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The push to negotiate more
MDs for rural Ontario
The NOW Alliance of doctors and
municipalities
thinks it has a better idea
By Hugh Coulthart
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Negotiations are about money
-- and much more
Access to care
is already in the mix, says the OMA chief
The NOW Alliance
makes explicit its reason for taking the issue
of physician shortages to the people of Ontario
through the media: "Because bargaining between
the government and Ontario's doctors is
held in secret behind closed doors," the group
says in their press release. And they're determined
to bring it out into the open.
NOW's challenge questions
the appropriateness of collective bargaining between
the OMA and the MOH as a mechanism for making
decisions with serious implications for the delivery
of healthcare to the
public.
But OMA chief Dr Lawrence
Erlick thinks the whole thing's a bit of a red
herring. "It's a misperception that the Ontario
Medical Association is a union and negotiates
as unions negotiate," he says. "When we sit down
to negotiate our master agreement, we're talking
about (fee) negotiating and improving access to
care. We'll come forward with solutions for access
that aren't strictly financial, but solutions
that help patients and help doctors provide care."
That begs the question: Wouldn't it be appropriate
for special public interests, such as underserviced
communities, to be represented in the process
of allocating funds to meet healthcare needs?
In Dr Erlick's view
they already are. "We have an eight-member negotiating
group," he says. "The chair is from Thunder Bay.
One of the other physicians is from Barry's Bay.
We have four family physicians and four specialists,
who represent a cross-section of understanding
of what's going on in medical care delivery across
the province. The government also has eight members,
again a cross section of representatives from
the ministry and physicians. We're negotiating
with the government of Premier McGuinty, which
was given a mandate and provided a platform to
the public. They are the public interest, in my
view, and they will decide on the priorities for
the public."
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The current collective agreement
between the Ontario Medical Association (OMA) and the
province's Ministry of Health and Long Term Care (MOH)
expires March 31. While the parties head into negotiation
of their 2004 agreement, the NOW Alliance has launched
a public campaign to force the issue of physician shortages
to the highest priority at the bargaining table. Negotiating
Ontario's Well-Being (NOW) gives voice to the common
cause of prominent associations of Ontario physicians
-- including Ontario's family physicians, rural physicians
and intern and resident associations. Municipal city
councils and chambers of commerce are also part of the
coalition.
When the NOW Alliance was
formed four years ago, the shortage of physicians in
several Ontario communities was critical. In 1996, the
province's MOH had designated 68 communities as underserviced,
their full complement of 2,869 physicians short by 100.
The Ministry's most recent count, reported in January
2004, found that the number of underserviced communities
had almost doubled, to 134, and the number of vacancies
had escalated to 665. "This is a frightening, outrageous
and unacceptable situation," said Ingrid Parkes, a founding
member of NOW and councillor of the northern Ontario
city of Kenora. But the situation is not confined to
Ontario's northern and rural communities. In the southwestern
Ontario city of Sarnia, a shortage of 27 family physicians
out of a designated complement of 67 means that the
ratio of physicians per 100,000 people is 56, compared
with a national average of 96.
Dr Lori Kolano, a Sarnia
family physician told the National Review of Medicine
that she has people "begging and pleading" to be taken
on as patients. "I feel like a witch, turning people
away," Dr Kolano says. "But I have no choice. Otherwise
I'd be working 16 hours a day." For the millions of
Ontarians living in underserviced communities and for
the physicians who are struggling to serve them, the
NOW Alliance is urging the OMA and the MOH to incorporate
into their 2004 agreement, measures to increase the
supply of family physicians in particular and to encourage
a distribution of physicians more closely commensurate
with the distribution of the province's population.
NOW's proposals include both
educational initiatives that will increase the future
supply of physicians, and recruitment and retention
strategies that will bring more immediate relief to
underserviced communities.
NOW supports the new Liberal
government in its efforts to increase the number of
places in the province's medical schools by 15%. Noting
that the number of students from rural Canada in medical
schools amounts to only 11%, when Canada's rural population
is 25% of the total, they want to see an aggressive
effort to attract more rural students to family medicine
on the assumption that many will return to their communities
on graduation. The idea presupposes making family practice
more attractive to new doctors than it is at present.
Central to NOW's strategies
is the premise that traditional fee-for-service compensation
does not recognize the unique environment of most underserviced
communities, particularly in rural and northern Ontario.
NOW wants to see alternative funding plans, not only
to address physician shortages but also to encourage
group and interdisciplinary practice.
OMA President Dr Lawrence
Erlick is cautiously positive about the Alliance. He
told the National Review of Medicine that, "the
principles of all their recommendations are in keeping
with many of our own." And notes that, "their recommendations
have gone to our negotiating committee to be considered
as part of the negotiations."
To support the OMA negotiators
and keep the issue on the table, NOW's immediate tactical
objective is to give physician shortages the highest
public profile. The Alliance plans a series of town
hall meetings across the province. It has also launched
a website (www.pairo.org/now),
soliciting signatures to an online petition to both
the Ontario MOH and the OMA. For a related article on
immigrant doctors, see also Time to trade in that
taxi license.
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