VOLUME 34, NO. 22, June 16, 1998

WHERE ANGELS FEAR TO TREAD: Why is the OMA turning its back on the public?

By Matt Borsellino

Another annual general meeting of the Ontario Medical Association has come and gone and again the OMA has missed an opportunity to grab the public consciousness on issues central to the medical profession today.

The 118th AGM marked the 21st time, stretching back to the early 1990s, that the OMA's 250 governors have held a council meeting closed to the media and public from gavel to gavel. No other provincial medical association in the country can lay claim to that dubious record.

Not only that, but on June 1 the OMA conducted its first ever "Doctor Day," a meeting of medical politicians and their counterparts at the provincial legislature (party leaders, cabinet ministers and bureaucrats) designed to help doctors learn the political process.

On April 9, Dr. Sharla Lichtman received a written invitation from OMA officials to Doctor Day after she expressed interest in attending the event. On May 20, after OMA staffers found out she is not an OMA member, she received a letter from then OMA board chairman and now president-elect Dr. Ron Wexler uninviting her. (The fact that all doctors are forced to pay the association about $1,000 in annual dues doesn't automatically make them a member.)

Only OMA members could attend, Dr. Wexler wrote after a decision by the board. "It was felt that not only is it fair to respect the wishes of some "Rand-ed" members who simply do not want to be members of the OMA, but also there must continue to be a benefit from membership," he noted in a letter to Dr. Lichtman.

"Members could easily ask what advantages there are to membership if nonmembers received the same benefits. I trust you appreciate the fairness of this decision since it recognizes the right of an individual physician to choose not to be a member of the OMA and gives benefits to those who wish to belong. I certainly would be pleased to have you as a member. Perhaps you would care to reconsider."

Perhaps it should also be mentioned that Dr. Lichtman is president of the Coalition of Family Physicians of Ontario, a group that's often been critical of OMA policymaking decisions.

The April issue of the Ontario Medical Review contains briefs by the four medical politicians who recently ran as candidates for next year's president of the Canadian Medical Association. Outgoing OMA president Dr. John Gray wrote that he wanted to use the CMA post as a launch pad for three areas of advocacy: for doctors, professional unity and patients.

If Dr. Gray wants to advocate for patients, barring them from a meeting where major issues of the day are discussed is no way to do it (to be fair, Dr. Gray has always favored open meetings). If the OMA wants to promote professional unity, it shouldn't exclude potential members from such important political information, education and networking sessions like Doctor Day.

My beef is with the faceless powers-that-be at the OMA. Apparently, they continue to believe it's more important for physicians to be able to speak out unfettered behind closed doors than to have the process opened up to the public. They're wrong.

Keeping the annual meeting closed sends the perception - I chose this vague word over the more concrete "message" - that Ontario's doctors have something to hide. Whether such a message is there or not, it's tough to deny the perception.

At least once a year, the OMA should open its collective eyes and ears to the problems and concerns of the people - vulnerable and ill - who they serve. The 1998 annual general meeting would have been the perfect chance.

Admittedly, one potentially explosive issue, a court action by the Ontario Association of Radiologists (OAR), was on the agenda. This session could have been left closed without having to bar the media and public from the entire meeting. In the end, little was said about the OAR's action since it's before the courts. Surely somebody must have known that was going to happen.

The OMA could have used the session to talk about issues behind the development and approval of a "utilization control package" without making any reference to radiologists. It would have been a great chance to present its views in a positive light. As it turns out, it's also something many specialists were expecting.

Weren't other items on this year's agenda - updates on government relations, primary care reform, specialty care, and a comprehensive, ongoing review of the fee schedule and how the fee-for-service budget can be spent better - all potentially relevant issues to patients and their families?

This leads to one other question: Is there something the OMA is trying to hide?

I'll admit I'm left wondering. During the days leading up to the meeting, I phoned for an advance copy of the annual reports scheduled for discussion. It's a common practice of mine to help me prepare for covering political meetings from coast to coast.

To my surprise, I was told there were no annual reports to be had, and there haven't been since 1994! I paused for a moment to rub my eyes, since in front of me were every one of the OMA's books of annual reports up until 1996. I let that slide.

Then I asked if such reports were being sent to OMA members across the province as well as council delegates. I was told OMA members would not be receiving reports as a matter of course, like their colleagues in other provinces. Other provincial medical associations mail out annual reports to all members as the most fundamental of services supported by $1,000 membership fees.

I find this rather odd. So, no doubt, will doctors across Ontario interested in medical politics and how their major lobby group conducts itself. Those doctors, by the way, will soon be paying the OMA $1,000 whether they want to or not as part of last year's deal with the province, giving the group the right to represent all doctors.

The OMA has clearly learned major lessons in public and membership relations since the "bad ol' days" of the early '90s. But, it's equally clear it hasn't learned them all.

This occasional series of personal insights by Medical Post national editor Matt Borsellino is designed to educate, stimulate and at times even irritate physicians involved in medical politics.