Blessed Are the Peace Makers……

I’ve done something that not a lot of doctors have done.  I’ve negotiated two $11 Billion dollar contracts.

I didn’t do it by myself of course.  I was part of a team that negotiated those contracts.  But I was the team leader, the Chair of the Negotiations Committee that negotiated those contracts.  Both times it was a lot of work.  There was a lot of stress.  I didn’t eat properly, I didn’t sleep properly.  I didn’t exercise properly.

And the whole time I was negotiating I had to run a family practice with 2,000 rostered patients.  In 2008, I spent almost 150 days in negotiations.  I may be cheating in my count.  On those days when i negotiated from 0800 to 2000, I counted it as a day and a half.  One time the members of my team, including current OMA President Mike Toth sat at the table from 8 in the morning till 3 at night.  We counted that as 4 half days or 2 full days.  Weird math but that’s how we accounted for our time.

And do you know what the toughest part of both sets of negotiations was?  It was saying “YES”.

In 2008 we got a great deal.  Our members were happy with the rate increases.  We addressed, but did not solve relativity.  We made commitments to improve patient care, attach family doctors with unattached patients and Improve community mental health medical services.  The Government seemed happy with the agreement at the time too, but shortly after our agreement, the world underwent an economic meltdown and the Province’s budget went from surplus to deficit.

In 2012 we had to face the Province’s fiscal challenge.  We did that by finding $850 million dollars in evidence based savings that did not have a negative impact on patient care.  We stopped paying for things that cost a lot but that were not improving quality.  For instance we stopped paying for annual physicals for adults 19-64.  We saved some money and improved care.

It sounds counter-intuitive but it can be done by looking at evidence, engaging clinical experts and working together to improve the way we deliver care.

Most people will understand that it was hard to say ‘yes’ to the 2012 agreement.  It was a negative deal for doctors.  But I can tell you that it was just as hard to be the one who said ‘yes’ in 2008.  It’s a lot of pressure to speak for 30 thousand colleagues.

It’s very easy to say no.  in negotiations it’s often the path of least resistance.  Unfortunately if solves nothing.  At the end of the day there is no agreement and no way forward.  There is no way to work together to improve patient care.

I’m sure it’s the same for the Government.  It’s easy to say no for them as well.  In fact it’s very easy because they have the Legislature of Ontario behind them and they can change laws and regulations.  By saying no in October 2015, they get everything they want fiscally.

However, they do not get a healthy, productive relationship with physicians.  Whether they respect physicians like they say they do or whether they regard us a cogs in a vast machine that they control from Queen’s Park they miss the chance to work with fabulous, dedicated and very smart people who only want to be able to care for their patients as well as they can.

At some point people from each side are going to have to realize that we are much stronger together than we ever are apart.

Someone will have to make Peace.

Scott Douglas Wooder, MD


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