tPSA Aftermath: Where do we stand now?

August 23, 2016 by | 4 comments

After the storm...

After the storm…

On August 14, 2016, for the second time in its history, the Ontario Medical Association (OMA) held a General Meeting of its members. This was a historic opportunity for the physician community to come together to debate the merits and shortfalls of the tentative Physician’s Services Agreement (tPSA) which was preceded by a comprehensive and balanced set of emails, teleconferences, and community meetings to allow for an informed vote. Ultimately, 55% of all OMA members cast a vote either in person or by proxy with 63.1% voting against ratification. In the immediate aftermath of this decision, both the membership and leadership came together to set a comprehensive contingency plan in motion to ensure that physicians remained united in their calls for adequate funding for sustainable high quality patient care…


If only…

Legal challenges, infighting, robo-calls, and a constant bombardment of one-sided emails flooded the inboxes of members from both sides of the debate. High stakes, high emotions, and all highly frustrating.


So who won? Likely nobody. The dust is still settling, but it’s clear that the government didn’t make the ‘doctor situation’ go away, the OMA will have to grapple with rebuilding members’ trust and respect amidst calls for high-level resignations, and the membership itself remains largely fragmented. Concerned Ontario Doctors (COD), the grassroots advocacy and engagement group that successfully rallied many physician members against the government cuts, also faces an important existential crisis in the aftermath of a successful “No” vote that saw the creation of a confusingly named and somewhat opaque Coalition of Ontario Doctors. Essentially all physicians, on both sides of the debate, are scrambling to get re-organized.

So where are we now? Whether you voted for or against the agreement we are all in the same boat: No contract. In fact we should all recognize that we are, and always have been, on the same side; while there was disagreement on the tPSA, we all care about high quality and sustainable patient care, and we all want a fair and transparent negotiations process. The OMA has been given clear direction to seek binding arbitration as a necessary component of any future negotiations, but it won’t happen overnight and only represents one component of a complex process. In fact, it may be many months before any new negotiations take place.


So what happens next? I humbly suggest:

1) Get involved: I wrote about this in the fall and it holds true today: there is no better time to get involved in the OMA.

Warts and all, the OMA is our best opportunity for a unified physician voice and change is most likely to happen from within. Flood the committees and elections with both names and ideas, and push for transparency and accountability.


2) Get loud: You’re angry. I’m angry. The media is often missing the key reasons for why (whether purposefully or not). Letters to the editor, Op-eds, blogs, etc. are all ways to start to change the message. If you’re not writing the message, then you should be spreading it.

2b) Get on message: The caveat to #2 is that unified messaging is more effective. We see it clearly in the sound bites from government that get high media uptake and resonate with the public: Doctors and money. We need to change the discussion to patients, healthcare funding, and high quality care. As frustrating as it is, emphasizing the impact of cuts on income, no matter how eloquent or how true it may be, is still all about doctors and money and is playing to the ministry’s messaging. Patients, care, funding.


3) Get realistic: There are problems with our healthcare system, and while many are outside of our control, some of them, whether we like it or not, are rooted within the physician realm. What is physician accountability? What is it supposed to look like? Should we be defining and implementing it, or should we wait for someone else to impose it?

What about bullying? Burnout? Physician supply and distribution? In each case, we are both well positioned to come up with potential solutions and at direct risk of outside interference if we do not. Take the elephant-in-the-room of relativity: The OMA has grappled unsuccessfully with this almost impossible issue (a fascinating and frustrating history worthy of its own post), and has often been blocked by motivated sections at risk of seeing cuts. The government has trumpeted this as an example of inappropriate compensation and self-management, and in the absence of an agreement, will likely make unilateral changes that could very well be entirely disconnected from the realities of clinical practice. I suggest we proactively own these problems instead of retroactively protesting the imposed outcomes.


4) Forgive: Lastly, we have to move on. Emotions ran high, and while much of the debate for ‘Yes’ or ‘No’ was respectful, some of it was vitriolic, dishonest, and downright unprofessional. It was a shame that some of the most productive and engaged debate our profession has ever seen was overshadowed by some of the ugliest behaviours. By all means I think we must address the process that brought us the tPSA and work to heal the divisions within our ranks, but we must also loudly condemn personal attacks that do nothing to advance or improve our collective voice.


But maybe I am just too “young and idealistic”…


Photo credit: matlacha

About the Author

Taylor Lougheed is a physician in Family and Emergency Medicine, and passionate about sustainable public healthcare, quality improvement and patient safety, medical education, and global health.


  1. Ernie

    I have been watching this process and fallout with great interest from BC, and thank you for your balanced view. My experience has been that divisions within the ranks of physicians are best healed quickly, as governments are not in the business of allowing time for regrouping.
    Good luck to all of my friends and colleagues in Ontario!

  2. Graham

    It was the 14th.
    I direct you to the working proposal, and am interested in your comments.

    • Taylor Lougheed

      Quite right, Graham. I’ve made the change, thank you.
      I have also downloaded the working proposal and will be reading it over. Thank you for your work on this.

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