In October, the Ontario Medical Association (OMA) and the Ontario Ministry of Health will sit down to begin negotiations on a new Physician Services Agreement (PSA) for 2021.
In February 2017, I was fortunate enough to be selected to serve on the OMA negotiating committee (NC) on behalf of Ontario’s physicians. I was encouraged to submit my application by a colleague and I am pretty sure mine was the last one submitted, just hours prior to the deadline.
When I got the call, I had prepared a short response reflecting my gratitude for the opportunity and soliciting feedback for future applications. I still remember Dr. Tatiana Jevremovic’s first words to me: “Are you ready to have your schedule blown up?”
And blown up it was. For the next three years, I would spend many hours in both internal meetings and bilateral negotiations. According to my records, I logged 599 hours in 2017, 765 hours in 2018 and 484 hours in 2019. Those were either face-to-face meetings or Zoom calls. This does not include travel time (up to 230 hours in 2018) or overnight stays away from home (68 in 2018). It also does not include all the emails (affectionately known as “Rita Bombs!”) and preparation time for these meetings, often reading and evaluating hundreds of pages of documents.
So, it is with great appreciation that I wish the 2021 Negotiations Task Force (NTF) well as it embarks on what will surely be another epic quest in search of a ratified agreement between Ontario’s doctors and the province. A great work lies before them.
Many issues remain unresolved from the 2017 PSA including improving access to primary care, revisiting the Academic Health Science Centers Alternative Funding Plan and Technical Fees (known as t-fees). Working groups to review these issues have been working diligently, although delayed by the pandemic. New issues on the radar include the gender pay gap, how we pay for healthcare infrastructure and the explosion of virtual care across the province.
Much like a hobbit, I was joined in 2017 by a fellowship of individuals who made the experience both entertaining and educational. While there were not a lot of potatoes, there were many devilled eggs and plenty of popcorn.
I refer to the five physicians on the NC as the Beatles: Paul, Laurie, Nik and David. They were veritable rock stars, leaders in their field with a great depth and breadth of knowledge. While most of you will remark that there were only four Beatles, not five, well, that is true. Sometimes being the Fifth Beatle is not such a bad thing. One could not ask for better friends on a long and winding journey.
I would be remiss if I did not pause to compliment the OMA staff that supported NC throughout the 2017 PSA. Without fail, they were there or available to give us whatever we needed to succeed. They worked weekends and holidays, responded to emails at all hours of the day and night. Too many to name (Rita, Nancy, Kathryn, Jasmin, Voytek, Joanna, Jamie, Colin, Andrea, Michael, Steve), they each deserve thanks for what they did, which was no less than the five physician members of NC.
For me, being on the NC was an education and experience that money simply cannot buy or a workshop can teach. For three years, I sat beside the brains of the band. Go ahead, change my mind.
While I initially viewed those across the table as adversaries, it became very clear early on that this simply wasn’t the case. The ministry team was led by Deputy Minister Dr. Bob Bell, former Sunnybrook CEO Dr. Barry McLellan, and then Health Quality Ontario President and CEO Dr. Joshua Tepper. All three have had distinguished careers in medicine and have held leadership positions. And much like her counterpart on the OMA team, while men sat at the table to argue, shout and gesticulate, it was Assistant Deputy Minister Lynn Guerrerro who sat quietly with most of the answers.
Sitting back, what I saw were simply two groups across a table trying to accomplish the same thing with different approaches, facing different pressures, serving different masters. We learned a lot from them, they learned a lot from us. Perhaps this was the most important thing to happen in those three years.
The cynic will say that this grudging respect for each other is nothing more than a Stockholm syndrome that came about from spending hundreds of hours together. I prefer to give credit where it is due.
OMA Counsel Howard Goldblatt (source: Twitter)
In that regard, I credit Howard Goldblatt and Steven Barrett, co-counsel for the OMA. After the OMA Council decried the government’s unilateral action in 2015, it demanded the OMA “get the guys the teachers got!” Well, get them we did and it was an inspired choice. Sometimes you can always get what you want …
I can say without hesitation that we would not have come close to the result we got without their help and guidance. Often kicking and screaming, they helped lead the OMA through one of its most difficult times in recent history and we came out the other side with not only a fair and reasonable arbitrated settlement but a binding arbitration framework (BAF) that prevents future government unilateral action and ensures Ontario’s doctors will receive fair treatment in all future PSA negotiations, including the one set to begin in October.
They deserve our thanks.
The BAF is one of my proudest achievements as a physician leader. It was signed just after 1:30 a.m. on May 16, 2017. I keep an original signed copy in my home office to this day, along with cards and letters from my patients and their families. Touchstones matter.
When I applied for NC, it was because I saw the damage that unilateral action had wrought. While physicians saw their compensation cut and programs slashed, it was ultimately patients that suffered.
It is this suffering that I worry about when I cast a glance west to Alberta. Nothing good will come of this conflict. Like Ontario, the sooner the Alberta government comes to realize this, the better. The Canada Health Act calls for a fair process to resolve disputes. That principle should be respected.
I would be remiss if I did not at least mention William Kaplan, who served as both mediator and arbitrator for the 2017 PSA. I never understood the value of mediation until I saw a professional mediator at work.
My favourite story about Bill? Whenever a new member would join our group, which was often, we would normally do a roundtable of introductions. And without fail, when I would introduce myself as a palliative care physician, Bill would always chime in “Stay away from that guy.”
If that isn’t the best street cred, I don’t know what is.
I do not compliment his 2017 arbitration award because I think “we won.” I compliment it because it was, in essence, justice. TheKaplan Award ended many years of hostility between doctors and the government going back as far as 2012. Ultimately, it allowed us all to finally move forward with an eye on improving patient care in Ontario.
Make no mistake, these next negotiations are going to be incredibly tough. We are facing a global pandemic that has wracked not only Ontario’s economy but the world’s economy too. Our healthcare system faced down catastrophe, which we avoided by the skin of our teeth. Yet, hallway healthcare remains the norm and our long-term care sector requires dire attention. The status quo is simply not an option.
A mutually agreed deal is the best and most viable option. While an arbitrated settlement seems likely, this cleaving of the Gordian Knot may not give us what we need going forward as we adjust to a new world with COVID-19 in addition to every other challenge facing healthcare in Ontario prior to the global pandemic. A mutual deal allows both sides to achieve what must be achieved with buy-in to ensure a quicker yet thorough implementation.
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Congratulations on this journey.
Very few know what it’s like to be part of this process.
Thank you Darren for this important reminder of the value of collaboration. Unfortunately reading this piece left me with a sinking feeling. The failure to achieve a negotiated settlement in 2014 is perhaps the greatest regret of my medical career. In fact, the stain of that 2014 non-negotiation colours my willingness to engage in medical politics to this day. Perhaps it can be a cautionary tale. Relationships matter. The 2014 non-negotiation damaged relationships. Some of them beyond repair.
Thanks Jon.
First, thank you for your work in 2014. We collectively owe a debt of gratitude to all that come before us.
I am thankful for the work done by the NC in 2016, 2014, 2012, 2008 and 2004, etc.
Very well said. Relationships are everything.
I left the 2017 NC feeling positive about the direction we are heading. My experience was different than yours in 2014. I guess part of the reason for writing this piece was a hope that PSA 2021 builds on the work done in PSA 2017. Now is not the time to take steps back.
We remember that well. It damaged many things that last to this day
Superbly written Dr. Cargill. You really captured the complexity of such high level negotiations
Thank you Dr. Rozario.
I want to take the time to really thank the staff at the OMA and MOH who worked tirelessly to support the process. Unsung heros.
As always, look forward to your questions, comment and/or gratuitous insults.
Thanks for the nod to Alberta. When we first wrote about the Alberta negotiations on HD, people said Ontario readers wouldn’t be interested. But these issue are universal and continue to repeat themselves. Another great contribution to the site. Thanks Darren!
Thanks Seema.
More than a nod. Most physicians see what is happening in Alberta as wrong and bad for patients.
I firmly believe in a neutral third party dispute resolution. Arbitration is fair and does not always rule in one direction. I saw this first hand. Let both parties make their case and agree to abide by the result.