Engage with LHINs? It’s not black and white.

No doctor is happy with Bill 210, let’s get that out of the way first. It ignored all of the feedback that was given by official physician groups, and proposes many changes that deeply concern all of us.

But what now?

First, I would encourage every physician to actually read the initial analysis provided by the OMA. It outlines very clearly potential problem areas in Bill 210, and articulates that large portions of the bill undoubtedly violate the Representation Rights Agreement. I understand that there has been some criticism that OMA leadership has not provided their editorial opinion on the analysis, but I’m a bit confused as to how that would add to our current understanding of the situation. I trust that the OMA executive agrees with the analysis until I hear otherwise.

Is the initial analysis all we are going to get from the OMA? Of course not. The bill needs ongoing analysis by OMA staff, with consideration from a legal, PR, and negotiations perspective. But this takes time. There has been some consternation that the OMA is not moving quickly on this issue, but I think this is a situation where expectations may not match a reasonable reality. The legislature is not sitting. The legislation will not move forward for many months. I would much rather that we have a cohesive strategy by the end of the summer rather than moving haphazardly too early. It is the not the role of OMA staff or OMA leadership to give off-the-cuff editorial opinions on an issue of this magnitude. I have personally pressed OMA staff that they provide membership with timely analysis on Bill 210 as soon as it becomes available. They’re well aware how anxious physicians are about the ramifications of the legislation, and the negative effect that the uncertainty has on our collective morale.

Now what about our involvement with the LHINs? The OMA is encouraging physicians to continue to attend LHIN consultation sessions. Some physicians disagree with this position, and feel the best course of action is to completely disengage from any LHIN discussions.

I understand where the disillusionment from physicians is coming from with the LHINs. The consultation sessions were a political sham, of course. The ministry did not take physician input into consideration in crafting the legislation, and physicians feel disrespected.

Some have asserted that physician involvement in the consultation process gave the ministry the ability to claim that they consulted physicians in crafting the legislation. But we have to realize that the ministry will engage in public deception no matter what our involvement. If even one physician participates (which we are guaranteed to have, with the Primary Care Leads), they will claim that physicians were involved. We can publicly disagree, but that public argument will be fruitless. We can collectively shun the LHINs, led by the OMA, but that makes it too easy for the ministry to accuse physicians of being obstructionist against legislation intended to “put patients first”. Again, good luck winning that battle in the media. It’s a lose-lose with this government. The minister of health’s press secretary flat-out lied on social media that the OMA didn’t respond to Patients First, despite an actual document proving him wrong. We are not dealing with reasonable people here.

We can’t make decisions based on how we plan on spinning this is the media over the next few years, whether we helped, or didn’t help, or how much we helped. We need to make decisions based on what we think is in our best professional interests, and what will improve patient care.

Every special interest group of health professionals in the province has outlined their positions on Patients First. Everyone is lobbying the government. And many of their interests directly conflict with our interests as physicians, and conflicts how we view system reform transpiring. Those groups will be thrilled to fill the vacuums at the LHIN tables, guiding the development of their implementation plans.

It’s important to distinguish between planning and implementation at the LHIN level. Most of the LHINs are still largely at the planning level. Their proposed plans were largely a disorganized mess, and the ministry has admitted that they did not give the LHIN adequate direction in that process. So most of the LHINs will be going back to the drawing board. Many of them proposed ideas that are unrealistic, and some illegal. The ministry has “assured” physicians that the LHINs will have to go through a “readiness evaluation” before they are given the green light.

What does that mean for us? It means we need to have our eyes and ears on the ground at the LHIN level. We need to know where each LHIN is in its individual planning, and we need to be vocal with opposition to LHIN proposals that are unreasonable, and remind them when they are overstepping their bounds. We need physicians at LHIN meetings telling the LHINs, “You can’t do that. That needs to be centrally bargained. We will complain publicly when this blows up. Be careful what you implement.” Look at the Toronto Central LHIN, and the “Primary Care Model Draft” that has been circulated on social media. We only have access to that document because physicians continue to be involved in their process.

Here’s what I would tell physicians. If you feel that your time is limited, and don’t want to be involved with your LHIN, I respect and understand that. I don’t know the circumstances of all of your interactions with LHINs in the past, and I understand if you don’t want to spend your valuable time with an organization for whose mere existence you fundamentally disagree with.

But for the physicians who are on the fence, I would warn you against taking some form of moral high ground by disengaging. Ignoring the LHINs between now and the fall will have no bearing on our success in getting back to the negotiating table. This legislation will likely be eventually moving forward in some form or another. It is the political reality of our current dysfunctional government. We can work to provide our input and attempt to intelligently guide the process, which yes, may end up being in vain. There are no guarantees here. But I for one am more comfortable going down swinging right now, pointing out problems and providing possible solutions, rather than be left trying to fix a potentially unfixable mess with our next government.

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