In one of the most unexpected e-mails I've ever opened, the President of the OMA, after reading some of my online comments about the tentative Physician Services Agreement (TPSA), asked if I wanted to become a proper advocate for the deal. Me. The guy who's compared the Ontario government to Wile E. Coyote, the Blue Meanies from Yellow Submarine, and WWF wrestlers. I turned the offer down, because I'm the last person in the world that should be advocating for anything.
But I would urge that Ontario's doctors to vote YES to the TPSA.
There are a thousand reasons to vote NO to the deal. The deal still entails cuts to physician services budget. The Ministry is increasing the pie, but factoring growth in the number of doctors, each slice of that pie is decreasing.
The language in the agreement can be read as overly vague. I'm used to these sort of vaguely-worded frameworks from my days in public health, but I can see why many doctors would find it discomforting, especially in light of the unilateral cuts of the past few years.
The process by which the agreement was negotiated lacked transparency. After reading many thoughts on this issue, I honestly can't make heads or tails of it anymore, but I concede it as a justification for a NO vote.
There's a sense that the membership was betrayed and disrespected by returning to the bargaining table without binding arbitration in place. The OMA had publicly stated this was a precondition for any negotiations.
But as I noted in my last post, there are positive aspects to the deal. Moreover, I don't see that a sensible alternative has been proposed. Much of the argument against the deal rests on an expectation of the public getting behind doctors in principled opposition to government heavy-handedness; or doctors staging a "palace coup" to oust and replace the current leadership of the OMA; or a breakup of the OMA with each section fending for itself; or the government bowing to a more aggressive stance by the doctors; or a strike that will "bring the Liberals to their knees"; or an arbitrator awarding the doctors the money cut and clawed back; or the Conservatives winning the next provincial election and reversing the cuts of recent years. The list of hypotheticals goes on and on. These strategies are all based speculation, not evidence of likely success.
A strike in particular is a spectacularly bad idea. True, past performance is no guarantee of the future, but repeat failure is a pretty solid indication of a bad strategic direction. Like invading Russia in winter bad.
Binding arbitration? The OMA is still going for it, but the deal absolves the government of the cuts. That stinks, no question about it. But the OMA lawyers have cited precedent that the money from the recent cuts isn't coming back anyway, arbitration or not. So arbitration will be there for the next round of negotiations, which bolsters the odds for a better deal.
Taking a stand on principle? I get it, but what's to stop individual doctors or even the OMA from decrying the cuts? As I wrote elsewhere online, my answer to anybody accusing me of being a sellout for voting YES is, "the Wynne government planned to cut more than a billion dollars from health care if this deal wasn't ratified. They intended to sic an army of clueless bureaucrats on family doctors to create more headaches and come between you and your doctor. This agreement will keep the pencil pushers out of doctors' offices, and make sure doctors have a say before any more money is cut from your medical care." Or something to that effect.
As for the OMA? The deal is four years of no surprises and no unilateral action. Get involved. Reform whatever processes and by-laws needed in the OMA so the membership never again need feel like it was sold out. If the leadership of the OMA won’t make changes, change the leadership of the OMA. Overhaul the OMA’s internal structure so there’s no more threats from individual sections to take their ball and go home if they don’t get what they want.
As I noted above, there's no lack of criticism out there for the deal, some of it sound, some of it vitriolic, some of it insultingly or laughably over-the-top. While the allusion to Chamberlain's appeasement of Hitler is out there, I cite this piece that includes a quote from Elie Wiesel as easily the most obnoxious I've seen. Somehow I don't imagine that when a concentration camp survivor talks about "oppressors" and "the tormented", he's thinking of doctors getting a pay cut in a negotiated settlement. But no amount of criticism makes up for the lack of a good alternative. It isn't a vote about whether or not doctors are getting shafted, it's a vote on the size of the shaft.
And that's all I can say beyond what I've posted elsewhere. Absent a sound, realistic plan going forward, Ontario's doctors are better off ratifying the tentative agreement than rejecting it. More importantly, with less anger and anxiety among their doctors, and fewer bureaucrats to make life difficult, the patients will be better off too.
Time to get away from all this stuff about doctors. Next time: TEQUILA!
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Wednesday, July 20, 2016
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