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Star Likens OMA to the Titanic in COFP Article

The following column by Ian Urquhart appeared in the August 14, 2002 edition of the Toronto Star…

Trouble Brewing Among Doctors

Growing militancy among the province's family physicians could split the Ontario Medical Association (the doctors' union), with profound implications for the government itself.

A group calling itself the Coalition of Family Physicians of Ontario is conducting a recruitment campaign this summer to beef up its membership and fight for "what they deserve."

Declares the recruitment letter mailed out last week: "Clearly the time has come for action! Real action. Political action."

Even before the recruitment drive, the coalition claimed a dues-paying ($120 a year) membership of about 3,000 family physicians, out of a total estimated at 8,000. The coalition's goal is to sign up 75 per cent of them, or 3,000 more.

"The vast majority of them are furious at the way things are going," says Doug Mark, a Scarborough family physician and president of the coalition.

What has the family physicians riled up is a combination of what they see as laughably low fee increases and increasing government intrusion into their practices.

Under a deal between the government and the Ontario Medical Association, doctors' fees have increased just 1.9 per cent this year. The coalition compares that unfavourably with Alberta, where doctors got a 35 per cent fee hike.

As for government intrusion, the coalition points to primary care reform. The provincial government is trying to enrol family physicians into "family health networks," where they would work in groups of five or more providing 24-hour, seven-day-a-week care to rosters of patients. The doctors would be paid a basic salary, topped up by some form of fee-for-service remuneration.

The government has said that enrolment in these networks is entirely voluntary but that its goal is to have 80 per cent of family physicians signed up by 2004. To date, only about 2 per cent have joined.

Says Mark: "If the government's goal is to have 80 per cent of us signed up, then one can only wonder what is in store for us. We believe primary care does not need reform. We believe doctors do not want to sign contracts giving government more control over their lives and incomes."

The coalition also believes that the doctors' union, the Ontario Medical Association (OMA), to which they must all pay dues of about $1,200 a year, is dominated by the specialists (surgeons and the like) and has not done a good job representing family physicians.

As the coalition sees it, the OMA has agreed to low wage increases in return for access to the levers of power. Under the deal it signed with the government, OMA-appointed doctors sit on joint committees with Queen's Park bureaucrats making decisions about the health-care system.

The OMA was also deeply involved in the design of the family health networks that the coalition finds so objectionable.

In effect, the coalition is saying that the OMA has been co-opted by the government.

There is irony in this in that the OMA has been accused by others (notably former Tory health minister Jim Wilson) of being too powerful and of frustrating government attempts to reform the delivery of health care by moving away from fee-for-service.

But where others see the OMA as too influential, the family physicians' coalition sees it as too cozy with the government.

The coalition will first try to achieve its goals by working within the OMA, where Mark sits on the governing council.

But if that doesn't work, Mark says the coalition will consider forming a breakaway union to bargain directly with the government on behalf of family physicians in the next round of negotiations, which is more than a year away.

The OMA, for its part, professes not to be concerned about the coalition's recruitment campaign. "It signifies we are an open and democratic organization," says OMA president Elliot Halparin, himself a family physician.

Asked if he plans a counter-campaign, Halparin replied: "I don't need to do that" because family physicians have access to the relevant information on the OMA's Web site. He sounded not unlike the captain of the Titanic dismissing reports of icebergs.

Why should these developments concern the government?

Because a more militant doctors' union would push for higher fee increases, thereby further straining a health budget that is already bulging at the seams, and it would further slow down the already snail-like pace of primary care reform.

A spokesperson for Health Minister Tony Clement this week acknowledged awareness of the coalition's activities but said the government is "not overly concerned" about it at this point.

That assessment may change in the coming months.

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