Re-establishing trust must precede primary care reform in Ontario

Last week was yet another banner week in the relationship between the Ontario government and Ontario’s doctors. Health Minister Eric Hoskins announced to every media outlet that “Unpredictable and frankly out of control billing by some doctors is a problem”. Predictably, physicians responded angrily, frustrated by the latest dishonest PR attack by the government on the profession.

Most concerning in all of this is the progressing erosion of trust that physicians have in the provincial government. Every sound bite of intentional misinformation over the past year has chipped away another piece of that relationship. Rather than view the government as a partner in building up our health system in an evidence-based manner, most Ontario physicians now view every new policy or statement from the Ministry of Health with overwhelming cynicism.

Why is this important? Why should the government care what physicians think or how they feel?

First, this should be a concern for humane reasons. A workforce that feels lied to, underappreciated, and ignored, will be a workforce that is very prone to burnout. Read this recent article from ethicist Art Caplan about physician burnout being a public health crisis, and see if you can see any parallels to the current situation with Ontario physicians. It may surprise the government, but to most physicians, their frustration with the government ceased to be solely about compensation a long time ago.

The second reason that the government needs to re-establish trust with physicians is a practical one.

Progressive Conservative health critic Jeff Yurek stated last week “The government is set to redesign the health care system, the biggest redesign in over 50 years, and they don’t have the doctors on side.”

Truer words have never been spoken. The magnitude of what is being planned is enormous. Completely transforming the way primary care is delivered in the province. Downloading responsibility to LHINs, and asking them to work with local health care providers to optimize access, establish local accountability measures, and provide local solutions.

With one major problem. It is difficult to move forward with any meaningful changes without overwhelming physician buy-in. Physicians, the one group in health care that has a birds-eye view of the entire system, with a strong connection to both stewardship and patient care, and with the potential to successfully steer these projects in the right direction, feel alienated by the governing powers.

To the LHINs’ credit (and mine in particular, the South West LHIN), they have made attempts to engage with physicians, but without a strong message and feeling of trust from the upper echelons of the Ministry of Health, rank-and-file physicians will not be willing adopters of any new system.

As an example, I wrote an article last week that called for a program that mandates that any billing specialist must register with the LHIN or LHINs in which they see their patients. Simple enough, I thought, and some LHINs already had similar plans in the works. But the most common feedback I received from physicians was “Great idea, but we don’t trust the LHINs to do this.”

Let that sink in. Physicians trust the Ministry and the LHINs so little that they don’t even feel comfortable with them maintaining a simple list, one that would likely help them in practice. And somehow this relationship will magically improve enough for physicians to become eager partners in this transformation?

The Ministry needs to begin the healing process, if for no other reason than to make it easier for the LHINs to do their job of engaging physicians. This likely involves coming to a amicable solution on compensation (I still have faith this is possible), and more importantly, stopping the anti-physician rhetoric coming out of Queen’s Park. Physicians feel defeated as it is, and don’t need a monthly reminder of the disdain that the government seems to have for them.

I truly hope that the government takes some of this to heart, as I don’t see a smooth path forward for primary care reform given the current distrustful climate. Something needs to change in this relationship, and it needs to change soon.



3 thoughts on “Re-establishing trust must precede primary care reform in Ontario

  1. Paul Lorne Ottawa

    Great post, Mario. Good description of the current situation and it’s implications for any attempts at health system reform. It will take a monumental shift in attitude and approach from the government to ensure buy-in from doctors due to the ill-advised strategy used by Hoskins/Wynne/Matthews, and sadly, I don’t think that the Liberals will allow that to happen. It will take more than solving the Physican Services Agreement issue to regain the trust of Ontario’s doctors.


  2. Connie Nasello

    Great post Mario. The provincial government has returned to tactics that did not work in the 80s and 90s. It did not regain the trust of physicians until well into the 2000s. The alphabet soup of family physician groups was viewed suspiciously by MDs, who wondered what the governments motivation was. Many of us on the outside viewed it as the carrot, and waited for the stick. The level of mistrust from those that practiced through the 80s- 90s never really went away. The MOH has never regained that trust and has overseen the awakening of a new generation of physicians, one that he thought were complacent. He has underestimated the social network generation, and is faced with young, passionate and literate physicians who are engaging the voters. Keep up the good work!


  3. William russell

    The redesign of primary care is being proposed at a time, when not only is the trust at an all time low, but the need to redesign is not apparent to most of us in the trenches.The last redesign which introduced the various models,was done when there was extra funding available,and did improve the number of patients having access.In the absence of similar extra funding,and in a poisoned environment such as we now have, the chances of success this time look very small unless the ministry drops its doctor hostile policy,and returns to the table with an attitude of positive engagement.



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