Some doctors in OMA dispute fighting for self-interest only
The Ontario Medical Association (OMA) and the so-called Coalition of Ontario Doctors (a recently formed group that opposes the OMA’s negotiating positions) are engaged in an epic battle with each other over the tentative Physicians Services Agreement (PSA) with the Ontario Ministry of Health and Long Term Care. The fight is an expression of the classic collision in medicine between selfinterest and self-effacement.
The coalition falls almost entirely on the side of self-interest. It is trying to protect the incomes of a minority of physicians whose fees may be at risk under the PSA and has repudiated the modernization of the fee schedule to be more in line with the nature and quality of services provided. The OMA falls in between, affirming the right of physicians to be involved in co-managing the health care system, while accepting the role of government in protecting the fiscal well-being of the province and the health status of the citizenry.
The coalition has so far successfully used OMA bylaws to scuttle an initial vote on the PSA, forcing an in-person general meeting of OMA members with the option of proxy voting. Last week, the coalition persuaded an Ontario Superior Court of Justice judge to annul the OMA proxy process, thus nullifying all proxy votes cast so far.
The court went further, imposing addi- tional questions for the vote. In a direct challenge to the elected OMA leadership, members will now be asked whether the OMA should have the authority to negotiate without the inclusion of binding arbitration (not part of the PSA) and whether future negotiations should require OMA section chairs to be fully apprised of the negotiating proceedings.
The new questions, if voted on favourably, will vitiate the standard bargaining procedures historically available to any parties negotiating with government, including unions.
We have seen this picture show before, way back in the early 1980s leading up to the 1986 so-called doctors strike held in protest over the banning of extra billing (doctors charging patients cash in excess of the OHIP fees) in Ontario. Just as the 1986 doctors did, the coalition hides its self-interest under the moral cover of defending the best interests of patients. The coalition uses the same hyperbolic language (“complete surrender”) and employs similar misrepresentations.
For example, the coalition states the agreement’s call for mandatory increased availability of primary care physicians is unaccompanied by extra funding — not true. The majority of such doctors have been contractually obliged for years under generous financial arrangements to increase availability, but the government has never enforced their contracts.
Now the OMA has correctly agreed that doctors should live up to their legal commitments.
The coalition and its solipsistic spokespeople are just doppelgangers of the doctors who, in 1986, held that disastrous strike, a strike that set the public’s trust of doctors back decades. Then, those doctors who opposed the government stuck crazy glue in the door handles of doctors who kept their offices open during the strike. The coalition is far more sophisticated, using the OMA bylaws and courts as its crazy glue.
The coalition simply wants to gaffle more from the health care budget for a small minority of physicians whose fees may be lowered, and if the coalition is successful in leading a defeat of the agreement, the profession will suffer the same fate as the 1986 doctors — an alienated public and a government that will respond mercilessly. Extra billing was banned in 1986 and the current Liberal government will act unilaterally.
The Physicians Services Agreement, while imperfect, is the most doctors can reasonably expect. Hopefully, for the sake of the majority of doctors, the agreement will be approved by OMA members (the vote ends Sunday) and the coalition will be sent packing. Anything less can only hurt the profession and the public.