It’s been a rough six months or so for the Ontario Medical Association, and an effort this week to clear the decks and get new leadership in place leaves plenty of questions — and may not get Ontario’s doctors any closer to victory in a long standoff with the province.
The government has been trying to negotiate with the doctors’ association for years now to lower the rate OHIP pays for certain services, tests, and procedures — arguing that new technologies have dramatically lowered costs in many cases, and that fee schedules should be adjusted accordingly. Having had the last round of billing changes imposed unilaterally by Queen's Park, in August doctors rejected a deal their leadership had endorsed. And a few days ago, the OMA’s executive council resigned after a confidence vote they technically won but that played poorly in terms of optics. (Health care is complicated.)
This isn’t the end of the trouble but a new beginning, because now the OMA needs to figure out who will replace those leaders, and what will be expected of them. None of this is obvious, and figuring it out won’t be easy.
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First off: the OMA's board of directors is composed of 25 physicians who are elected (indirectly, but I'll spare you some of the details) by the OMA membership. The executive is chosen from members of the board — and the just-resigned executive members did not resign their positions on the board, so they are still part of the OMA's leadership.
Next wrinkle: timing. There is a crop of newly elected OMA board members, including some of the more prominent critics of the departing leadership, but they only take their seats in May. The executive could be reconstituted out of the current board membership, which would probably upset the dissidents who demanded the confidence vote in the first place. Or the OMA could technically keep running without an executive in place until the new board members take their seats. (It would be a stretch — February to May is a long time — but it’s not impossible.)
If the executive is eventually reconstituted from that new contingent of board members, that’s where things get interesting. The Liberals haven’t tried very hard to hide their disdain for the OMA's concerns, saying that this dispute over billing is being hijacked by a handful of well-compensated specialists at the expense of general practitioners, ER doctors, and patient health. Whether the government has to bargain with moderates or more critical doctors may matter to the OMA membership, but it’s not clear health minister Eric Hoskins (or the provincial treasury) will cough up more money, no matter who is sitting across from him.
Hoskins and the government have gambled so far that as long as they can keep the spotlight on millionaire MDs, they won’t really lose in the public eye over the issue. (Compare physicians, whom the government is willing to pick a fight with, to teachers, who are getting deals that are generous enough to buy labour peace that will last through the next election.) Even some of the members of the departed executive have acknowledged the tough spot they’re in. One, James Stewart, told the Medical Post: “When you’re dealing with a majority government that doesn’t care about physicians’ opinions you can jump up and scream all you want; it’s not going to matter.”
Physicians have relatively few levers to pull. Doctors can’t strike because they’re independent contractors and not really employees (the OMA can bargain on behalf of doctors but isn’t a union). They can, however, reduce non-emergency medical services, subject to the rules of the College of Physicians and Surgeons of Ontario. Their problem, though, is they can’t be certain voters will side with them in blaming the government for any work slowdown.
Doctors do have at least one other option: Wait things out until next year, then try to help get the Liberals out of office in the 2018 provincial election and take their chances with a new government.
- Hoskins: It’s up to the OMA to bring doctors back to the bargaining table
- Steve Paikin: Is the doctors’ battle becoming politically partisan?
- The Agenda: Dissecting the doctor dispute
The OMA has said it wants the kind of binding arbitration that police and other emergency services get, since (like emergency workers) they aren’t allowed to strike. On its face it’s a fair request, but scratch the surface even a little and the problems become clear. Binding arbitration almost always means workers see compensation increases — that is, they cost governments more. (Arbitrators hand out decisions for police and fire service salaries that municipalities find onerous, for instance, with no consideration of the local government’s ability to pay.)
An arbitration decision that increased the $11.5-billion OHIP billing budget by even 2 per cent more than the government planned for would require them to find an additional $230 million or so. That’s comparable to the entire annual budget of some ministries. It’s no surprise that other provinces that do allow binding arbitration with doctors nevertheless almost always give themselves a “get out of jail free” card, with the option of suspending any decision they think is too generous.
Progressive Conservative leader Patrick Brown has said he’d consider allowing binding arbitration. That’s hardly an ironclad commitment, but it is more than the OMA’s been offered by anyone currently in government. But even if Brown follows through, it’s nearly certain a PC government would keep the same card other provincial governments have. It would be crazy not to, given the budget implications.
The angry members of the OMA might get their wish and put a new, more confrontational leadership in place. They might, in 2018, see the last of a Liberal government they feel has treated them shabbily and put patient care at risk with spending cuts. But even if those things happen, it’s hard to see how they'll wind up with more money in their pocket.