The last nine months have been a stressful time for Ontario physicians, and has reached a boil over the past week with the announcement of further cuts by the Liberal government. Physicians have been active both in print and on social media in record numbers, and we are finally seeing the physician engagement on this issue that we have desperately needed for months.
As part of the vented frustration, the OMA has come under fire by many for a perceived lack of leadership in this crisis. The negotiating team from 2012 certainly deserves fair criticism for agreeing to a Representation Rights Agreement that allowed negotiations in 2015 to end with unilateral action. But I think we need to realize that in the short-term, the organizational muscle behind the OMA may still be our best bet to try and salvage something from this debacle. The OMA is a representation of the will of physicians. If enough physicians stand up and demand certain action from the OMA, they will have to act. With the number of splinter physician groups that are forming out of frustration with the system, the OMA is in a position where they must listen to membership, or risk becoming irrelevant.
One of the positives of this past week’s social media explosion has been the number of great ideas that have been put forward by physicians. Part of the downside of social media is that great ideas often drown under the wave of the next post by the next person, so here’s my summary of what the OMA needs to do immediately.
1) At the OMA Spring Council, Council agreed unanimously that “The Ontario Medical Association demand the Representation Rights Agreement be amended to add a binding dispute resolution mechanism”. The general understanding was that the window was three months for a response, and the details provided to membership by the OMA on this has been very disappointing. The OMA must provide both membership and the government with a clear timeline for when responses and resolution on this issue are expected, and need to follow through with legal action should expected deadlines from the government not be met. At this point, the government cannot be trusted as a reasonable partner, and they will stretch this out as long as possible. The OMA cannot allow this, and must use the immediate threat of legal action to create some urgency. Membership must be provided with very detailed and timely updates as to this process, perhaps even weekly.
2) Job action has been discussed by many physicians. Some ideas have been reasonable, others not so. The OMA must urgently provide its members with a “menu of options”, a list of detailed forms of job action that the OMA endorses. There has been great debate as to what the focus of these actions should be. Should they drive up non-physician expenditures to inconvenience the ministry? Should they be intended to inconvenience patients? Should they reduce non-urgent access for patients? (For the record, I think all three of those will hurt us in the long-run.). I know the OMA has been criticized for its reluctance to support any sort of job action, but this is an opportunity for it to provide membership with a list of approved actions to provide us with a united front. Rogue doctors reducing care will only disrupt their own physician-patient relationships, and will have very little impact on government policy.
3) The OMA must urgently create a publicly available database of physicians who have stopped working in Ontario since January 2015. The public will take notice of this growing list, and government will gradually feel the heat. I am tired of hearing the government boast about adding 700 doctors this year. Counter that with this list of the departed. Publicize the hell out of this list.
4) Along the same lines, many physicians have expressed interest in the leaving the province. The OMA should provide a form letter to its members, where physicians can sign a “Letter of Intent”, with the province or country they have inquired about moving to. This will not have any binding terms, but will provide the OMA with quantifiable data of the number of physicians who are considering moving. Again, putting numbers to this will make this situation very real for the ministry. Publicize the hell out of these numbers.
5) The OMA must urgently meet with family physicians in the Niagara, Guelph, and North York regions. They must inform those physicians that with the primary care reform being implemented by the ministry, obstructing that implementation temporarily is one of our few bargaining chips to push the government to binding arbitration. For those physicians who have yet to sign any contracts, the OMA must ask those physicians to refrain from doing so as a gesture of support for the rest of Ontario physicians.
6) Do not spend another dime on the #Carenotcuts campaign. It was a sensible campaign, but has failed to move the needle. Save that money for publicizing the threat of physicians leaving the province.
So there it is, OMA. There’s your blueprint. Please don’t wait for “physician consultation” and “road shows” to gauge physician sentiment. The last week has made things very clear. Physicians want action. Now.