The Tentative 2016 Physician Services Agreement: Beyond the rhetoric

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  • Murray says:

    What is in the agreement that outlines the extent to which a Physician is liable for their individual quality of service ? The link to the ‘tentative document” is a dead link.

    Thank You

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  • Seesall says:

    What about patient and caregiver responsibility? The medical consumer should contribute in some measure to responsible use of available resources. The current “free credit card” for medical care is not sustainable.

  • Ray Fredette says:

    The coalition charges that the agreement is confusing and vague, yet the coalition itself details precise statistics to support its position. All members have access to the terms and time to analyse. It may not be to the coalition’s liking but it is not confusing or vague. The coalition complains that the OMA is promoting the ratification of the agreement yet, as bargaining agents, the OMA is duty and honour bound to do so within the definition of two-party negotiations who have a tentative agreement. The coalition needs to brush up on labour law and negotiations procedures and should not build straw men to obfuscate the actual content of the deal.

    • Gerald Goldlist says:

      I am not sure that the Oma is duty bound to promote the deal, but even if it were, spending millions of membership dollars to influence the vote, denying access to membership contact information and presenting a manipulative proxy arrangement is scandalous. And I don’t have to be a labour lawyer or even a brain surgeon to see that

      • Ray Fredette says:

        So your complaints are related to internal politics and procedures, likely legitimate, not the content of the agreement.

      • Gerald Goldlist says:

        The OMA’s tactics in pushing this deal are despicable.

        I have explained why I vote No in my reply to Steven Barrett’s recent opinion piece.

  • Ksy11 says:

    Dr. Faulds,
    Many thousands of docs are not “leaders in the health care system locally,regionally,nationaly and globally”as you say. They are the ones who are seeing your patients at 4 am,and weekends,sacrificing their health and families,who are too busy or not in a position to teach or have an academic or government role,and who are literally keeping this system (which CLEARLY can no longer fund itself) afloat while you read medico-sociological fluff pieces like the one you quote. They are older,worn out,seeing elderly and increased immigrant populations (which take much more time), in high volume,dangerous FFS situations (which also keeps this system afloat- the line ups would be even more brutal if it was all salary and AFA). They have been rewarded with over a decade of income decreases as a reward for their decades of experience,dedication and lousy hours,then told they all have to work as a teammate with the Liberals because everyone knows its patient interests that drive their decision making,and academics like you,from your comfortable desk, think this is a good thing. Another speech from the Hazelton Lanes politburo. Membership has its privelages…

  • Ksy11 says:

    Read the comments after i made my first…I see another academic has chimed in as a follow up to her Huffington Post propaganda column… who has bought real estate in a cheaper area, during cushy times, and makes income not based on lousy hours and FFS nightmare line ups, and also happens to be part of the Hazelton Lanes funded cafe life,feels a 6 page agreement,which will float for 5 -6 years ,with no details of any kind, thinks making a little less money wont hurt her now well established life but will keep her and her OMA buddies feeling important…sorry,just telling it like it is…

  • Ksy11 says:

    Another terrible argument from a university academic who is not working to see 40 people at 2 in the morning…likely salaried and loving the pace…

  • Cathy Faulds says:

    The CanMEDS Leader Role describes the
    engagement of all physicians in shared decisionmaking
    for the operation and ongoing evolution of
    the health care system. As a societal expectation,
    physicians demonstrate collaborative leadership
    and management within the health care system.
    At a system level, physicians contribute to the
    development and delivery of continuously improving
    health care and engage with others in working
    toward this goal. Physicians integrate their personal
    lives with their clinical, administrative, scholarly,
    and teaching responsibilities. They function as
    individual care providers, as members of teams, and
    as participants and leaders in the health care system
    locally, regionally, nationally, and globally

    • Merrilee Fullerton says:

      I don’t believe that the CanMEDS leadership program envisioned that the reckless spending of the Ontario government would result in MDs being forced to shoulder the debt costs of government mismanagement.
      That’s not what leadership in medicine or health care should be.
      Physician leaders can advocate for patients and a resilient system. They should not be leading the profession to be a scapegoat.

    • Gerald Goldlist says:

      ‘Physicians integrate their personal lives with their clinical, administrative, scholarly,and teaching responsibilities.”

      I believe that I speak for most of us who spend the majority of our lives in clinical practice treating patients, when I say that we wish the OMA would spend more of our hard earned RANDED dollars to advocate for the physicians of Ontario gand less on being Social Justice Warriors.

  • Cathy Faulds says:

    Thank you for this piece. Your first question; “Are physicians responsible for only their individual patients, or do they also have a responsibility to help ensure that the health care system functions well?” can be answered not only by the CPSO but also by the CANMEDS roles. We have a manager role that is clearly defined as “contributing to the effectiveness of the healthcare system” http://www.educationforhealth.net/publishedarticles/article367_13.gif. I do not see that we can separate ourselves from the advocacy we do for patients and the management of the system in which we work.
    This is a major cultural change for many in our profession and has not been easily digested nor the opportunity easily appreciated.
    Teaching the physician manager role is now an important aspect of many residency programs. This reference is concerning the psychiatry program at U of T. http://staticcontent.springer.com/lookinside/art%3A10.1176%2Fappi.ap.33.2.125/000.png

    • Merrilee Fullerton says:

      In response to Dr Faulds: Physicians being made solely responsible for cost overruns creates a terrible OMA-MOH manufactured conflict of interest. This distorts the Trust that is integral to the patient-physician relationship.

      The deal is poorly thought out, lacks details and worst of all it damages trust. The medical profession would be wise to toss it out and start again.

      “Management” isn’t and should not be at the heart of the patient-physician relationship.

  • Chris says:

    Dr Bayoumi, *how* are physicians expected to change their behaviour to keep from going over budget? The only possibility is to see fewer patients, and you know that. And most of us find that completely unethical.

    We literally can not change our behaviour to fit this fantasy outcome the OMA has dreamed up. And they know that. So their plan is simply to cut physician fees as we approach the budget ceiling every year (this is the “co-management” part).

    There are lots of ways to “engage in the stewardship of health care resources” but this unpredictable nightmare is not an acceptable one.

  • Merrilee Fullerton says:

    It becomes an issue of divided loyalty and bias.

    If preserving the system is the priority rather than serving the patient, what recourse does a patient have?

    If the government wants a “Patients First” system, why does it appear to put them secondary? Perhaps the legislation should be called “System First”.

    If physicians are required to be accountable gatekeepers, who are they accountable to—-their patients or the government?

    The Ontario government has chosen to spend tens of billions of tax payer $ on projects that have demonstrated minimal to no value and on projects that have overcharged Ontario tax payers by over 37 billion dollars according to the Ontario Auditor General.

    Now the Ontario government wants the province’s physicians to carry the burden it created.

    The Ontario government wants MDs to be accountable for rationing care yet it is not accountable for its wasteful spending that has driven up provincial debt dramatically and caused a billion dollars a month to be spent on servicing its debt—a billion dollars a month that could have gone to health care or other areas that create opportunity and positive potential.

    It’s interesting to note that many MDs who earn significant amounts of income through work other than patient care speak in support of the deal that will affect the ability of others to provide patient services.

    It’s unsettling.

  • Gerald Goldlist says:

    Your talk of rhetoric is breathtaking in the face of the lack of transparency by the OMA. The duly elected representatives of the patients created this health care system. Physicians are not responsible for it, but just doing the best we can.


Ahmed Bayoumi


Ahmed Bayoumi is a general internist and health services researcher at the Centre for Research on Inner City Health in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.

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