The wrong response to Bill 210 and LHIN engagement sessions

Today, we received the much anticipated response to Bill 210 from the OMA. While the analysis, prepared by Peter Brown and Leianne Musselman from the OMA Health Policy Department, does go through the entire bill and list the various possible areas of impact on physicians, there is no corresponding opinion from OMA leadership regarding the likely or possible implications of these areas of impact. We, as OMA members, are left to ponder the possible ways in which this bill may affect our practice, if it passes into law. Indeed, the harshest condemnation of the analysis is reserved for the areas in which the proposed law contravenes the Representation Rights Agreement (RRA), which protects physicians from direct negotiations with the LHINs or the MOH. In these cases, the analysis is quite clear and firm.

Perhaps a more focused reaction will be forthcoming from the OMA. So far, the main reaction, apart from threats to protect the provisions of the RRA, seems to be to actually encourage members to attend LHIN “consultation” sessions across the province. The OMA is going so far as to provide “toolkits” to members who attend these sessions, so that they can “raise questions and concerns” and report back to the OMA on the content of these meetings.

I feel this is the wrong approach to both the bill and the LHINs.

Firstly, apart from the RRA concerns, the OMA must be seen to take a stand on Bill 210. While there may be areas that are of little concern to physicians directly, the question is: Is this the direction that is likely to lead to improvement in our health care system? If not, why not? Making an analysis available without opinion leaves the impression that the OMA Board feels individual doctors should decide for themselves, and let the chips fall where they may. While I agree that we should all analyze the Bill to determine its effect on our own practices, our patients and our own professional lives, there is a bigger picture here. The control that the LHINs will have over physicians working in a FHT or hospice is extremely concerning. The fact that the Minister can add “any other person or entity or class of persons or entities that is prescribed” to the list of controlled persons/entities, means that no practice is truly immune to the intrusive and controlling provisions of this bill. Without a strong direction, physicians will exert very little influence on improving or changing this proposed legislation.

The other concerning section in the legal analysis is Heading 11: Sub-LHIN. This section implies that the OMA is surrendering any opposition to the exponential increase in administrative bloat in the health care system. In fact, it seems that the OMA is looking forward to exploiting the increased availability of “physician leader” roles despite having been proved so far to be ineffectual and non-influential:  The OMA analysis states: “Defining the boundaries of the sub-LHIN, the planning authority, governance structure and physician leadership opportunities are key areas of interest for the OMA and work is underway to identify opportunities that exist to ensure that physicians play a key role in shaping this approach to local health service planning.” So here we can see that the OMA will not oppose the expansion of the bureaucracy, which will suck ever more money away from front-line provision of care, and the Association will take part in developing these superfluous administrative structures that will grow and grow as we have seen over the last decade of the LHIN era.

Regarding the OMA comments on the ongoing LHIN “consultation” sessions, why don’t we call these what they truly are: a sham. The LHIN “engagement” sessions prior to the release of Bill 210 were quite obviously a sham (point out one change made to Bill 210 due to physician feedback), and the consultations done during the development of the Price-Baker report were….wait, oh yeah there weren’t any. What we do see, for example in the report of the Central LHIN, is that these organizations are claiming that dozens of physicians were involved in the production of a progress report to be used as the basis for implementation of Bill 210. The fact is that most of these physicians attended meetings for one reason: to “raise questions and concerns” about the Price-Baker report. Oh, and also, they did it for free. Why do we want to keep going back to these sessions, where well-paid bureaucrats sit smiling and dutifully recording physicians’ comments, which are then filed under “Irrelevant” back at the office. Based on past experience, these ongoing sessions provide no benefit to physicians: No changes will occur based on our feedback. No collaboration with the OMA will occur regardless of how many physicians “report back” the goings-on at these meetings. What will happen is that physicians will collectively donate huge amounts of time, representing tens of thousands of dollars in unpaid consultation services, for nothing.*For calculations, see below*

What do I advocate?

  1. A deeper and more relevant analysis of Bill 210 to identify for physicians the ways that this Bill will impact their autonomy, their physician-patient relationships, their control over their professional life, along with a financial analysis of the likely increased cost to the system to implement these changes.
  2. An opinion or series of clear opinions about the bill that can be clearly communicated to the media and our patients: What is good? What is bad? What suggestions do we have? It might be a good idea to consult with the Section of General and Family Practice regarding these opinions.
  3. Strongly advocate membership to refuse to participate in any further planning/engagement/consultation sessions with the LHINs in the setting of the current power imbalance between the government and the profession. Clearly state that negotiating Bill 210 in the absence of a fairly negotiated PSA (and the establishment of binding dispute resolution) goes against the interests of Ontario’s physicians. Make it clear that the OMA will advise all of its members to not cooperate with the planning or implementation of any of these changes until a PSA is reached and the major concerns we have with the scheme are addressed adequately.
  4. Publicize the government’s plan to expand spending on administration and the effect this will have on the PSB and hospital budgets in this era of “net zero” budgeting. This should be a no-brainer.
  5. Get political. Provide any interested politician or political party with the tools needed to fight this ill-conceived bill. Stand side by side with those who will publicly commit to protecting our health care system and who will acknowledge that without physicians’ true and valued input, the system will continue to flounder, patients will continue to die waiting for needed treatment, families will continue to struggle with inadequate resources to care for loved ones, and all health care providers will continue to bear the burden of trying to stay afloat under the heaving bureaucracy.

And for those of you who espouse the “if you aren’t at the table, then you’re on the menu” philosophy, I have news for you: Physicians are on the menu. They ARE the menu. Sitting at the table will not alter that, but you might just get caught snacking on one of your friends.





*(77 physicians consulted with Central LHIN. If we assume 2 hours per physician, this is 154 hours. Meeting honorarium for OMA committees is currently $114/hr plus travel, but lets forget travel: the time itself amounts to $17,556. Multiply by 14 LHINs and that gives a very conservative estimate of $250,000 that has already been donated. This is a fraction of what will be expected before the Bill is passed and forever after.)



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