitimizes all of the unilateral cuts the government made to our profession in 2015 and then doubles down on this with a hard cap on the physician services budget (PSB). This hard cap will start with slashing $200 million worth of fee codes from the current budget – to be decided later in an unspecified way which is impossible to predict. The deal does some handwaving with its figures, but overall over the next 4 years, the allowable increase in the PSB is 3.1% per year – less than the increases in 2 of the last 4 years according to OMA Economics. Last year alone, despite 7% across-the-board cuts, physician services grew by 3.3%. Any cost overruns will trigger additional cuts. We will be responsible for funding the increased health care use that coming our way with an aging population! This places us in a direct conflict of interest: caring for our patients or keeping to the government’s budget. This in my opinion is a serious issue and sets a dangerous precedent.

8 years of straight cuts will leave many of our colleagues unable to purchase new equipment and forced to cut costs by laying off staff – including nurses and support staff who themselves work hard on our patient’s behalf.

This agreement also sets the baseline for future negotiations – for contracts that we will depend on when we become staff physicians!

Worrying lack of detail

This deal is only 6 pages long. It sacrifices detail and relies upon future good-faith negotiations between the OMA and the MOH. The same MOH that is being sued by the OMA for violating the Charter of Rights and Freedoms. The same OMA that was successfully litigated by the Ontario Association of Radiologists over the faulty proxy vote form that, in the judge’s opinion, “is all of unhelpful, unclear, unbalanced, and unfair. It is a catalyst for a governance meltdown at the upcoming general meeting“. Current actions by these two parties appear self-serving. This gives me pause about their ability to co-manage the budget to find solutions to improve the healthcare system.

The final and arguably the most critical point for us as residents lies in the answer to this question:

How is this going to affect my job prospects?

I am wary about the long-term impacts of this contract will have. At a health policy level, public statements by individuals with insider knowledge have revealed OMA discussions on reducing new physician influx from 950 to 750 per year. These statements have been substantiated by firsthand accounts of OMA roadshow meetings relating to the “unsustainable growth” of the net 950 new physicians per year. A letter obtained by PARO from the MOH states that no discrimination will occur towards new physicians. However, it is deeply concerning that PARO had to seek these assurances in the first place. Additionally, we will be only one member at a table with multiple other stakeholders. If the political climate changes, it is unclear how much protection that letter will offer residents.

I am a surgical resident. I have seen firsthand the decrease in surgical volumes due to cuts to OR times. Between the eroding OR times at an institutional level, and the anticipated and promised cuts in the TPSA, there is no reason for current surgeon practice groups to hire new graduates. This will compromise our job prospects, and is a secondary fallout from the underfunding created by the TPSA.

For my Family Medicine resident colleagues, the TPSA restores managed entry positions. However, this promise rings hollow. Patient rostering fees and income stabilization are not reinstated, meaning that new FHO practices will likely lose money in their first 1-2 years. This will have dramatic economic implications for new family doctors. Worse, it is a huge barrier for those who do not have additional financial support from a spouse or family. Finally, the New Graduate Entry Program remains; this fatally flawed program should be fought tooth and nail by the OMA.

Regardless of how you vote, learn both sides of the debate. As for me, I will vote No.

Sincerely,

Victor McPherson, MD, MSc
PGY5 Urology, Western University

1 2 3 4

Coalition of Ontario Doctors
145 King St. W, Suite 2750
Toronto, Ontario M5H 1J8

www.coalitionofontariodoctors.ca