The Ontario Medical Association and Ministry of Health and Long-Term Care have reached a tentative Physician Services Agreement. So what does this mean for doctors and patients, and the Ontario health care system?
In contemplating this question, I thought I might impart a recent personal experience that provides some context to consider not only the various elements of the proposed agreement with government, but equally important, the spirit of this undertaking.
A little more than 24 hours after the tentative agreement was reached, I awoke in the middle of the night with extreme stomach pain — my bowel was twisted.
I was rushed by ambulance to the nearest hospital, seen in the emergency room, diagnosed, and treated. The first procedure was unsuccessful. Six hours later, a second procedure resolved the problem.
I remained in hospital overnight. The next morning, I returned home, walking upright on my own with no assistance. I have since had a follow up with a specialist, and am awaiting a laparoscopic sigmoid colon resection, that will repair the matter once and for all.
Why am I sharing this episode? Well mainly because my 36-hour experience, from the arrival of the ambulance attendants to my discharge from hospital, can only be described as first rate (albeit with some discomfort).
I encountered numerous highly skilled, dedicated health professionals, working together in teams, all of whom were clearly committed to providing the best quality care and treatment. I was well informed at every step. I had the benefit of state of the art tools and equipment.
Frankly, the episode reinforced to me how very fortunate we are to live in a province and a country that hold health care in such high regard.
Quality, collaboration, efficiency, mindfulness — these are vital facets of our new tentative agreement.
I believe the proposal is good for patients, respects doctors, and recognizes the fiscal challenges the province finds itself in.
Of course our agreement won’t address all the challenges in the health care system and it won’t erase the deficit. But it does provide important stability for providers and patients, and the government as well.
And we have established an important framework for consultation, resource management, and improved modernization and efficiency in health care.
The tentative agreement largely protects improvements to the health-care system accomplished during the past decade. And it reaffirms the medical profession’s commitment to stand up for our patients, while being mindful of the province’s economic circumstances.
Yes, there are some fee reductions and all Ontario doctors will share in a payment reduction beginning in April 2013. But we have been successful in finding system savings, without negatively impacting patient care. And government has reversed many of the most punitive measures that were imposed on the medical profession in the spring. In this aspect, the tentative agreement does go a good way toward restoring trust in our relationship.
Just as importantly, this deal offers Ontario’s doctors a more clear idea of how future fee negotiations will proceed. For example, the Ministry will not be able to unilaterally make changes without first going through a process of facilitation and conciliation with recommendations that are made public.
This is important because Ontario’s doctors have been seeking a meaningful dispute resolution mechanism for a long time. The measure is similar to what British Columbia already has, and is something that Alberta – whose physicians recently had a four-year agreement imposed upon them – would like to have.
In addition, the Health Minister will continue to consult with the Ontario Medical Association to seek our advice about significant health care policy and system issues that affect physicians and patients.
Everyone agrees about the need to improve access and quality of care and to reduce health care costs. We will never achieve those goals unless physicians and the province work together to eliminate waste and identify savings — and that is exactly what happened when we returned to the negotiating table in September. And both sides will continue to work together to find more efficiencies and more ways to improve patient care.
A number of initiatives will improve access and help to modernize the delivery of health care. E-consultations will enable patients to communicate with their doctor more easily and allow for more virtual connections between family doctors and specialists, as will an expansion of telemedicine services. However, there is still a pressing need for more physicians in Ontario, particularly in rural areas.
Physician leadership is essential to improved care. When doctors are able to use their experience and expertise to make evidence-based changes to health delivery models, everybody gains.
This agreement was born from the conflict in the spring when the government acted as if by forcing their fiscal restraints on doctors they could create a better health care system. Without physician engagement governments cannot implement change in the health care system. Physician leadership and collaboration improve health care. This Agreement will enable physicians to be meaningful partners in improving health care while we work together to effectively manage resources.
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You say:
Everyone agrees about the need to improve access and quality of care and to reduce health care costs. We will never achieve those goals unless physicians and the province work together to eliminate waste and identify savings”
Maybe we could start by returning to the rotating general internship model with primary care delivery being the bailiwick of anyone who holds a medical license and MD degree. Family medicine residencies in my opinion are more harmful than helpful to the health of the public. They are but a failed attempt at attaching prestige to a field that for years was felt to be not academically rigorous. In response, medical students take the one chance they have to apply to residency and pick a higher-paid, more prestigious specialty over family medicine. The fact that a family doctor cannot find any opportunities to retrain in specialties is also a problem that scares away applicants.
The above is important because timely access to care is very limited, and this is directly related to the paucity of family doctors offering full-scope practice, while on the other side we have unemployed orthopedic surgeons. When patient’s can’t see their family doc, they go to the ER. When family docs can’t keep up with the patient load, they inappropriately refer.
Now, should we re-instate the general licensure model, we could actually have MDs out there providing primary care without the fear of being stuck in that career should they desire more academic specialist training, nor will patients have to worry about not seeing their doctor, nor will doctors and patients have to worry about unqualified charlatan practitioners filling the need.
The OMA should push to get its act together and do what its supposed to do: ensure the patients are well taken care of and have ready access to primary care. Do this, and the government will be a lot more easy to deal with than it is presently. Right now you just look like a bunch of overpaid specialists who aren’t getting results.
Dr. Weir, I hope you are feeling better and best wishes for a speedy recovery. I’m sorry to hear of your difficulties.
Big problems ahead for the health care system. Government would be wise to value the input of physicians. We make the “system” work. Without MDs the system will not function. Be very clear on that point.
You’re doing a great job Doug. This has been a tough year for doctors, and the OMA, under your leadership has maintained a credible, steady voice through out.
More important than your work as a medical politician, is the work that you do to help kids who have mental health challenges.
Thanks for your work on both fronts!
I do not hesitate in agreeing with the statement that we will never achieve goals for improving our health care system unless physicians and the province work together to eliminate waste and identify savings. However, the statement that “Physician leadership is essential to improved care” causes me to pause and reflect, as do some other comments that appear to ignore other health professionals in the collaboration. Effective and efficient delivery of primary health care requires the involvement and active application of the expertise of physicians, as well as other, oftentimes less costly, health human resources such as pharmacists, physiotherapists, nurse practitioners, midwives, podiatrists, dieticians, etc. I understand that the physician-government relationship was the focus of this commentary so focus there does not necessarily mean that Dr. Weir or the OMA do not embrace the important role of these other professionals. It would be nice to see OMA actively promoting multi-disciplinary health care and working with others to facilitate the way for physicians to fully integrate other health professionals into their practices. Improved quality of patient care aside, I can’t help but believe that physicians would have a more rewarding and less stressful work-life if they did this. We’ve come a long way since I last worked as a pharmacist in the community but we still have a long way to go.
Your anecdote has nothing to do with this agreement.