Minister Preaches Transparency but Practices Something Else

On March 26 Jeff Yurek asked Ontario Minister of Health, Eric Hoskins about negotiations with the OMA. Mr. Yurek seems concerned about the future of Family Medicine in this Province. He knows that the Minister has slashed fees to all physicians, but his treatment of family physicians, especially new graduates, has been especially harsh.

Amongst other things, the Minister will not allow new physicians to join capitated practices- FHOs except in certain as yet undefined areas. Since hundreds of young physicians will finish their residency programs on June 30, they would like to know were they will be allowed to set up shop in a team friendly environment.

Minister Hoskins repeated his assertion that family physicians can practice wherever they want, just not in FHOs and not in Family Health Teams. They are free to work in walk-in clinics or set up fee-for-service practices. That’s fine I suppose but this is the same government that has had a policy of discouraging fee-for-service for the last 15 years.

Minister Hoskins went on the say, in the Legislature: “what I will say to the member opposite is that the OMA negotiations were about one thing and one thing only: They were about physician remuneration. They were about the amount of dollars that physicians in this province earn.”

Well this is certainly news to me. I helped negotiate OMA-MOH contracts in 2004, 2008 and 2012. In 2008 I was Chair of the OMA negotiations committee and in 2012 I was Co-Chair. I always thought we were trying to put in place a better system. We were trying to remove barriers to care. We were trying to make things better for our patients.

Let’s look at the actual language in these contracts.

“AND WHEREAS the OMA and Minister wish to continue to work together in a relationship based upon mutual respect, trust, consultation and co-operation in order to improve health care in the Province of Ontario:”

That is one of the whereases, the statements of agreed upon principles between the parties.

That language is found in both the 2004 and the 2008 agreements. In 2012 we negotiated a perpetual Representation Rights Agreement and you guessed it the exact same language is in there too. We commit to “improve health care in Ontario”. The Minister never informed the OMA that he was abandoning the notion of improving the system to concentrate solely on money. It would have been nice to know ahead of time that they were abandoning their principles and their contractual commitments.

What else is in these agreements?

We negotiated stable hospital on call arrangements. We negotiated funding for 500 primary care nurses at a total cost of 40 million dollars annually. That’s money that goes to nurses, not doctors. We negotiated Primary Care Reform. We stabilized the Academic community so that research and teaching could be done for the benefit of us all. I could go on for pages about the things we agreed to that  concentrated on making things better for our patients.

The OMA committed to finding a family doctor for minimum of 500,000 unattached people.  We found medical homes for well over a million people.  Too many it seems now as the Minster is loudly complaining about the increased costs.

These items were about improving the health care system; they were not about the dollars that physicians earn.

And whom did the Minister appoint to his latest Negotiations team. Doctor Kevin Smith, a prominent hospital CEO led the Ministry team in 2014. Professor David Price, a nationally recognized expert on primary care, joined him. In fact David co-Chairs the Minster’s Expert panel on Primary Care.

I know both Kevin and David well. I have a lot of respect for both of them. But you don’t use that much brainpower and stature to negotiate dollars and cents. You use them because you know that negotiations between doctors the government is a golden opportunity to transform care.

That opportunity was wasted in 2014/2015.

So why is the Minister telling an opposition MPP in the Legislature that negotiations with the province’s doctors is only about money when it is clearly about so much more? Is he afraid to admit that he failed in one of his most basic jobs as minister?

I don’t know. You’ll have to ask the Minister.

If I were Mr. Yurek I would be wondering if the Minister was being completely transparent in his answers.

Scott Douglas Wooder, MD