The Tenative Psa Agreement

[NeuroD]

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?

Because it's FAR from perfect, I think its better to stand up to the liberals and endure a little more hardship, than to give in to avoid being beaten on in the short term.

[shikimate]

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?

 

How does it serve the population of Ontario well? In a desperate attempt to balance the budget the Liberals are cutting funding to hospitals, cutting nursing positions, and now are cutting physicians. It's all about 2018, they want labour peace so they can get re-elected, that's all they care about. They are not afraid to borrow money to buy labour peace with other groups, or fund their pet projects like ORPP (to the tune of 70 mil down the sink). They are like the person who crys poor after exiting the doors of a 5 star casino.

 

The demand for physicians service is endless, and that's the problem. I don't deny there's an onus for physicians to use the resources properly, but what about patient's onus to use the system properly? Isn't this truly a tragedy of the commons? 

 

PARO and OMSA says the agreement is fair for new grads. Of course it's fair because everyone, old and new docs, are getting screwed to the same degree. Just because everyone is equally screwed doesn't mean it's fair. Don't let a short term carrot make you forget that unilateral cuts and denying binding arbitration are what's unfair.

 

Had I kept my membership of this deadbeat OMA I'd vote NO without a blink. 

[NeuroD]

All of Virginia's e-mails are leaving a nasty taste in my mouth. It's becoming harder to believe that she isn't going to gain personally (favor? future positions) from this.

 

The e-mail from the "Coalition of Ontario Doctors" was refreshing. I really hope enough people vote NO and decide to stand up for doctors and show the government (and it's sympathizers within the OMA) that we won't back down from fair, reasonable, and civil negotiations just because you play hard ball with us.

[shady]

I have to say I'm also pretty disappointed in the OMA. Their job should be to explain the pro's and con's of the agreement at hand - afterall, they're supposed to represent all doctors. Sure it doesn't mean they can't endorse one side or the other, but they have to entertain both options.

 

What they're doing right now is pushing their agreement hard with daily emails without addressing comments from people with concerns. Why not sit down and have a debate with concerned ontario docs, or put out a document outlining details of what's coming up (other than that tiny infographic). As a sidenote, if what concerned ontario docs say is true, and the agreement lacks specifics and is only 6 pages long, then that's very concerning.

 

I think I'm going to vote no. Although, I'm open to changing my opinion should anything change

[ralk]

I have to say I'm also pretty disappointed in the OMA. Their job should be to explain the pro's and con's of the agreement at hand - afterall, they're supposed to represent all doctors. Sure it doesn't mean they can't endorse one side or the other, but they have to entertain both options.

 

What they're doing right now is pushing their agreement hard with daily emails without addressing comments from people with concerns. Why not sit down and have a debate with concerned ontario docs, or put out a document outlining details of what's coming up (other than that tiny infographic). As a sidenote, if what concerned ontario docs say is true, and the agreement lacks specifics and is only 6 pages long, then that's very concerning.

 

I think I'm going to vote no. Although, I'm open to changing my opinion should anything change

 

The full tentative agreement can be found here (login to an OMA account may be required). It is only 6 pages long in its substance, plus a contract at the end which codifies that agreement in legal terms. Decisions on most details have been deferred.

[tdp43]

Something to keep in mind is that the OMSA is a subsidiary of the OMA and therefore the message urging med students to vote yes is not surprising.  If anyone is involved with the OMSA I'm interested to know how much the OMA was involved in the position statement.  

[ralk]

Something to keep in mind is that the OMSA is a subsidiary of the OMA and therefore the message urging med students to vote yes is not surprising. If anyone is involved with the OMSA I'm interested to know how much the OMA was involved in the position statement.

The OMSA isn't required to endorse the agreement. You'll notice that there are other OMA groups openly opposing the PSA, so dissent is allowed and the OMSA could have done the same if they had wanted to.

[Lactic Folly]

The OMSA isn't required to endorse the agreement. You'll notice that there are other OMA groups openly opposing the PSA, so dissent is allowed and the OMSA could have done the same if they had wanted to.

Is there any possibility of power differential compared to the other OMA sections?

[kbinners]

How about this perspective? I'm sympathetic to this view. http://www.huffingtonpost.ca/dr-brenna-velker/physician-services-agreement_b_11174174.html

[ralk]

Is there any possibility of power differential compared to the other OMA sections?

Absolutely. However, the information I've gotten from OMSA representatives leads me to believe this was still an independent determination. That doesn't make me any happier about their endorsement, but I don't believe their standpoint was coerced or otherwise unduly influenced.

[Lactic Folly]

How about this perspective? I'm sympathetic to this view. http://www.huffingtonpost.ca/dr-brenna-velker/physician-services-agreement_b_11174174.html

Thanks for sharing - interesting read. The comments are also informative, especially the account of what happened in the past when the OMA negotiated an agreement with the government.

[ralk]

How about this perspective? I'm sympathetic to this view. http://www.huffingtonpost.ca/dr-brenna-velker/physician-services-agreement_b_11174174.html

The argument about having a seat at the table has been made frequently, but here's the thing - we already had a seat at the table. The OMA had a seat when negotiations started 2 years ago. Physicians have been involved in billing adjustments and other healthcare planning on a regular basis. Yet, when that became inconvenient for the government, they took that seat away.

 

This isn't the first time we've been in this situation either. In 2012, part of the argument for taking a cut to billing fees was to keep a seat at the table. What you're seeing in the negotiations over the last 2 years is what a seat at the table looks like.

 

The author correctly points out that our favour with the public is pretty low. Think that'll improve after we agree to a program intended to cut services for patients, rather than to fight tooth and nail against it? And what happens in 4 years when, just to keep pace with inflation and growing patient demand, we'd need to ask for a 5% increase in the global physician budget? What kind of public support will we have then, with the government undoubtedly spinning that as a request for a 5% raise (even though it would barely be a cost-of-living adjustment)? We do ourselves no favours by being complicit in a bad deal. I'd much rather let the government treat physicians terribly for a few years than consent to a system that lets them slowly bleed both physicians and patients for years beyond.

[thestar10]

OMA has in the past vetoed/taken over OMSA events but I believe in this case the OMSA isn't being coerced.

 

Omsa has a privledged view of how the Deal was made as the chairs sit on the board.

[GrouchoMarx]

im tempted to vote yes so that we all feel the pain together. nothing in the agreement effects pathology to any extent since its already been decimated. if were all swimming in the same shark infested waters maybe we could all get out after a while if we work together.

 

pathologys had this problem since the 80s and not a peep from the oma or anyone about that. salaried employee government- controlled practice. lowering standards to recruit cheaper foreign obedient labor. eliminating practice independence. 

 

now the same thing is being put upon everyone else. why should i care?

[NeuroD]

The argument about having a seat at the table has been made frequently, but here's the thing - we already had a seat at the table. The OMA had a seat when negotiations started 2 years ago. Physicians have been involved in billing adjustments and other healthcare planning on a regular basis. Yet, when that became inconvenient for the government, they took that seat away.

 

This isn't the first time we've been in this situation either. In 2012, part of the argument for taking a cut to billing fees was to keep a seat at the table. What you're seeing in the negotiations over the last 2 years is what a seat at the table looks like.

 

The author correctly points out that our favour with the public is pretty low. Think that'll improve after we agree to a program intended to cut services for patients, rather than to fight tooth and nail against it? And what happens in 4 years when, just to keep pace with inflation and growing patient demand, we'd need to ask for a 5% increase in the global physician budget? What kind of public support will we have then, with the government undoubtedly spinning that as a request for a 5% raise (even though it would barely be a cost-of-living adjustment)? We do ourselves no favours by being complicit in a bad deal. I'd much rather let the government treat physicians terribly for a few years than consent to a system that lets them slowly bleed both physicians and patients for years beyond.

I was going to say "how about a blarg post about the tPSA we could share", forgetting you already wrote one.

 

Give this a read/share. The post above + the blarg linked below are more informative than that article.

 

https://medicalblarg.blogspot.ca/2016/07/oma-tentative-agreement.html?m=1

[tdp43]

Can someone enlighten me if the Ontario Superior Court of Justice really struck down the proxy vote?  

 

I looked on the OSCJ's website but this information is not available. 

[ralk]

I was going to say "how about a blarg post about the tPSA we could share", forgetting you already wrote one.

 

Give this a read/share. The post above + the blarg linked below are more informative than that article.

 

https://medicalblarg.blogspot.ca/2016/07/oma-tentative-agreement.html?m=1

 

Was hoping to follow up on that post in the near future - it's been sitting in my draft pile for a week now... My position hasn't changed, but there's been a lot of new developments since that post! The dynamic of this vote has been changing rapidly.

 

Can someone enlighten me if the Ontario Superior Court of Justice really struck down the proxy vote?  

 

I looked on the OSCJ's website but this information is not available. 

 

The "No" groups seem pretty confident that this is the case and the OMA hasn't denied it. They haven't confirmed it either though. Was asking the OMA about rules for proxy votes before this ruling was announced and they mentioned (after the announcement) that they'll be sending out updated information soon. Too soon to tell for sure I guess, but I think it's a real decision by the Superior Court.

 

On a somewhat unrelated note, regardless of the outcome of this vote, I think it's worth remembering that the real fight starts after the vote concludes. Whether a "Yes" vote prevails or a "No" vote does, we're going to have a very divided group of physicians in Ontario facing a very bad funding arrangement. Both are going to take a lot of time and energy to address. While I do want to push for a "No" vote, it's definitely worth reading all opinions on this topic. For one, we're going to have to work together moving forward after the vote. Secondly, current medical students are the next generation's senior doctors, including those running the OMA. We'll be fighting over how to fund healthcare our entire careers - we'd better learn the lessons from this debacle now, or we're just going to repeat it again when it's our turn at the reins.

[shikimate]

im tempted to vote yes so that we all feel the pain together. nothing in the agreement effects pathology to any extent since its already been decimated. if were all swimming in the same shark infested waters maybe we could all get out after a while if we work together.

 

pathologys had this problem since the 80s and not a peep from the oma or anyone about that. salaried employee government- controlled practice. lowering standards to recruit cheaper foreign obedient labor. eliminating practice independence. 

 

now the same thing is being put upon everyone else. why should i care?

 

I feel now is a good opportunity for pathology to become more involved. Many docs are awakening to the politics and grassroot groups on the Internet has really ignited passion on different sides of the debate. Now it's the time to improve awareness and show people pathology cares about the well being of the medical community and wishes to be an active participant in these issues. It doesn't matter which side of an issue you stand on, what matters is that you offer your input, and listen to other's input, and make others aware of your contribution to the discussion.

 

I would also encourage pathology residents to apply for your resident association (eg PARO) representative positions, because different residency has different challenges and it's good when PARO has input from many specialties.

 

On a side note, the resident section of CAP-ACP has really stepped up the game in 2015 and the result is obvious: not only have they secured benefits from CAP-ACP for residents, residents now also has a greater say in how annual meeting is run and has a lot more input into shaping the future of the specialty. Lastly, communication amongst residents also improved.

 

All this came about because dedicated individuals were not afraid to work hard to put out suggestions and vocalize their input. I would challenge pathologists/pathology residents to do the same for OMA/current negotiation.

 

Think about it, when the government can wipe out a big chunk of your paycheque with one stroke of a pen, it's well worth it to dedicate some of your energy and time into political lobbying.

[ploughboy]

Can someone enlighten me if the Ontario Superior Court of Justice really struck down the proxy vote?  

 

I looked on the OSCJ's website but this information is not available. 

 

Yes.  You should have received a revised proxy form from "Computershare" which is the oddly-named third party the OMA has contracted to manage the proxy voting.

 

Check your spam email.  If it's not there, you should contact PSA2016@oma.org.

[GrouchoMarx]

I feel now is a good opportunity for pathology to become more involved. Many docs are awakening to the politics and grassroot groups on the Internet has really ignited passion on different sides of the debate. Now it's the time to improve awareness and show people pathology cares about the well being of the medical community and wishes to be an active participant in these issues. It doesn't matter which side of an issue you stand on, what matters is that you offer your input, and listen to other's input, and make others aware of your contribution to the discussion.

 

I would also encourage pathology residents to apply for your resident association (eg PARO) representative positions, because different residency has different challenges and it's good when PARO has input from many specialties.

 

On a side note, the resident section of CAP-ACP has really stepped up the game in 2015 and the result is obvious: not only have they secured benefits from CAP-ACP for residents, residents now also has a greater say in how annual meeting is run and has a lot more input into shaping the future of the specialty. Lastly, communication amongst residents also improved.

 

All this came about because dedicated individuals were not afraid to work hard to put out suggestions and vocalize their input. I would challenge pathologists/pathology residents to do the same for OMA/current negotiation.

 

Think about it, when the government can wipe out a big chunk of your paycheque with one stroke of a pen, it's well worth it to dedicate some of your energy and time into political lobbying.

 

did you see all of the organizations that are involved with this Coalition of Concerned Physicians? Mostly all of the professional organizations in Ontario EXCEPT the OAP. Are the OAP so afraid of virginia walley that they dont want to challenger her? 

 

the whole reason the proxy vote has been struck down by a judge is because the heavily lobbying groups like OAR within that coalition pushed for it. same way they pushed for the cuts from two years ago to be spread over everyone rather than come down on them alone. meanwhile pathologists are commanded by the government ie CCO at far less than at arms length and are paid pithy salaries.

 

notice the coalition is not mentioning anything about some of the absolutely ridiculous billing rates for some specialties. thats because those specialties are in heavy control over that coalition due to $$$.

 

if you go to OAP this year (im not, waste of time) i bet nobody will say a word about anything to do with this, the same way they said nothing about the suffocating CCO oversight, the fact that half of ontario is salaried, and all of the other stuff that we deal with.

[NeuroD]

The quotes in COD's email from the judge's ruling are pretty damning... I was excited about the OMA a few months ago, but I haven't even begun medicine yet and I'm already put off and cynical about it, and I don't think I'm alone. Feels like another "establishment" fight. I'm starting to feel about the OMA the way I feel about Eric Hoskins.

 

 

--------

Today, the Court released Justice Paul Perell’s ruling. 

The following are excerpts:

“In my opinion, the Executive Committee [of the OMA] has abused the authority provided to it by s. 84(3) of the Corporation Act, which specifies the form and content of a proxy.”

“The resolution with respect to the 2016 PSA, however, is not the only matter before the general meeting and it seems unfair and confusing if not somewhat sneaky for the OMA to make no recommendation about the other matters…”

“The current is unhelpful, unclear, unbalanced, and unfair. It is a catalyst for a governance meltdown at the upcoming general meeting."

“The proxy is likely to compromise the fair conduct of the meeting…"

[ploughboy]

the whole reason the proxy vote has been struck down by a judge is because the heavily lobbying groups like OAR within that coalition pushed for it

 

That plus the fact that the way the proxy was worded was, ya know, kinda crappy.

 

Or, to use the words Justice Perell used: "unhelpful, unclear, unbalanced, and unfair".

[GrouchoMarx]

That plus the fact that the way the proxy was worded was, ya know, kinda crappy.

 

Or, to use the words Justice Perell used: "unhelpful, unclear, unbalanced, and unfair".

Yet if there were no challenges to it, it would have gone through unabated.

 

Pathologists can't bill or operate labs and it's probably unfair yet nobody challenged it so here we are.

[shikimate]

did you see all of the organizations that are involved with this Coalition of Concerned Physicians? Mostly all of the professional organizations in Ontario EXCEPT the OAP. Are the OAP so afraid of virginia walley that they dont want to challenger her? 

 

the whole reason the proxy vote has been struck down by a judge is because the heavily lobbying groups like OAR within that coalition pushed for it. same way they pushed for the cuts from two years ago to be spread over everyone rather than come down on them alone. meanwhile pathologists are commanded by the government ie CCO at far less than at arms length and are paid pithy salaries.

 

notice the coalition is not mentioning anything about some of the absolutely ridiculous billing rates for some specialties. thats because those specialties are in heavy control over that coalition due to $$$.

 

if you go to OAP this year (im not, waste of time) i bet nobody will say a word about anything to do with this, the same way they said nothing about the suffocating CCO oversight, the fact that half of ontario is salaried, and all of the other stuff that we deal with.

 

I do realize OAP is not part of COD. I even emailed OAP asking for their position on the TPSA and it's been >1 week with no response. 

 

I am not surprised about the inaction, because like you said earlier the culture of pathology is not one that is known to make a lot of noises. However I see that as further impetus to encourage pathologists, especially pathology residents, to become more involved, not just in the TPSA, but in anything that affects us, be it resident committees, CAP-ACP, PARO, OMA, CMA, etc etc.

 

A lot of times all it takes is one or few active individuals (eg. the leaders of COD) to awaken dormant members, especially those that were indifferent to the issue. 

 

I think pathologists lack a "businessman" mentality, whereby success for a business is not only dependent on its internal well being or internal cost measures, but also it's critical to look for new markets, expand horizons, acquire new capital , new methods of revenue etc etc. Not only that, lobbying the government for favorable regulation is also a key aspect of any successful industry.

 

I know there are other colleagues out there who think like this, and that this is more of an "American" mentality, and it doesn't really fit with the culture of a lot of areas of medicine, or medical system in Canada. I am confident some day I will meet like minded people, be in Canada or in USA, and am confident this mentality is the one that will advance the medical profession further.

[ploughboy]

Yet if there were no challenges to it, it would have gone through unabated.

 

This is what I hope -- that after all this mess, there will be a generation of active, engaged physicians working within the OMA (or, in worst-case scenario, the successor organization) so that this doesn't happen again.