The Tenative Psa Agreement

[futureGP]

Glad the results were a no. 

 

It is cowardly to want to give into an agreement of such terrible level with the government when we have come this far.

 

The continued unilateral cuts are all sacrifices we should endure to reach the long-term stability that we need. the OMA may have stated that this deal would have been temporary and we would have continued with the legal challenge for binding arbitration but the whole atmosphere after reaching an agreement would have halted that process given our human tendency to get comfortable with the status quo.

 

If the government continues unilateral cuts, let them do. It just gives more reason for us to seek a more permanent solution to this type of abuse we get from our incompetent government.

[tdp43]

I just got an email from the OMA stating the PR firm Navigator has been let go. It also says that if negotiations were to resume then they would let its membership know.

 

Why did it have to come to such a bitter vote for these things to happen.  Or at least claim to happen.

[rmorelan]

I just got an email from the OMA stating the PR firm Navigator has been let go. It also says that if negotiations were to resume then they would let its membership know.

 

Why did it have to come to such a bitter vote for these things to happen.  Or at least claim to happen.

 

No idea - seems like early one people in the OMA got really attached to the proposed deal and really rallied around it. Staked it all on it in fact. It would have been 1000x better if they instead said something like:

 

"Hey, here is the best offer we have managed to hammer out so far. Has some good points, and has some bad points. Let's talk about this deal and see if it is something we can live with while we keep up the legal challenge for binding arbitration. We are going give you our analysis for pro and con and welcome others to discuss what is proposed in a respectful manner"

 

then we would have done what we needed to do in a better environment. OMA would be able to go back to the table if rejected say yeah this is just not something we can live with etc. now we have to get a new negotiating team together, new mandate from everyone, and then go back - that is going to take a lot of time and retread over a lot of the same stuff. It is absolutely necessary at this point but still time consuming. 

 

and the rage at the OMA is higher than ever. 

[ralk]

I think the OMA leadership group was very, very afraid of not having a deal in place. As bad as this deal is, the unilateral cuts we will almost certainly endure at this point are guaranteed to be worse in the short term. That seems to have terrified the OMA enough for them to push for the agreement hard, even if that approach likely backfired. There was a logic to their support of the deal, even if the majority of OMA members - myself included - didn't accept it.

 

I also wish they had taken a more neutral position, even with the endorsement. Perhaps residents saw a different side than I did, but PARO was the one group who I thought did the best job of all the official and unofficial physician organizations. They secured guarantees specifically for their members during the negotiations. While they endorsed the deal, they provided a reasonably coherent rationale for that support and didn't press their members to vote one way or the other despite that endorsement.

 

I'm incredibly glad the PR firm was fired, it was pretty clear that they were an issue at all stages of this process. The OMA's public PR pre-tPSA was weak, disingenuous, and may have worked against us in the negotiations. At least on that front, I could see what they were trying to go for and why, even if it was a pretty bad idea that we should never have stuck with. On the other hand, whoever advised the OMA down the path they took post-tPSA announcement, where they were aggressively pushing the deal on their members to the point that they were cold-calling OMA members, those people shouldn't work in PR or any sort of group management ever again. That was an obviously poor decision right from the beginning, yet they stuck with it through the whole process, even after it was painfully obvious that approach wasn't helping. It is going to take a long time to recover from the mistrust that spawned from that effort.

[tdp43]

So what if that was the OMA's strategy all along to elicit a "no" vote without saying so - aggressively lobby its membership in a tacky manner, turn membership off from voting or from voting yes, and then they are justified to tell the province that they did all they could.  

[ploughboy]

On the other hand, whoever advised the OMA down the path they took post-tPSA announcement, where they were aggressively pushing the deal on their members to the point that they were cold-calling OMA members, those people shouldn't work in PR or any sort of group management ever again. That was an obviously poor decision right from the beginning, yet they stuck with it through the whole process, even after it was painfully obvious that approach wasn't helping.

 

I feel like the OMA purchased the "You Too Can Influence An Election!!!" package from Navigator, and tried to use strategies designed to sway the general public on a very different sub-population.  Could be wrong, though.

[ploughboy]

So what if that was the OMA's strategy all along to elicit a "no" vote without saying so - aggressively lobby its membership in a tacky manner, turn membership off from voting or from voting yes, and then they are justified to tell the province that they did all they could.  

 

Sometimes, before I fall asleep at night, this thought crosses my mind as well...

[rmorelan]

Sometimes, before I fall asleep at night, this thought crosses my mind as well...

 

I think that gives the OMA way too much credit - if they were that smart, or rather that Machiavellian, they would have being able to set all this up better in the 2000s when the doc shortage was so high they have maximum political power. Plus it would rely on multiple prominent OMA people (including past presidents) falling on their swords for this to happen.

 

To somewhat bastardize Harlon - let us not attribute cunning to what can be adequately explained by stupidity.

[ploughboy]

I think that gives the OMA way too much credit - if they were that smart, or rather that Machiavellian, they would have being able to set all this up better in the 2000s when the doc shortage was so high they have maximum political power. Plus it would rely on multiple prominent OMA people (including past presidents) falling on their swords for this to happen.

 

To somewhat bastardize Harlon - let us not attribute cunning to what can be adequately explained by stupidity.

 

Ya, probably.  It's just me seeing ghoulies and ghosties and long-legged beasties as I fall asleep.

 

Hanlon, no?

[rmorelan]

ha, yes typo

[Bambi]

The Peter Principle is alive and well.

[Redpill]

Minister Hoskins' letter to the OMA: https://news.ontario.ca/mohltc/en/2016/08/minister-hoskins-letter-to-oma.html

 

Thoughts?

[NLengr]

Minister Hoskins' letter to the OMA: https://news.ontario.ca/mohltc/en/2016/08/minister-hoskins-letter-to-oma.html

 

Thoughts?

Fuck him. This guy is poison to the negotiating process. He needs to be shuffled out of health before an agreement will ever be reached.

 

The offer for binding arbitration isn't an actual offer since they're demanding physicians not be allowed to incorporate. He knows that's unacceptable. It's political talk, not an actual offer.

 

Most other provinces have binding arbitration. Physicians can still incorporate. There is good precedent across the country. The government knows if they go to court over binding arbitration, they will probably lose.

 

The letter basically says "We aren't negotiating anything beyond what we offered. Physicians are gonna work for free once we hit a predetermined compensation cap".

 

Sooner the liberals are out of power, the better it is for all Ontario. The Wynne government is a financial, economic and social disaster.

 

On the plus side, I'm some glad I am never going to practice in Ontario.

[shady]

Fuck him. This guy is poison to the negotiating process. He needs to be shuffled out of health before an agreement will ever be reached.

 

The offer for binding arbitration isn't an actual offer since they're demanding physicians not be allowed to incorporate. He knows that's unacceptable. It's political talk, not an actual offer.

 

Most other provinces have binding arbitration. Physicians can still incorporate. There is good precedent across the country. The government knows if they go to court over binding arbitration, they will probably lose.

 

Problems arise when the alternative is this. http://www.theglobeandmail.com/news/national/ontario-pc-leader-patrick-brown-promises-to-scrap-sex-ed-curriculum/article31583258/

 

And we aren't even in election season yet! As much as I dislike Hoskins, I shudder when I think of what other social policies the conservatives have up their sleeve

[rogerroger]

This whole issue is a mess. I take no side. OMA / COD, whatever... The source of the problems is the sick-joke of a Liberal provincial government. 

 

The definitive fix is changing the provincial government or leaving the province. All OMA resources should be put towards changing the provincial government and shoring up public opinion towards this aim. The Liberals are just the worst. Anyone that is awake and not brainwashed can put these facts together. Ontario is such a damn mess; it's unbelievable. The whole place is well on its way towards becoming a Canadian version of Michigan. 

 

If you like to control your fate, I suggest getting off the "Ontario ship" before it hits the inevitable iceberg. Do your training outside Ontario if you can. Practice outside Ontario if you can.  Ontario can go down in flames. I will certainly be watching from elsewhere. Maybe 10-20 years from now we will see a more functional province...

 

Globally we have entered into an era where provincially, federally, and globally, leadership is often very very weak and misinformed. We will probably spend the rest of our better years cleaning up the mess that is being made right now, and this goes far beyond the PSA issue.

[shady]

This whole issue is a mess. I take no side. OMA / COD, whatever... The source of the problems is the joke Liberal provincial government. 

 

The definitive fix is changing the provincial government or leaving the province. All resources should be put towards changing the provincial government and shoring up public opinion towards this aim. The Liberals are just the worst. Anyone that is awake and not brainwashed can put these facts together. Ontario is such a damn mess; it's unbelievable. The whole place is well on its way towards becoming a Canadian version of Michigan. 

 

If you like to control your fate, I suggest getting off the "Ontario ship" before it hits the inevitable iceberg. Do your training outside Ontario if you can. Practice outside Ontario if you can.  Ontario can burn. Maybe something better will emerge from the ashes?

 

Globally we have entered into an era where provincially, federally, and globally, leadership is often very very weak and misinformed. We will probably spend the rest of our better years cleaning up the mess that is being made right now, and this goes far beyond the PSA issue.

 

With all do respect, I think this is hyperbole.

 

Just because there is a labour dispute between doctors and the province doesn't mean the whole place will burn. Personally, I'm not prepared to jump ship on my home province.

 

I love pay raises as much as the next person, but I'm not gonna uproot myself for a 7% cut in pay. There are more important things in life

[NLengr]

With all do respect, I think this is hyperbole.

 

Just because there is a labour dispute between doctors and the province doesn't mean the whole place will burn. Personally, I'm not prepared to jump ship on my home province.

 

I love pay raises as much as the next person, but I'm not gonna uproot myself for a 7% cut in pay. There are more important things in life

It's not just a labour dispute. The entire province of Ontario is an economic and financial disaster right now and unfortunately the Liberal government has done sweet fuck all to solve any of the problems. They've left a train of scandal, excessive spending and mismanagement across the province. The sooner they're gone, the better for everyone in the country.

[NLengr]

Problems arise when the alternative is this. http://www.theglobeandmail.com/news/national/ontario-pc-leader-patrick-brown-promises-to-scrap-sex-ed-curriculum/article31583258/

 

And we aren't even in election season yet! As much as I dislike Hoskins, I shudder when I think of what other social policies the conservatives have up their sleeve

You guys have an NDP party too. It's not a two party system. If you dont like the conservatives, you could vote NDP.

[ralk]

With all do respect, I think this is hyperbole.

 

Just because there is a labour dispute between doctors and the province doesn't mean the whole place will burn. Personally, I'm not prepared to jump ship on my home province.

 

I love pay raises as much as the next person, but I'm not gonna uproot myself for a 7% cut in pay. There are more important things in life

 

Keep in mind that a 7% cut in real terms is exactly what the OMA offered in the negotiations and is something I think most physicians would have readily accepted. What the Ontario government has imposed for the last two years, then offered in the tPSA is a deeper cut than that, especially if the utilization projections end up being overly optimistic.

 

Even then, if the tPSA had simply been a vote to reduce physician salaries by a significant amount, no other strings attached (binding arbitration in subsequent negotiations, no clawbacks associated with an arbitrary global physician budget), I probably would have voted for it. I'm not sure how likely such a deal would have been to passing, but the issue here extends far beyond a straight-forward pay cut. I voted against the tPSA - and strongly oppose the government's framework for unilateral actions - not because of what they do for the next 4 years, but because what they have the potential to do for the next 20 years beyond that. Regardless of its short-term effects on physician salary, a global physician cap with clawbacks is just bad economic policy - the incentives it provides would cause major issues for our healthcare system in the medium- to long-term.

 

Despite this, I'm not leaving the province either. We've had bad provincial governments before, we will again, but we survive. Every other province has their share of terrible governments too, the grass isn't greener everywhere else. More importantly, while the Wynne government has made some terrible, terrible decisions, their mistakes are recoverable. I hold out little hope that any replacement government - conservative or otherwise - will be a bastion of good policy-making. However, I expect their mistakes will be different and I'm hopeful that on this issue at least, their policies will be less damaging in the long-term. And when the next government brings out terrible policies in other areas - such as regressive social policy - I'll happily fight against those. Still, I'm not going to become complicit in a terrible policy now because I'm worried about what stupid things the next group will do.

[ralk]

Minister Hoskins' letter to the OMA: https://news.ontario.ca/mohltc/en/2016/08/minister-hoskins-letter-to-oma.html

 

Thoughts?

 

Well, you can tell he's a full-on politician. I do love the deep concern for the poor Family Physicians (who made up a significant portion of the "No" vote) being oppressed by the rich, over-earning specialists. Though that concern might have held more weight if FM hadn't been one of the specialties hit harder by the unilateral cuts... I guess more recent cuts have been more targeted to higher-earning specialties, though these haven't exactly shielded FM either and they come only after FM was hit hard in the initial round of unilateral cuts.

[shady]

You guys have an NDP party too. It's not a two party system. If you dont like the conservatives, you could vote NDP.

NDP was not pro doctors in the last dispute. Only the conservatives were

[NLengr]

NDP was not pro doctors in the last dispute. Only the conservatives were

I meant more from an overall alternative to the liberals, not so much regarding physicians. Besides, the NDP can't be anymore hostile to docs and at this point aren't scandal plagued disasters.

[rogerroger]

Keep in mind that a 7% cut in real terms is exactly what the OMA offered in the negotiations and is something I think most physicians would have readily accepted. What the Ontario government has imposed for the last two years, then offered in the tPSA is a deeper cut than that, especially if the utilization projections end up being overly optimistic.

 

Even then, if the tPSA had simply been a vote to reduce physician salaries by a significant amount, no other strings attached (binding arbitration in subsequent negotiations, no clawbacks associated with an arbitrary global physician budget), I probably would have voted for it. I'm not sure how likely such a deal would have been to passing, but the issue here extends far beyond a straight-forward pay cut. I voted against the tPSA - and strongly oppose the government's framework for unilateral actions - not because of what they do for the next 4 years, but because what they have the potential to do for the next 20 years beyond that. Regardless of its short-term effects on physician salary, a global physician cap with clawbacks is just bad economic policy - the incentives it provides would cause major issues for our healthcare system in the medium- to long-term.

 

Despite this, I'm not leaving the province either. We've had bad provincial governments before, we will again, but we survive. Every other province has their share of terrible governments too, the grass isn't greener everywhere else. More importantly, while the Wynne government has made some terrible, terrible decisions, their mistakes are recoverable. I hold out little hope that any replacement government - conservative or otherwise - will be a bastion of good policy-making. However, I expect their mistakes will be different and I'm hopeful that on this issue at least, their policies will be less damaging in the long-term. And when the next government brings out terrible policies in other areas - such as regressive social policy - I'll happily fight against those. Still, I'm not going to become complicit in a terrible policy now because I'm worried about what stupid things the next group will do.

 

 

10% of every Ontario tax dollar is now used to pay the INTEREST on the provincial debt which currently stands at $315 billion with no plans to do anything but accumulate more debt for the foreseeable future. Every Ontario resident has $22,000 of provincial debt. Let's remember, Ontario is now the most indebted sub-sovereign borrower in the world, yes, the entire world. Ontario has twice the debt of California... Interestingly, the Liberals, in their infinite wisdom are open in saying they plan to add another $50 billion to this debt by 2019. Seriously??? Something has got to give, if not now, then tomorrow.

 

Health care is the biggest portion of the provincial budget accounting for nearly 40% of everything spent. Yeah, I don't see anything bright or optimistic about this picture. You are looking at a generation worth of cuts in Ontario with health care taking the brunt. There is no way to avoid this. The only choice in Ontario is which poison you want to take. Stormy decades ahead for Ontario no matter who is elected. 13 years of Liberal mismanagement are now catching up to Ontario. 

 

The only choice is the Conservatives. They are at least warm towards doctors. But don't fool yourself, cuts are coming in some shape or form, there is no choice, even with thr Conservatives at the helm. The place is an economic basket case. The only difference is that cuts under the conservatives might come from other parts of the budget. 

 

The NDP are just the worst. Sure, maybe they have an advocacy role, but never ever should be let anywhere close to unrestricted access to funds. If you elect the NDP that is basically the equivalent of Ontario committing economic suicide. Let's review the evidence. The NDP has one consistent economic record, creating budgetary messes on a grand scale within a remarkably short period of time. They are experts at this. Just take a look at their recent "work" in Alberta and their efforts in Ontario in the early 1990s if you doubt this... Let's not forget that the only time an NDP government was elected in Ontario resulted in the provincial debt being doubled in 1 term. The last people you ever want making critical economic decisions are the NDP, full stop.

 

People often forget that governments should only do two things. The moment a government goes beyond these two things they are screwing up. The first thing is to spend taxpayer money wisely and not incur unneeded debt. This way constituents are taxed minimally and can have the freedom to spend their own money without interference from talking head politicians. The second is to provide safety and to maximize the potential of their constituents. Ontario has failed repeatedly on both fronts. First by spending like a bunch of fools and incurring huge interest payments. Second, by making services such as health care prop up the costs of these numerous mistakes. Things such as the cool $2.5 billion spent on the Pam Am games last summer or the $1 billion burned on canceling the construction of power plants comes to mind as an example of how poorly Ontario is run... It's a gong show.

 

I'm just thankful the choice to eject from Ontario exists. This is not a short-term problem. The PSA issue is only the opening act in a decade-plus struggle that is starting. If you are in the position to put you tax money and your hard work elsewhere consider it, explore your options. 

[rogerroger]

Minister Hoskins' letter to the OMA: https://news.ontario.ca/mohltc/en/2016/08/minister-hoskins-letter-to-oma.html

 

Thoughts?

 

I look forward to seeing where Hoskins ends up after his stint as MOH is over, with him being so popular it should be interesting. 

[ralk]

10% of every Ontario tax dollar is now used to pay the INTEREST on the provincial debt which currently stands at $315 billion with no plans to do anything but accumulate more debt for the foreseeable future. Every Ontario resident has $22,000 of provincial debt. Let's remember, Ontario is now the most indebted sub-sovereign borrower in the world, yes, the entire world. Ontario has twice the debt of California... Interestingly, the Liberals, in their infinite wisdom are open in saying they plan to add another $50 billion to this debt by 2019. Seriously??? Something has got to give, if not now, then tomorrow.

 

Health care is the biggest portion of the provincial budget accounting for nearly 40% of everything spent. Yeah, I don't see anything bright or optimistic about this picture. You are looking at a generation worth of cuts in Ontario with health care taking the brunt. There is no way to avoid this. The only choice in Ontario is which poison you want to take. Stormy decades ahead for Ontario no matter who is elected. 13 years of Liberal mismanagement are now catching up to Ontario. 

 

The only choice is the Conservatives. They are at least warm towards doctors. But don't fool yourself, cuts are coming in some shape or form, there is no choice. The place is an economic basket case. The only difference is that cuts under the conservatives might come from other parts of the budget. 

 

The NDP are just the worst. Sure, maybe they have an advocacy role, but never ever should be let anywhere close to unrestricted access to funds. If you elect the NDP that is basically the equivalent of Ontario committing economic suicide. Let's review the evidence. The NDP has one consistent economic record, creating budgetary messes on a grand scale within a remarkably short period of time. They are experts at this. Just take a look at their recent "work" in Alberta and their efforts in Ontario in the early 1990s if you doubt this... Let's not forget that the only time an NDP government was elected in Ontario resulted in the provincial debt being doubled in 1 term. The last people you ever want making critical economic decisions are the NDP, full stop.

 

People often forget that governments should only do two things. The moment a government goes beyond these two things they are screwing up. The first thing is to spend taxpayer money wisely and not incur unneeded debt. This way constituents are taxed minimally and can have the freedom to spend their own money without interference from talking head politicians. The second is to provide safety and to maximize the potential of their constituents. Ontario has failed repeatedly on both fronts. First by spending like a bunch of fools and incurring huge interest payments. Second, by making services such as health care prop up the costs of these numerous mistakes. Things such as the cool $2.5 billion spent on the Pam Am games last summer or the $1 billion burned on canceling the construction of power plants comes to mind as an example of how poorly Ontario is run... It's a gong show.

 

I'm just thankful the choice to eject from Ontario exists. If you are in the position to consider it, I strongly suggest you explore the options.

 

Well, Ontario isn't the most indebted sub-sovereign borrower in the world. Not even the most indebted in Canada. That dubious distinction goes to Quebec, which has a higher debt-to-GDP ratio and a higher debt-per-capita level. It's absolute levels of debt are smaller, but it's a smaller province both in terms of population and GDP. US states are a poor comparison when it comes to debt, as they have vastly different regulatory frameworks, borrowing authority, and accounting practices. California, for example, has extensive unfunded liabilities (Ontario has some as well, but not nearly to the same extent). There's a reason that despite overall higher debt, Ontario is able to finance that debt at a notably cheaper rate than California.

 

The situation still isn't good, far from it, but the sky is not yet falling. We do need to take steps to address the province's high debt-to-GDP ratio, both on the spending and revenue sides. With a reasonably competent government, that could be done with a minimum of true pain, though I agree that "reasonably competent" part is unlikely to happen any time soon. Healthcare is going to have to be cut as part of any debt-reduction strategy. Again, that doesn't necessarily have to be painful, as there is mountains of inefficiency and wasted spending in our healthcare system which should be addressed. Some of that wasted spending goes to physicians and, despite my strong opposition to the tPSA and the current unilateral cuts, I'm in absolute favour of reducing physician compensation where it makes economic sense.

 

Even with the inevitability of some mismanagement, none of the above prospects scare me to the point of even considering leaving the province. Physicians in Ontario are still reasonably well-compensated, taxation levels are still quite reasonable when you compare to other provinces, and the overall quality of healthcare - while it could be much better - is still pretty good. Now, because I'm hoping to into FM, I will likely have the luxury of portability that other physicians may not due to job markets, infrastructure requirements, etc. If things get terrible in a hurry, I'm happy to have the option to leave Ontario. Still, I see no reason to panic at this stage and I'd much rather focus on pushing for competent policy-making, then on running away from incompetent policy-making - because let's face it, it's not just Ontario where politicians suck at their jobs, and I have no expectation that the grass would be greener anywhere else.