Unity, Where Art Thou?

Taylor LougheedJanuary 31, 2017 by | 19 comments

Unity

Hands or fists?

At this past weekend’s special OMA council meeting convened to discuss and vote on motions of non-confidence in the board and the removal of the board executive, the word ‘unity’ made a surprisingly frequent appearance. By my rough estimate, it was mentioned at least 200 times by both sides of the impassioned debate. When you have to mention something this often, it becomes quite clear that you don’t have it. To be sure, it actually seemed like everyone who took to the mic agreed that we are a divided profession and that it is necessary to come together as a unified force against the ongoing hostile government actions. How to achieve such unity however, was the source of much debate, and some colourful language. Some clearly felt that we needed to stop hamstringing the OMA with a stream of special meetings – two held within the last year is unprecedented, costly, and detracts from ongoing work. Others felt that current leadership were no longer the ones to lead the OMA forward, having lost the support of the membership after a one-sided, expensive, failed tPSA campaign and ongoing poor progress with a belligerent government. Whether the way forward was with existing leadership or new leadership everyone seemed to feel their way would lead to more of this rather elusive ‘unity’. But unity doesn’t just grow on a tree or come in an e-mail. You can’t just wake up one morning and have a mug of physician unity. So for all of this talk about coming together, the meeting actually achieved the worst possible outcome. Instead of providing a clear ‘yay’ or ‘nay’ to a way forward, we are left with this terribly muddied water where a board has lost the confidence of council, but an executive that has survived ouster. A clear direction either way could have been leveraged into a form of temporary unity (a la “council has provided clear direction, let’s get on with the task at hand”). The result is that we ended up just exposing to everyone just how exactly divided we truly are. Whether you voted for ‘new blood’ or for ‘old blood’ we may just be left with ‘bad blood’.

What has been most interesting to me, however, is how surprised everyone is by this growing chasm in the profession. Perhaps I missed the golden era of medicine, but at no point in my early career have I ever appreciated a fully functional medical farm for all of the disparate silos. As a medical student the first OMA meeting I attended was following contract negotiations. The bitterness and division in the room as the pie was fought over was very eye opening. Have no doubt: I am incensed by the hostile government actions. I am frustrated with the OMA having to transform itself in the midst of a crisis. But the blame for our division is shared broadly. The day a supervisor in medical school suggested a student is ‘too smart’ for family medicine was the day we divided. The day a colleague disparaged an orthopaedic colleague for ‘not knowing medicine’ was the day we divided. The day we decided one colleague’s yearly worth was three times more than another’s, was the day we divided. We are being forced to confront the shifting sands around us: Medicine has changed dramatically over the last 10-20 years, and patient expectations with it. We are collectively dealing with a redefining of our roles, attacks on our autonomy, decreased perceptions of respect, all on top of the unilateral cuts. These issues barely leave any space on our collective plates to even consider addressing that old monster of relativity. We have been ignoring these powder keg issues within our profession for far too long, and now they are being used against us. The fact that the government is able to needle us for grotesque wage gaps, is because we let these gaps continue to exist. The fact that they can forcefully redefine our roles, is because we haven’t redefined ourselves. We are the only attendees at our own horse buggy convention.

So where do we go from here?

First, the special council was called legally and the outcome was democratically achieved. It’s over. You can agree or disagree with how it came about or the outcome, but what is rather clear to me is that the continued sabre rattling from other discontented groups is counterproductive. OMA elections are right around the corner, and they’re going to be more contested than perhaps any time in the organization’s history. Let’s elect representatives that work toward a new and revitalized OMA.

Second, the government is continuing to carry out an aggressive mandate hostile to physicians. Doctors are an integral and defining part of a functional healthcare system and have to be partners in system reform. Where is the line in the sand for job action? Doctors who previously weren’t charging patients for refills or work notes, have started. Others are posting signs, or completing time consuming paperwork with the patient present. Sections are starting to propose their members withdraw from government and LHIN consultations. The last and most distressing option is concerted job-action with selective withdrawal of services. The government, doctors, and patients will all be losers in such a scenario, and are now locked into a massive game of chicken. It is certainly clear that the government will not budge without a significant political threat being effectively wielded. Will we wield it? Will you?

Third, we should recognize that the biggest threat to our profession is not changing in a time of change. The government’s actions are the most distressing because they challenge our current perception of what medicine is. If you poll patients you will find that they are now defining medicine differently than we are. We can debate patient accountability1 and unnecessary access until we’re all red in the face – but in our current divided form we will most certainly not win this fight. The time for us to ask the difficult questions of ourselves is long past due. Are we practicing to scope? If not, how do we support each other in achieving that? How do we appropriately define delegation of tasks to other qualified professionals? What is ‘fair compensation’? Can we respect the roles that each of us play within our system? ’Tradition’ or ‘the way it has always been done’ are not appropriate defences against an ever-changing world. If we do not do the heavy lifting and position ourselves for where medicine is heading, I can guarantee that others will continue to do it for us.

 

New to NonNocere? Read a related post, share with a colleague, or leave a comment!

Photo credit: Steve Spinks

Taylor Lougheed

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. http://nonnocere.ca/2016/02/missing-ingredient/

19 Comments

  1. Ontario Doc

    A lot to think about in this post, Taylor. I agree that we are not very united as a profession and maybe have never been. A lot to work on. But first things first is the OMA exec has got to go and we need to get a contract from the government.

    • Taylor Lougheed
      Taylor Lougheed

      Thanks for taking the time to comment, Ontario Doc. I imagine that our divisions may make it difficult or impossible to achieve an agreement with the government that every section is satisfied with. Even looking back at the 2012 agreement shows that certain sections voted against it.

  2. Andrew S

    I’ve never thought of it this way, but you’re right. I’m early in my FM career, and VERY early on could feel the divisions, hidden curriculum, stereotypes. Never really felt that united feeling outside of places like FMF.

    • Taylor Lougheed
      Taylor Lougheed

      Thanks for commenting, Andrew S. It sounds like I’m not alone as an early career physician feeling that there isn’t a lot of professional unity sometimes. I’ve always loved attending FMF, in large part for the opportunity to socialize and catch up with colleagues across the country. Perhaps we’ll meet in Montréal this year!

  3. Fed up

    Great post, but one thing should be emphasized: The exec has got to go!
    Failed tPSA, failed confidence vote, failed leadership.

    • Taylor Lougheed
      Taylor Lougheed

      Thanks for reading and commenting, Fed up. The exec is certainly in an incredibly difficult situation, and I will admit that I do not fully understand (nor am I privy to) the reasons for them staying on.

  4. Dennis Kendel

    Dr.Lougheed demonstrates courage and professional integrity in raising for discussion some of the seeds of division in our profession. I concur with his observation that “the day we decided one colleague’s worth was three times another was the day we divided”. Until we implement a more equitable compensation model for all physicians this huge disparity in earning capacity between colleagues will be a potent wedge between us. We also need to demonstrate collective leadership though physician-led stewardship of the total public budget allocated to healthcare. Take a look at how the medical groups in high preforming system like Kaiser Permanente do this and ask “why could we not do the same” ?

    • Taylor Lougheed
      Taylor Lougheed

      Thank you for taking the time to read and comment, Dennis. I agree with your point about Kaiser Permanente, and think that there is an opportunity for us to learn from a number of other integrated health systems and adopt some of their key successes. In Kaiser Permanente’s case, I am particularly interested in how they have managed to generate an organizational culture of constant quality improvement (which I feel is foundational to the concept of system stewardship).

  5. Darren Cargill

    Well written. Thanks Taylor.

    Please use a bigger font for the more senior members of the profession… 🙂

    • Gerry Goldlist

      Darren, If you have a windows computer, just click Ctrl + and the whole screen gets bigger. If you are using other computers, iphones or laptops, I am sure you can enlarge your own screen. Do a google search until you find a site that addresses your specific device.

    • Taylor Lougheed
      Taylor Lougheed

      Thanks for commenting, Darren! I’ve increased the font for the various posts, so hopefully that will help!
      Adding to what Gerry mentioned below, if you have a Mac computer: command and + or – will increase or decrease the font size in the browser window.

  6. Mamadoc

    I have been in practice for over thirty years and yes, my practice has changed in many ways as knowledge evolves and will continue to do so; that is a fact of life and not earth shattering news. Physicians have had a great deal of responsibility for bringing about change and modernization in medicine.

    I am not ready to let patients define what medicine should be today and in the future without patient accountability and responsibility. I am confronted with demands for various tests and drugs daily as a reflection of modernization and Dr. Google, not to mention the variety of alternative practitioners who contribute to the misinformation with the goal of pleasing the patients.

    Fee relativity is the elephant in the room that needs to be addressed by physicians for physicians, not haphazardly by the minister of health through the medias with semi-vailed accusations of fraudulent billings.

    As for Dr. Kendel’s suggestion that we should perhaps model ourselves on Kaiser Permanente, I would offer that KP is essentially a for-profit corporation, with salaried physicians, that has been criticized for their mental health care, as well as faced criminal and civil charges for patient dumping. KP is not exactly a stellar organization role model for a non-profit government that has continued to deny its physicians binding arbitration.

    The original question was where is unity. I would suggest that there was unity on Sunday January 29, 2017 with 55% voting non-confidence in the OMA leadership. A well-run organization and well-prepared chair would have stopped the meeting immediately and asked the executive to resign voluntarily. That did not happen which is further evidence that knowledgeable and effective leadership is sorely lacking at the OMA.

    • Taylor Lougheed
      Taylor Lougheed

      Thanks for taking the time to read and comment, Mamadoc! I absolutely agree that patient accountability is an essential part of any system discussion – and even wrote about it almost a year ago: http://nonnocere.ca/2016/02/missing-ingredient/
      My argument is that as a divided profession we are not presenting a cohesive alternative definition. While we’re busy getting our own house in order, the ‘new’ definition of on-demand medicine continues to establish itself.

      Fair criticisms of Kaiser Permanente. I am wary of the ‘grass is greener’ type of comparisons, but do think that there is a huge opportunity to learn from a variety of models – both the good and bad. KP is often cited as an example of an integrated care system with a strong culture of continuous improvement and high quality care. I honestly don’t know how OHIP would truly stack up against them, but suspect not well.

      I agree that January 29th was unprecedented in the history of the OMA. I would have expected some form of recess or break to allow the Executive and Board to have an emergency meeting, and found it unusual that the remaining votes continued as if nothing had just happened. However, I don’t interpret a 55% non-confidence vote in our representative organization’s board as a show of unity, and instead see it as showing how fractured we truly are.

  7. Regina

    Well said Taylor. I sat across from you on Sunday morning. To say it was eye opening would be putting it mildly. I learned a lot. Your post explains a lot of key points quite well and I appreciated reading it .
    Regina

    • Taylor Lougheed
      Taylor Lougheed

      It was nice meeting you this past weekend, Regina. Thanks for reading and taking the time to comment.

  8. Gerry Goldlist

    Excellent article. Taylor, you have done a great job of summarizing the issues. They are complex and varied. There are multiple goals and opinions of how to get there. I am glad you did not push your personal agenda. This let’s us view your perspective of the situation without arguing the specifics in yet another forum.

    • Taylor Lougheed
      Taylor Lougheed

      Thank you for your kind comment, Gerry, and for taking the time to read through the post.

  9. DocRelativity

    Well said. Relativity ignored for too long. “One colleague’s yearly worth was three times more than another’s” brings diagnostic radiology to mind. Placing all diagnostic radiologists on a relatively high (but lower than present) salary of 400K and re-distributing can help.

Leave a Reply

Your email address will not be published. Required fields are marked *

Share this post

Did this post get you thinking? Share with your network and get the discussion started!