By Patrick Nelson, Principal at Santis Health
If the impasse between the governing Liberals and Ontario doctors was a bag of milk, it would have expired and been yanked from the shelf months ago. In fact, that relationship began to sour even before the real fight started last summer when the agreement between the Ontario Medical Association’s (OMA) leadership and the government was rejected by the majority of doctors in the province.
No one wins when governments have extended fights with doctors. Especially patients.
Putting aside a few public outbursts by the Minister of Health, Eric Hoskins and the OMA’s leadership, the attention over the last few months has largely been focused on internal political strife within the OMA. The politicking at the OMA makes Queen’s Park look tame. When the Executive of the OMA resigned earlier this week, a growing and vocal group of doctors finally got some blood. Whether they got all of the blood they wanted remains to be seen.
Still, the OMA Executive should be acknowledged for taking this step, albeit late. They take their direction from the Board of Directors, especially on important matters like contract negotiations. It’s hard to imagine any scenario where they were acting without the Board’s authorization. The message to the organization’s most ardent critics: the OMA accepts responsibility for its action and will change.
The OMA is also currently in the midst of its annual elections for new Board members and new members of its governing council, a body of hundreds of doctors from across the province that ratifies contracts and elects Presidents. The physician discontent with the OMA will undoubtedly mean new faces at every level of the organization. The membership’s edict to have binding arbitration in place before negotiations can resume is unlikely to change with this new leadership.
Before the government and doctors can agree on a new contract, they have to first agree to meet.
Money is the root of the issue for both sides. Government wants a hard cap on the physician services budget. Sounds simple enough, but when you consider the growing needs of an aging population, and the thousands of newcomers that arrive to the province each year, it’s a tall order. The only way to cap the physician services budget is to cut the per service fees doctors receive. Despite what you might read, most doctors can accept a freeze on their compensation, but they can’t accept that they should be made to pay for the growing costs of delivering health services in reduced fees.
The infighting at the OMA has been a gift to the governing Liberals. Each day that goes by without a new contract presumably saves government money. Just as importantly, it has allowed them to introduce new health reforms that impact doctors, and focus on putting out fires in other files. Unusually, they appear to be trying to present Premier Wynne as the defender of your pocketbook, rather than the champion for social issues most would argue she was elected to protect. The Premier’s speech from the throne last spring mentioned health care five times, and referenced electricity costs twenty-one times.
Both government and the OMA have been failing miserably at their respective strategies. The Premier’s polling remains low and the OMA has yet to convince government that it has the backing of patients or even its own members. When strategies don’t work, smart organizations change course.
The OMA will have to present a new face, with a new approach, stop pointing at each other and demonstrate to government that Ontario’s doctors are united behind a common goal that patients can support. If they remain divided they will fail. They will have to decide whether they want a contract with this government or work to replace it in the next election. An uncomfortable position for most doctors.
If polling numbers don’t improve, the upcoming election may also drive change in the government’s strategy. A pivot back to presenting the Premier as the leader best suited to protecting Ontario’s valued social programs rather than our pocketbooks might be prudent. The upcoming budget may reveal hints of changes to come. Will health garner more attention and investments or not?
A change in the leadership of the OMA and the government’s attitude towards doctors may provide for a small window of opportunity to salvage and rebuild the relationship. Both sides will be weighing the risks that will come if this impasse continues through an election. Politicians never forget their friends and foes during elections. But the prospect of fighting doctors who see hundreds of thousands of patients each day, is a risky election strategy in itself.
For the sake of patients, let’s hope both sides see the benefit of putting the expired relationship aside and take advantage of the opportunity to revive the important partnership that must exist between our doctors and our government.