Well, it's been an interesting week or so for Ontario physicians. The tentative Physician Services Agreement (tPSA) outlined by the OMA was bound to be controversial from the offset, but I don't think many were predicting the situation would get this acrimonious this quickly. A lot of information has been flying around about the tPSA, not all of it true, most of it unhelpful, and virtually all of it biased in one direction or another.
Here's what I've been able to piece together from reading everything I can on the subject and talking to some people directly.
1) Whoever you provide as a proxy must vote the way you indicate.
That goes for the OMA too. The OMA's initial communications implied otherwise, but they confirmed to both me and now to the OMA members publicly that preferences are indeed binding and that no other substantive measures can be brought forward. Talking to those within the OMA in one form or another, the explanation for this apparent attempt to deceive seems to come from incompetence rather than intentional deception. For this reason, I've chosen to let the OMA represent me as my proxy, despite voting against the tPSA. I'll be keeping an eye on my own vote to ensure my wishes are respected. If they aren't, it sounds like the Coalition of Ontario Doctors will be more than happy to sue the OMA on my behalf.
2) The OMA doesn't particularly like this deal either.
With the sheer volume of one-sided marketing the OMA is putting out about this deal, you'd think they really like what they agreed to! Well, I don't think they do. They've been brushing aside their own reservations in order to whip up support for the vote - which all else aside is a terrible way to convince on-the-fence people that you hear their concerns - but I think those on the inside really do see this as the best option they're going to get. They'll be the first to admit that it's far from what they'd prefer and privately more than a few will admit it's below what they think is fair. The OMA sees physicians as powerless to get a better deal, however, and accepted the tPSA on that premise.
3) Trust in the OMA is low. Trust from the OMA is lower.
It's fairly clear to any half-interested observer that the OMA is not well-liked right now. Physicians don't even believe the OMA will execute a fair vote, let alone fight on their behalf. Lots of conspiracy theories abound about the OMA's true intentions or allegiances. For their part, the OMA doesn't seem to like many of the physicians they represent either. There doesn't appear to be much belief that rank-and-file physicians can be trusted to behave like reasonable adults. The OMA's negotiation and marketing with respect to the tPSA reflect this mistrust. That's not to say that the OMA is trying to work against its members or anything that nefarious, but there appears to be an attitude that being completely open and honest with members will only make a viable deal more difficult to obtain.
4) Both sides claim moral high ground, but vested interest prevail.
There are plenty of people on each side who are voting the way they are for noble reasons. However, the groups supporting or opposing the tPSA most vigorously clearly have reasons to do so beyond the overarching merits of the agreement. On the "No" side, there are a lot of high-earning specialties who would be the hardest hit by any deal which seeks to reign in the salaries of wealthier physicians, something both the Ontario government and the OMA appear to support in principle. On the "Yes" end, there are groups deeply connected to the OMA who would benefit professionally from continues ties with the OMA and/or the Ontario government. I don't doubt the sincerity of most individuals' convictions in this debate, but it's worth noting how often a person's opinion on the tPSA happens to line up with what will benefit them the most.
I'll follow up shortly with a more substantive post on the tPSA considering the new developments. For now, I'll continue to try to learn a lesson from this whole mess - namely that communication, especially with colleagues, is a tricky business, but absolutely vital to working together in our healthcare system.
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