Broadly speaking, all of Ontario’s 34,000 practicing doctors and medical trainees are represented by the Ontario Medical Association (OMA). Over its 137 year history, the OMA is the only organization that negotiates labour agreements for doctors across Ontario, advocating for their political, clinical and economic interests.
By and large, medical care in Ontario outside of hospitals is delivered in community-based clinics that are managed by physicians. Many members of the public are surprised to learn that doctors must run these clinics much like small businesses. The product is a doctor who has all the tools at hand to treat and care for patients, sort out necessary referrals, review the results of tests and investigations, perform outpatient procedures and surgeries, do house calls, and so on. Behind the scenes though, doctors employ office staff, allied health providers, and technologists; pay for leaseholds, office supplies, and medical equipment; and ensure that clinics comply with regulatory frameworks and administrative burdens like other small businesses. In addition to clinic work, many physicians also provide in-hospital services like coverage of emergency departments, operating rooms, acute care and rehab wards, obstetrics and so on. Often, this kind of care comes with a demand to work hours that extend long past the normal weekday including overnight, weekend and holiday coverage. On top of this, doctors wear other hats in medical education, administrative leadership, medical research and policy development at local, regional and provincial levels.
Given how intrinsic physicians are in health care, physician expertise is a necessary component in the conversation around keeping patients healthy and safe. In rural and remote areas, one physician will adopt multiple roles at all levels of health-care provision; in urban areas, the burden is often shared. Given the multiple demands competing for physician attention, it’s no surprise that doctors face exhaustion and burnout like every other worker in the province. It’s also no surprise that doctors know exactly what will and what won’t work in their communities for health care delivery.
Doctors make a large footprint on the economy through job creation, business investments, and also by caring for workers so they are well enough to remain productive contributors to the economy. The chart below highlights the economic impacts generated from physician practices:
I will admit that, the OMA did not have a positive or productive working relationship with the previous Liberal government since 2015. As labour negotiations hit an impasse, the government resorted to unilateral actions, imposing changes on physicians and the healthcare system rather that work with doctors towards mutually-respectful solutions. The changes ranged from direct clawbacks to physician pay to restricting primary care clinic startups to less funding for chronic disease care. The impact of these unilateral actions was profound. It not only led to a complicated, fractious relationship, but worsening access to care across Ontario. Net income for all physicians dropped by 30% on average and physicians were unable to expand services even though patient need continued to grow.
As it stands, Ontario’s doctors are going into their fifth year without a contract. On June 7, the new PC government took seat at Queen’s Park. The expectation is to reset the relationship with the government. Doctors need a trusted, collaborative partner to not only finish labour negotiations, but also lead health system reform and achieve better patient outcomes.
Examples from the past — like Smoke Free Ontario — have demonstrated the positive impact of doctors and government working together on the lives of Ontarians. This is why during the recent provincial election, the OMA released a platform entitled “Not a Second Longer: A Platform for Better Healthcare” that gave recommendations on how to improve health care and patient care in Ontario. As an association, the OMA’s goal will be to work with the new government to see these suggested policies become a reality. I’ll highlight 3 key issues from the OMA platform below.
Ontarians everywhere are struggling with growing wait times for doctors, medically necessary tests and in-hospital care. Wait times are a symptom of a system that is significantly under-resourced. As doctors, we witness firsthand the frustration and health risks incurred as patients wait for appointments, necessary tests and procedures, as they wait for home care, and as they wait for care in emergency departments and hospital corridors while hospitals run over-capacity.
Current wait times for non-emergency cataract surgery is 232 days. Knee replacement surgery: 228 days. MRI’s 98 day wait. These wait-times are magnified in Northern Ontario, and access made more difficult by resources stretched across a vast geography. My President’s Tour this year stopped in several towns and cities in Northern Ontario, and I can attest to the difficulties they face trying to access health care. These waits are hard on patients, their families — and on the doctors who stretch to fill the gaps. Without adequate specialist support, family doctors seek out extra training to cover the local emergency department, obstetrics, palliative care, geriatrics, in-patient critical care, and even local ORs providing anesthesia or doing C-sections. Many Northern Ontario physicians walk a knife’s edge between being a busy doctor and a burned out doctor.
As frontline workers, doctors see the gaps that exist in our system. We want to work with the government on closing them. Working in tandem, we can streamline services, manage issues with wait times and look for innovative ways to fund the system so that we can achieve the Canada Health Act’s call for timely health care for all.
Mental health support and services
Mental health services have reached a tipping point. Over 12,000 children and youth wait up to 18 months for care. Patients report spending up to six days in noisy, overcrowded emergency departments, waiting for a psychiatric ward bed to open so that they can continue recovering. First Nations communities struggle with a suicide epidemic among their youth. And even as existing psychiatrists work full out, all doctors admit Ontario’s health human resources do not match the needs of our population. The reality is that by 2041, 8.9 million Canadians will live with a mental illness. Knowing this, it is imperative that the government work with doctors to address the shortage of mental health services now.
I was thrilled to hear the government commit to a $3.8 billion investment in mental health, addictions and supportive housing in their Throne Speech. This funding will be critical to improve the existing shortfall. Deciding how this funding is best allocated is where the frontline experience and expertise of doctors becomes essential.
4 out of 10 people will live to 90. As time passes, this number grows. As people live longer, they often require more complex care — whether it be home care, retirement homes, an assisted living facility or live-in caregivers. Health Quality Ontario pegs the current wait for a long-term care bed in Ontario at 149 days. In rural and Northern communities, the wait is 6 times as long. Caregiver burnout is rampant as families juggle care for frail elderly relatives with children, mortgages, jobs and busy schedules. Government funding and planning has not kept pace with changing demographics, that much is clear.
During the election, the government committed to building 30,000 new long-term care beds. Though this is a great first step, building new long-term care beds is only one piece of the puzzle. In order to find practical and sustainable solutions to get ahead of this growing crisis, doctors and specifically those working with seniors, need to be at the table where policy decisions are made.
How we move forward
The OMA’s focus is on advocating for its physician membership now and on shaping a better health care system for the future. We are committed to working with the new government to ensure that physicians have an agreement in place, to ensure that patients have access to the care they need, to ensure that hallway medicine becomes a thing of the past, and to build the strongest healthcare system possible. I know that these things won’t and don’t happen overnight, but I believe these goals are achievable. I and the rest of my colleagues are ready to roll up our sleeves, build a strong partnership with the government and get to work.
Liz Davidson handles Specialist, Issues Management, Government Relations & Issues for the Ontario Medical Association (OMA). Find out more by visiting www.oma.org.