Doctors must DeciDe if they are health care leaDers or clock-punchers

The rifT in Ontario’s medical community boils down to a simple question: are doctors still stewards of the health care system, or are they just a higher-paid class of rank-and-file employee? The OMA traditionally projects the image of doctors as leaders. Because they know what’s best for patients, they also have special insight on how to organize and manage everything else—clinics and hospitals and support staff and supplies and equipment.

This is the view of Virginia Walley, who insists her organization isn’t a union. Walley is soft-spoken and even-keeled, and articulates a clear view of what she thinks her profession must be. “The trust we are given by patients and the public comes with broader responsibility for the system,” she says.

Her traditional view of the profession is no longer the prevailing one. Last year, when Queen’s Park and the OMA were trying to get back to the bargaining table, the OMA asked the government to grant binding arbitration. They argued that, because doctors cannot strike, they wanted to defer to a neutral arbitrator, and both sides would have to abide by the arbitrator’s ruling. The government’s answer came swiftly and decisively: no. In response, the OMA launched a court challenge and made their position clear. Until they have binding arbitration, they won’t discuss anything else.

From the government’s perspective, binding arbitration would be a financial disaster. It is the same mechanism that has, over the last decade, granted monstrous pay increases to police and firefighters while also making it impossible to reform those services. And unlike police officers or firefighters or nurses, doctors set their own work hours. If an arbitrator awarded physicians a large pay increase, and doctors responded by increasing the number of patients they saw, they’d bankrupt the province. It nearly happened in British Columbia: back in 2002, an arbitrator there granted doctors a 20 per cent fee increase. The government promptly passed legislation to invalidate the ruling.

The demand for binding arbitration signals a deep transformation within the profession. Doctors think they’re being shafted by the man and want court protection from abuse of power. When they ask for binding arbitration, and when they refuse to discuss anything else until they get it, they are abdicating their role as stewards of the system. They no longer see themselves as management but as labour.

Walley has insisted, over and over, that most doctors want to be system leaders. The results of August’s vote do not support her claim. Of the province’s 28,000 practising physicians, there are plenty—probably a majority—whose sole ambition is to be good front-line caregivers. That is as noble an ambition as any other. Even patients don’t need their doctors to be leaders. They just need them to be good doctors.

The trouble is that, right now, governments and taxpayers need their doctors to be more. The OMA may not survive the infighting between the system-leader collaborationists and the arbitration-orbust hardliners. Even Walley, who so willingly negotiated with the province, now says that arbitration should come before any other talks.

The OMA has a split personality and might actually be better off as two separate organizations: a union to negotiate the contracts and play politics, and a professional association of physician leaders who are interested in reforming the health care system. In late August, Hoskins even conceded that he’d be open to recognizing the OMA as a union— although that would mean they’d have to disclose their salaries and relinquish the right to incorporate.

While we all wait for the OMA to sort itself out, the budget continues to buckle. Doctors can blame the ministry all they want for underfunding it, but no government can fund an antiquated and ballooning system forever. Even Ottawa is getting involved: the feds have suggested that health care needs an overhaul, and they will not give the provinces more money if it will only be used to pay for doctors’ compensation. Health care needs fixing, and the question is who will lead the fix. If the OMA stalls the reform process for years, they may get much more than they bargained for. ∫

A study of health care systems rated Canada among the worst in the developed world, especially for timeliness, safety and efficiency