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Government must engage with physicians to ensure the future of Ontario Healthcare

When the current impasse between the OMA and Ontario Ministry of Health started in January I wrote an early response. Fundamentally the  healthcare system in which we work and try to improve and build upon is in need of repair. A public that assumes that 'free healthcare' can continue in a form unchanged from the 1980s gives a cynical and complacent government the fuel to try and carry on and vilify one of the system's most important elements (physicians) in the process. I have written about this complacency before.  Most physicians understand the current fiscal reality and are ready to be active partners in building the best health care system into the future. Current frustration lies in the lack of willingness of our current provincial government to engage. Government sponsored initiatives such as the Naylor report at the federal level have highlighted that a fundamental re-think of Canadian healthcare is necessary. Simply invoking clawbacks to deal with budgetary issues seems short-sighted and will ultimately fail the public.  Protecting the long-term health of our universally accessible healthcare system will require a mature and thoughtful debate.

Physicians understand the healthcare system.  Their patients trust them during times of great stress and need.   They have many thoughtful ideas on how to manage our current fiscal issues in PARTNERSHIP.  They are committed to a fully funded and excellent public healthcare system.   Please engage them.

I thought I would share a note from one of my talented and hard-working colleagues at TEGH, sent to Kathleen Wynne. He expresses the profession's current frustration as well as the yearning desire to be part of the solution in a manner as good as any I have seen over the last 9 months.

There is a way forward but a respectful mutually inclusive dialogue will be needed.

Here are Dr Warner's thoughts.  Comments welcome.

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Dear Ms. Wynne,

I just called your constituency office and the person who answered the phone asked that I formalize my feedback via email.
I live on a street in your riding. I voted for you.

I am an intensive care unit physician.

I make a good living and feel fortunate to be doing something I love.

I have never reached out politically before, but the move by the Liberal Government to impose cuts to fee for service (and other) compensation without warning or transparency, is egregious.
Furthermore, physicians have not been told when future claw-backs will occur, or how they will be implemented/calculated.

Your job is to get re-elected and balance the budget.

My job is to take care of patients and, in an ideal situation, work with government to improve the health care system.
I have an MBA…..I am 36 and the head of my department….I am the type of guy you want working with you to make things better.
Unfortunately, your latest move has served to alienate your most important allies in reforming the health care system, physicians.

We both know that my pay has not increased by 61% since 2003. We know that that aggregate budget for physician services may have increased by this amount, but the number of physicians has also increased along with Ontario’s population.
The minimum wage has increased by 64% over the same period of time and MPP remuneration has increased by 66%. Please stop using the numbers in a disingenuous way to make me and my colleagues appear greedy. It is really hurtful.

We also know that gross income is not equal to net income. When we discuss teacher or MPP remuneration, we talk about net income ie. The value of pensions and benefits are not included.
You and Eric Hoskins continue to quote gross income to make us look better compensated than we really are.

Overall, your tactics are very disappointing.
Given the skill set of Drs. Hoskins and Bell, you had a great opportunity to use these brains to make real, systemic changes to the healthcare system which could lead to long-term cost savings.
Instead, you have decided to play politics with a group of highly capable and motivated people by portraying them as entitled.
The future of health care in Ontario will be forever harmed by your tactics.

Please stop using the numbers in a misleading way.
Please allow us the dignity of participating in binding arbitration.
Please be transparent today about what claw-backs will really look like at the end of the fiscal year.

Sincerely,
Michael Warner

Michael Warner, MD, FRCPC, MBA
Medical Director, Critical Care Services
Head, Division of Critical Care
Toronto East General Hospital
Lecturer, Department of Medicine,
University of Toronto