The Tenative Psa Agreement

[thepricechopper]

I am a strong no.

 

Lack of real long term stability. Binding arbitration is needed to prevent another scenario like this in 4 years.

 

Continued underfunding and perhaps some slight restrictions being lifted, although these were restrictions the government had forced upon us. I do not plan to approve of the government taking a large chunk out of our funding and then we applaud when they give a few crumbs back. 

[NLengr]

Yes, but probably in the short term, whereas the effects of the deal are long term. I'd rather wait until the liberals are voted out for a much better deal. They don't have a lot of fans. At the very least, they're likely to be more reasoaable around elections (that's assuming they want to get reelected, but given their behavior it's hard to believe that they do).

No matter what they do in the next two years, the liberals are toast at the ballot box next election. The premier has an approval rating of about 25% and the government isn't much better. The only worse premier in the country is Dwight Ball of NL who just unleashed a devastating budget on NL and is frankly the greasiest politician I have ever seen.

 

This deal isn't a good one. In fact, it's total junk. Better to reject it and wait out the problems rather than settling for the sake of settling and creating more of a mess in the future.

 

Binding arbitration is key. Just like in most other provinces. A deal without binding arbitration included should never be approved. Lack of binding arbitration is the root of the whole problem right now.

[thestar10]

Yeah, I think that a lot of Docs think that because the conservatives are attacking the liberals on health care that they will favour doctors if elected. I think that's a bit naive and I wouldn't expect the conservatives to do anything different from the liberals.

 

No political party can ignore doctors simply because our payments are roughly 10% of the entire provincial budget.

[NLengr]

I am conflicted about my vote. On one hand, I hate that this deal came about in such a bizarrely hidden way, and it seems like an awful deal. On the other hand, the OMA seems to feel like it's the best we're going to do.

 

I really don't want to leave the province and frankly the province should want to keep me given the state of my specialty, but geez.

The last thing anyone should do is trust the OMAs judgement. They've demonstrated their complete and utter incompetence repeatedly during this whole debacle.

[amichel]

Yeah, I think that a lot of Docs think that because the conservatives are attacking the liberals on health care that they will favour doctors if elected. I think that's a bit naive and I wouldn't expect the conservatives to do anything different from the liberals.

 

No political party can ignore doctors simply because our payments are roughly 10% of the entire provincial budget.

Uh, the healthcare budget, not the entire one.

[thestar10]

Uh, the healthcare budget, not the entire one.

Nope. It's the total budget.

In the 2016 budget $51.8 billion is spent on healthcare of which $11.6 billion is currently budgeted for physician payments (after around 7% in cuts). We are over 20% of the healthcare budget.

Total Ontario budget is around ~130 billion so it's probably more accurate to say 9% but I was rounding.

[ploughboy]

So I just sat down with the TPSA, OMA's supporting documents, and the various pieces by Concerned Ontario Doctors...Kathryn

 

Hi Kathryn,

 

Thank you so much for actually taking the time to learn about this agreement!  Whether it is endorsed or voted down, there are big changes coming that could affect your entire career.  I don't think I'm being histrionic in saying that.  I'm pretty sure both the "yes" and "no" sides would agree that the status quo ain't working and we need a change.  How that change happens will be influenced by the OMA membership's response to this TPSA.

 

Since I don't have to worry about running a clinic, I can't answer most of your questions with any sort of credibility.  But please post any other questions you may have.  Or repost the really burning ones, and I'll take a whack at them.

[amichel]

Nope. It's the total budget.

In the 2016 budget $51.8 billion is spent on healthcare of which $11.6 billion is currently budgeted for physician payments (after around 7% in cuts). We are over 20% of the healthcare budget.

Total Ontario budget is around ~130 billion so it's probably more accurate to say 9% but I was rounding.

Okay, I see what you mean, but that's payments. Some people are making it seem like physicians somehow make 10% of the budget, which is kind of like calling the budget for a school the "payments" to the teachers.

[thestar10]

Okay, I see what you mean, but that's payments. Some people are making it seem like physicians somehow make 10% of the budget, which is kind of like calling the budget for a school the "payments" to the teachers.

Yeah, it is easy to forget that that money is paying for many thousands of offices and even more jobs. 

[NeuroD]

You should be able to register on the OMA website as an incoming medical student.

 

If you go to https://www.oma.org/MEDICALSTUDENTS/Pages/OMAMembership.aspx

you can register now.

After registering, where do we go to vote? I don't see an obvious link in the agreements section.

[thestar10]

Voting opens July 27th

[kbinners]

Since I don't have to worry about running a clinic, I can't answer most of your questions with any sort of credibility.  But please post any other questions you may have.  Or repost the really burning ones, and I'll take a whack at them.

 

Hey Ploughboy,

 

I think my main question is: what were the membership hoping for with this agreement that they didn't get?

• I understand that people seem to want the right to binding arbitration, but the OMA is still pursuing a charter challenge to achieve that and agreeing to this deal doesn't get in the way of that. So that seems moot. (Plus, I hate to say it, but binding arbitration really isn't such hot shakes. For people who already don't trust the government or the OMA to represent them, why would they trust  a wildcard arbitrator?)
• Did they want a reversal of the cuts of two years back?
• Do they want a promise that whatever physician expenses are, they will be covered? (Sorry to be ignorant, but is that the system we had until recently, eg no budget or cap on physician services?)
• Do they want more specifics on how fee schedules may be altered?

What specific parts of the agreement are doctors unhappy with (and why)?

• The thing I hear the most about is the lack of binding arbitration (but see 1st point above)
• Someone above mentioned a lack of longterm stability (beyond 4 years)... but would anyone really want to sign off on an agreement that claimed to be a binding contract for say 10 years? Wouldn't both sides potentially want to revisit the issue ahead of that?
• A few people have suggested waiting for a non-liberal government... I'm sorry, are you suggesting that a conservative government is going to be more generous towards health care spending...?? I have serious doubts on that front. This seems like a week argument for a 'no' vote.
• PARO mentioned concerns about "implementing any restrictive or discriminatory measures on new doctors once they are training in the Canadian medical system". What are they alluding to? Where is this in the agreement?

If you can fill me in on any of these points, I'd be grateful

[NeuroD]

Voting opens July 27th

Looks like anyone who recently became a member is out of luck. You had to join before July 11th to be eligible to vote. I joined July 14th, so my voice dosen't count. That makes perfect sense!

[NLengr]

Hey Ploughboy,

 

I think my main question is: what were the membership hoping for with this agreement that they didn't get?

• I understand that people seem to want the right to binding arbitration, but the OMA is still pursuing a charter challenge to achieve that and agreeing to this deal doesn't get in the way of that. So that seems moot. (Plus, I hate to say it, but binding arbitration really isn't such hot shakes. For people who already don't trust the government or the OMA to represent them, why would they trust a wildcard arbitrator?)
• Did they want a reversal of the cuts of two years back?
• Do they want a promise that whatever physician expenses are, they will be covered? (Sorry to be ignorant, but is that the system we had until recently, eg no budget or cap on physician services?)
• Do they want more specifics on how fee schedules may be altered?

What specific parts of the agreement are doctors unhappy with (and why)?

• The thing I hear the most about is the lack of binding arbitration (but see 1st point above)
• Someone above mentioned a lack of longterm stability (beyond 4 years)... but would anyone really want to sign off on an agreement that claimed to be a binding contract for say 10 years? Wouldn't both sides potentially want to revisit the issue ahead of that?
• A few people have suggested waiting for a non-liberal government... I'm sorry, are you suggesting that a conservative government is going to be more generous towards health care spending...?? I have serious doubts on that front. This seems like a week argument for a 'no' vote.
• PARO mentioned concerns about "implementing any restrictive or discriminatory measures on new doctors once they are training in the Canadian medical system". What are they alluding to? Where is this in the agreement?

If you can fill me in on any of these points, I'd be grateful

Binding arbitration is the standard in most provinces and in contract disputes almost always renders a finding that is favorable for physicians. Now the government just arbitrarily decides to do whatever they feel is in their best interest (The clawback system currently in place as an example).

 

There is a reason almost every essential service uses binding arbitration. It almost always benefits the non government party.

[NLengr]

Hey Ploughboy,

 

I think my main question is: what were the membership hoping for with this agreement that they didn't get?

• I understand that people seem to want the right to binding arbitration, but the OMA is still pursuing a charter challenge to achieve that and agreeing to this deal doesn't get in the way of that. So that seems moot. (Plus, I hate to say it, but binding arbitration really isn't such hot shakes. For people who already don't trust the government or the OMA to represent them, why would they trust a wildcard arbitrator?)
• Did they want a reversal of the cuts of two years back?
• Do they want a promise that whatever physician expenses are, they will be covered? (Sorry to be ignorant, but is that the system we had until recently, eg no budget or cap on physician services?)
• Do they want more specifics on how fee schedules may be altered?

What specific parts of the agreement are doctors unhappy with (and why)?

• The thing I hear the most about is the lack of binding arbitration (but see 1st point above)
• Someone above mentioned a lack of longterm stability (beyond 4 years)... but would anyone really want to sign off on an agreement that claimed to be a binding contract for say 10 years? Wouldn't both sides potentially want to revisit the issue ahead of that?
• A few people have suggested waiting for a non-liberal government... I'm sorry, are you suggesting that a conservative government is going to be more generous towards health care spending...?? I have serious doubts on that front. This seems like a week argument for a 'no' vote.
• PARO mentioned concerns about "implementing any restrictive or discriminatory measures on new doctors once they are training in the Canadian medical system". What are they alluding to? Where is this in the agreement?

If you can fill me in on any of these points, I'd be grateful

Binding arbitration is the standard in most provinces and in contract disputes almost always renders a finding that is favorable for physicians. Now the government just arbitrarily decides to do whatever they feel is in their best interest (The clawback system currently in place as an example).

 

A charter challange is only necessary because the Ontario government refuses to give physicians the same negotiation rights and privileges of most other provinces because they know it won't benifit the governing party. The Liberals could agree to binding arbitration tomorrow and it wouldn't legally be any problem to set up.

 

There is a reason almost every essential service uses binding arbitration. It almost always benefits the non government party.

 

For your last point, there has been multiple times the government has floated the idea of geographically restricting where new physicians can work (aka not Greater Toronto or Ottawa) or paying new physicians less then established physicians per procedure even though they are doing the exact same procedure.

[ralk]

Hey Ploughboy,

 

I think my main question is: what were the membership hoping for with this agreement that they didn't get?

• I understand that people seem to want the right to binding arbitration, but the OMA is still pursuing a charter challenge to achieve that and agreeing to this deal doesn't get in the way of that. So that seems moot. (Plus, I hate to say it, but binding arbitration really isn't such hot shakes. For people who already don't trust the government or the OMA to represent them, why would they trust  a wildcard arbitrator?)
• Did they want a reversal of the cuts of two years back?
• Do they want a promise that whatever physician expenses are, they will be covered? (Sorry to be ignorant, but is that the system we had until recently, eg no budget or cap on physician services?)
• Do they want more specifics on how fee schedules may be altered?

What specific parts of the agreement are doctors unhappy with (and why)?

• The thing I hear the most about is the lack of binding arbitration (but see 1st point above)
• Someone above mentioned a lack of longterm stability (beyond 4 years)... but would anyone really want to sign off on an agreement that claimed to be a binding contract for say 10 years? Wouldn't both sides potentially want to revisit the issue ahead of that?
• A few people have suggested waiting for a non-liberal government... I'm sorry, are you suggesting that a conservative government is going to be more generous towards health care spending...?? I have serious doubts on that front. This seems like a week argument for a 'no' vote.
• PARO mentioned concerns about "implementing any restrictive or discriminatory measures on new doctors once they are training in the Canadian medical system". What are they alluding to? Where is this in the agreement?

If you can fill me in on any of these points, I'd be grateful

 

Highly doubt the Conservatives would be better in the short term, but it's the long term I worry about with this current deal. No binding arbitration as at least a weak check against unilateral government actions and maintenance of the PSA means that regardless of current changes to physician income, the stage is set for future governments to easily reduce physician compensation without any way to stop them. There will always be an incentive to reduce physician income, but it shouldn't be able to be done on a whim, as this deal largely allows.

 

I'm hopeful the lawsuit provides a legal guarantee for binding arbitration, but physicians have few labour rights and it could well fail.

 

I don't think the goal is to have all physicians services covered. Heck, that's never been true, unpaid labour is part of the job. What physicians are fighting for when rejecting a cap is two things. First is certainty in billings. When we perform a task, we have no say in how much we get paid for it, but at least in the previous system, we knew what the compensation would be. With clawbacks, that's not the case. If a visit would normally net me $33, now it could get clawed back to $32 after the fact. Makes it very hard to plan things financially, both from a professional and personal perspective. Second is that it punishes physicians for things beyond their control, such as increases in population or the aging of that population. Physicians largely don't control how much care patients need, we just provide it when they need it. The PSA cap means that if patients need more care and we provide it, we suffer financially. That's a very poor system for physicians wanting to do the right thing for their patients and it faults physicians for something that really should be the Ontario government's responsibility: financially providing for the health needs of Ontarians. Physicians don't want carte blanche to charge whatever they want to the government, but they do want the authority to provide the necessary care for their patients and to get paid an agreed upon amount for the work that they do.

[Bambi]

Personally, I've already packed up and left Ontario for beautiful British Columbia. Fee for service isn't perfect, but I refuse to work in the type of health care system the Ontario Liberals have now created. One less FP in Ontario I guess...

Others have done and will do the same. Physicians have the option to vote with their feet!

[kbinners]

Looks like anyone who recently became a member is out of luck. You had to join before July 11th to be eligible to vote. I joined July 14th, so my voice dosen't count. That makes perfect sense!

 

What do you know -- I joined ON July 11th. So I guess I'm not off the hook.

[ploughboy]

Hey Kathryn,

 

Sorry for the delay.  Here's how I see it.  Trying to be succinct, so may have glossed over some things.  Attempted to be semi-neutral, but in the interest of full disclosure I will be voting "no".

 

 

 

 

I understand that people seem to want the right to binding arbitration, but the OMA is still pursuing a charter challenge to achieve that and agreeing to this deal doesn't get in the way of that. So that seems moot. (Plus, I hate to say it, but binding arbitration really isn't such hot shakes. For people who already don't trust the government or the OMA to represent them, why would they trust  a wildcard arbitrator?)

 

I've read a lot on both sides regarding BA, and the more I read the more confused I get.  I honestly don't know, because the OMA and COD legal opinions seem to be mutually contradictory.   It makes my head hurt, and I can't give you a good answer.

 

 

 

Did they want a reversal of the cuts of two years back?

 

While that would be nice, I think the first step that most people want is to stop further cuts.  Unfortunately, Ontario is really broke.  So I don't know how this will play out.

 

 

 

Do they want a promise that whatever physician expenses are, they will be covered? (Sorry to be ignorant, but is that the system we had until recently, eg no budget or cap on physician services?)

 

That would be nice.  For the last little while we have been operating in a situation of clawbacks.  About a year ago the MOH set a hard cap on the physician services budget, and any overage was clawed back from individual physicians.  So your OHIP reconciliation statement might show that you billed $10,000 for your services in a month, but you are only getting paid $9,300 of that.   You did $700 of free work, in other words.  Not only that, but you didn't know at the time that you were doing it for free.  This has, understandably, pissed off a lot of docs. 

 

The tPSA talks about "co-management" of the Physician Services Budget, which is a great idea in theory.  When it gets down to the details...well there are none, at least not in the tPSA as she is written.  That's one of my biggest beefs with the agreement (see below).

 

Related note about expenses - a number of people have argued that this tPSA will lead to docs being responsible for the financial implications of increased health-care utilization.  Given our demographics, the boomers are starting to suffer from all the usual diseases that people their age get, and that's only going to get worse.  So if in a given month 100 people show up in my ER, all having heart attacks and legitimately needing medical care, why should this increased utilization be my problem?  They were sick, I helped make them better, I billed for it.   Why shouldn't I get paid?
 

 

 

Do they want more specifics on how fee schedules may be altered?

 

Abso-friggin-lutely.   I think a lot of opposition to this tPSA comes from how few specifics there are in it.  It's only a few pages long -- shorter than your line of credit paperwork, shorter than your apartment lease, shorter than the instructions for the Ikea furniture that you're going to put in that apartment.  And this is supposed to cover a $10B/yr part of the provincial budget for the next four years.  The mind boggles.

 

 

 

Someone above mentioned a lack of longterm stability (beyond 4 years)... but would anyone really want to sign off on an agreement that claimed to be a binding contract for say 10 years? Wouldn't both sides potentially want to revisit the issue ahead of that?

 

I think it is dumb to sign a four-year deal with an election coming up in two years.  It gives up too much leverage.  The counter-argument is the agreement will provide "stability" and give the OMA and MOH a chance to sort out things in the longer term.

 

 

 

 

A few people have suggested waiting for a non-liberal government... I'm sorry, are you suggesting that a conservative government is going to be more generous towards health care spending...?? I have serious doubts on that front. This seems like a week argument for a 'no' vote.

 

Agree.  To me it feels like the current government has significantly exceeded it's "best before" date.  However, the provincial Conservatives have a demonstrated history of snatching defeat from the jaws of victory.  Even if they were to win the election, they will likely do so on a platform of fiscal cuts.

 

And the NDP?  They're no friend to doctors, imho.

 

I feel this ties back into the previous point -- it's not bright to sign a four-year deal with an election a couple of years away.

 

 

 

PARO mentioned concerns about "implementing any restrictive or discriminatory measures on new doctors once they are training in the Canadian medical system". What are they alluding to? Where is this in the agreement?

 

You are correct, this is not in the document.  However, apparently there have been side conversations between the MOH and OMA regarding an MOH objective to limit the number of new docs practicing in Ontario, and this is one of the Ministry's agenda-items for the next little while.  The citation for this is Dr. David Jacobs' open letter to the OMA, found here:  https://www.facebook.com/concernedontariodoctors/posts/861070524027055:0

The money quote is:  "I was on the calls when significant cuts to new physicians entering the Ontario workforce and to medical school spots were discussed as part of the PSA presentation, yet it appears nowhere in the document except in the most vague language. A precise number was discussed as alluded to by Dr. Nadia Alam. How can we be sure that other major system changes are not also hiding in what is more of a pamphlet than a contract?"
 

The number mentioned by Dr. Jacobs is a cut of 200 med school spots.

 

The idea of controlling health care expenses by limiting the number of physicians in practice certainly isn't a new one (see the effect of the Barer-Stoddard report on the number medical school spots in Ontario for an example).  Forcing new grads to practice in underserviced areas is also not a new idea.  Ontario physicians rejected this idea in a previous tentative PSA (sorry, don't know which one off the top of my head), and collectively we have been very good about not "eating our young".

 

The "no's" argue that this is one of several issues where, although the PSA doesn't mention it explicitly because it is so darn brief, endorsing the PSA will put the issue on the table.

 

Interestingly, PARO has issued a new (and very long) email, which I will post separately.  Basically, they feel their concerns have been addressed and they have been promised a seat at the table.  I dunno.  If I were just starting my training I'd be worried about what's going to happen in the next few years, PSA or not.
 

 

 

And finally, here are my problems with the PSA

- Process:  it was not at all transparent, and OMA appears to have ignored its own internal procedures when negotiating it (see Dr. Jacobs letter, above). 

- Agreement length (1) : while four years may provide "stability", we shouldn't be signing on for that long in the face of an election

- Agreement length (2) : It is six pages long.  I think this would be a decent stab at some terms of reference under which to negotiate an actual PSA, but this is far too short.  It should be 50-100 pages long to cover what it needs to cover.

- Sales job: the OMA is selling this agreement really hard.  So hard, in fact, that my natural reaction is to push back and question why it doesn't just sell itself.

 

Hope that helps!

[ploughboy]

Update:  the referendum has been cancelled, to be replace by a general meeting of OMA membership.  Below is what was sent out by OMA, signed by Dr. Walley (OMA President)...

 

Yesterday, we announced that the OMA will be holding a General Meeting of our membership - to vote on the tentative PSA. This decision was made in response to a petition submitted to the OMA, as provided for in our bylaws. I want to be clear on what this means:

• The previously scheduled OMA referendum and Special Council Meeting are canceled.
• All RoadShow meetings, TeleTownHalls, and other informational sessions, etc. continue. It is important members make an informed decision, based on fact.
• You will receive a notice of the General Meeting no later than Sunday, which will include details on date, time and location. As part of the notice, you will also receive instructions as to how to cast your vote. I strongly recommend that you read the notice closely and carefully.
• The members’ vote that will occur as part of the General Meeting will provide a binding decision on the proposed PSA. It is an opportunity for you to have your voice heard.

I want to emphasize that you do not need to immediately cast your vote or take any action.

I urge you to carefully examine the information we are providing you to fully understand the tentative PSA before making any decisions.

OAR LEGAL ACTION TO OBTAIN YOUR PERSONAL CONTACT INFORMATION
I have to advise you that the Ontario Association of Radiologists (OAR) has taken legal steps to require the OMA to share its membership list, including your address and email address. Please note that the OMA did not have a choice in the matter; it is legally required to provide the OAR with your information.

Anything you receive from the OAR may NOT reflect the views of the OMA.

I encourage you to continue visiting the Tentative PSA Infohub to the get the facts about the proposed Agreement and to send us any questions you may have.

[ploughboy]

And here is the latest from PARO, offered without comment...

 

 

What Does the OMA Deal Mean for Residents?
    
In my last message, I committed to report back to you on the tentative Physician Services Agreement between the Ministry of Health and Long Term Care and the Ontario Medical Association. I also promised that the PARO Board would work hard on your behalf to get an assurance that the intent of the tentative Physician Services Agreement is not to provide a mechanism to introduce any discriminatory measures against new doctors in practice.
 
Your Board of Directors, our senior staff, and legal counsel have done what you should expect of us. We have closely examined the tentative Physicians Services Agreement from the perspective of residents and of our future members, who are currently in medical school, and we have worked hard to ensure that our concerns are addressed.  
 
I am now in a position to summarize in plain language the aspects of the tentative Physician Services Agreement (PSA) that we were concerned about on behalf of our members, and even more importantly, tell you what we have done to have our concerns addressed.
 
When push comes to shove and there is limited funding to pay doctors, historically, governments and some medical associations have resorted to bringing in measures that discriminate against the newest in the profession. This pattern began in the mid-80's when the British Columbia government brought in legislation to prevent any new doctor from working at all!
 
Residents across the country galvanized and fought a six-year battle all the way to the Supreme Court of Canada to overturn this outrageous legislation. Since then, there have been multiple attempts in various provinces, including Ontario, to bring in billing number restrictions and other types of discriminatory practices directed at new doctors in all specialties, including limiting such things as where they could work and discounting the amount they got paid. In each instance, residents were able to mobilize to reverse and dismantle these schemes.
 
As recent as last fall, the Ontario government unilaterally introduced the New Graduate Entry Program (NGEP) specifically directed at NEW family medicine graduates. This program not only set out geographic restrictions, but also established limits on the type of work new family doctors could do, as well as establishing a scheme that would see new doctors paid less than their established counterparts for the exact same work.
 
PARO has also been concerned that other unjustified restrictive measures could be aimed at new graduates from Royal College specialties (for example reducing their fees for locum coverage or surgical assists).
 
Even more recently, this spring, the Government introduced Bill 210 (The Patients First Act). We were concerned that this Bill had the potential to open the door to implementing similar restrictive practices against all new doctors, in all specialties.
 
Every time that PARO has perceived a threat to the ability of our members to be able to enter the workforce, we have reacted swiftly, thoughtfully and effectively. In the past few years, we have had repeated commitments from the OMA that they would never again participate in schemes that discriminated against new doctors in the system. As soon as the New Graduate Entry Program was introduced, we met with the OMA and secured their support to do what they could, to dismantle this discriminatory program and they reminded us of their position that new doctors should not be singled out and treated unfairly.
 
I promised you in my last message that we would once again work on your behalf to ensure that the tentative Physician Services Agreement could not and would not be used inappropriately against new doctors.
 
The OMA has in previous years provided this assurance (including through Council Resolutions). In our correspondence with the OMA concerning the tentative PSA, they have stated, that although the review of physicians resources and co-management of the system is a bilateral process, the OMA has no intention to disadvantage medical students or residents.
 
However, we felt we needed more if we were going to be able to tell our current and future members that our concerns about your ability to enter the workforce had been addressed - so we have worked even harder on your behalf.
 
Through a series of conversations and discussions and countless hours of hard work on the part of your Board, our staff and our legal counsel, I am extremely pleased to be able to tell you that this morning I received a written commitment from the Government, that should the tentative Physician Services Agreement be ratified, new graduates will be treated fairly, equitably and on the same terms as our more senior colleagues. The government has told us in writing that these assurances apply equally to the co-management process envisaged in the tentative PSA. This means that new graduates will not be discriminated against.
 
The letter from Government also demonstrates their commitment to ensuring that the perspective of new graduates is heard by agreeing that a PARO representative will be a full member of the OMA-Government bilateral group.
 
As well, as evidence of the intent of Government to respect the role of new doctors in the system, and as part of the deal that the OMA negotiated, the tentative PSA actually removes the contentious components of the New Graduate Entry program that we so strongly objected to. The tentative PSA restores managed entry into the FHN and FHO models and allows new graduates to practice in these enrolment models in a location of their choice. Even more, the tentative agreement the OMA and Government negotiated removes the parts of Bill 210 that caused us concern.
 
As a result, for the first time ever, PARO has secured written assurances from the Government that protects the future employment and practice opportunities of new graduates and ensures that we won’t be treated in a discriminatory fashion just because we are the newest to work in the health care system.
 
I am aware that the tentative Physician Services Agreement is controversial and that certain groups of doctors and individual doctors opposed to the deal have been expressing their concerns.  We have listened hard to these concerns and appreciate why some specialties are not in favour of the tentative PSA.
 
However, I believe PARO has done what you should expect of us. We have focused on the two things that we think should be top of mind for all residents:
 
First, and most important, was making sure that when we finish our training we are able to practice medicine and that as new doctors, we are not treated unfairly or discriminated against but instead, treated in the same way as our more senior colleagues already in the system.
 
Second, as the future of the profession, we have been concerned about how the Government negotiates with doctors. Unfortunately, the OMA, unlike PARO, does not have access to binding arbitration, which we believe is an essential tool to address the power imbalance between government and a profession that is not effectively allowed to strike or take any effective job action. Therefore, we were very pleased to see that even in doing this deal, the OMA did not negotiate away, but secured their right, to continue with their Charter Challenge designed to ultimately obtain a binding dispute resolution mechanism.
 
Many members of the PARO Board and PARO General Council have been approached by colleagues asking for guidance on how to vote and whether to ratify this deal. Similarly, many of us in leadership positions have been contacted by those opposed to the deal, insisting that we encourage residents to vote no. And in fact, last week, a practicing doctor unassociated with PARO caused quite a stir when they falsely tweeted that PARO had rejected the deal.
 
The PARO Board will not tell or direct you to support or not support the agreement - we respect your individual choice.
 
However, we have felt an obligation to try and obtain assurances that your future ability to practice as a new graduate will not be subject to discrimination as a result of this deal.
 
Through hard work and tenacity, I believe we have accomplished even more than just obtaining assurances.  For the first time in history we have a written commitment from Government, that should this deal be ratified, new doctors entering practice will not be treated differently from their established colleagues.
 
The PARO Board is comprised of residents from many different specialties from all over the province. As members of the PARO Board, each of us takes the responsibility of working on your behalf very seriously.  To that end, members of the PARO Board have decided to support approval of the tentative agreement based on the commitment that we have secured from government and in order to protect the interests and future practice opportunities of all of our members in all of the specialties that PARO represents.

We are aware that on July 25 the OMA received a petition calling for a Special Meeting of the membership and have decided to cancel the referendum on the tentative PSA.

As details about the implications of the OMA Special Meeting become available I will share them with you, but please be assured that PARO will continue to strongly advocate on your behalf to protect your future practice opportunities.
 
Sincerely,

Stephanie Kenny, MD
PARO President

[ploughboy]

And finally, a request...

 

I've just finished my training.  11 years of it.  I know very well what it's like to be a premed/med student/resident.  You're busy.  You might not feel like you have a handle on the issues.  You might not think your vote matters, and anyway you feel so far from being done that maybe everything will have changed by the time you'll be in practice so really why bother?

 

But here's the thing:  med students and residents are the second and third largest voting blocks in the membership.   Your votes are important.   And this general meeting is historic -- there has only been one other general meeting like this, it was in the 1980s and it was so big they had to hold it at Maple Leaf Gardens.  No matter if the tPSA is approved or defeated, the effects will still be felt by the time you're ready to practice (it may seem like it is a long way away, but the time will pass so quickly that it will take your breath away).

 

Since the referendum has been cancelled in favour of the general meeting, and since not everybody will be able to attend the meeting, proxy votes will be HUGE.  Expect a blizzard of emails over the next couple of weeks asking you to transfer your vote to a proxy.  Please, don't give your proxy away to just anybody!

 

If you are in favour of the agreement, give your proxy to those in favour (likely to the OMA directly).

 

If opposed, give it to those opposed (likely COD will have people designated to hold "no" proxies).

 

But please, please, please...if the OMA sends you an email that says "click here to give your proxy to the OMA", don't just shrug, click on it without thinking, and move on.  This is really important!

[shikimate]

 

But please, please, please...if the OMA sends you an email that says "click here to give your proxy to the OMA", don't just shrug, click on it without thinking, and move on.  This is really important!

 

Cannot emphasize this enough, whichever side you're one it's important to read about both side of the story before clicking. Treat this with the amount of consideration you would, say for placing quadruple chemo order on your patients.

[NeuroD]

They're pushing really hard with the e-mails. Makes me feel like there's something up.

 

Had I not missed the registration deadline, I would have voted no.

[mavrik13]

They're pushing really hard with the e-mails. Makes me feel like there's something up.

 

Had I not missed the registration deadline, I would have voted no.

 

This is honestly one of the most frustrating things to me. I am tired of getting daily e-mails from Virginia Walley.

 

After thinking about this for the past few weeks, overall I feel the deal is far from perfect, but I think that on the whole it serves the population of Ontario well. I think too many people are out to protect their own pockets, and realistically, I think the days of earning >500k in medicine are likely going to come to a close in the coming decades. I am OK with that. I don't like the idea of a hard cap on physician billings, but what should we expect? There should be some onus on us to try and reduce... I don't agree this is the method, but I can see the need for it from a government perspective.

 

My biggest beef with the tPSA is the lack of info. They want to co-manage 200 million in cuts - how will they do that? Clearly they will target "over-valued" specialties, but what does this mean on an individual level? Will they refuse to create new positions instead of cutting back fees?