Steven Barrett is legal counsel to the NOW Alliance and the Professional Association of Interns and Residents of Ontario, and a partner in the law firm Sack Goldblatt Mitchell. He has represented various physician groups in negotiations with government and other healthcare sector providers.

With the government of Ontario and the Ontario Medical Association (OMA) now closeted in negotiations for a new physicians services agreement, the NOW Alliance � a coalition of grassroots community, rural and new physician organizations � is continuing to push for the inclusion of a comprehensive package of incentives to help resolve doctor shortages.

Physicians should have a meaningful voice in determining their compensation and working conditions. But participation by other stakeholders and public interest groups is equally important.

No one with experience in collective bargaining can seriously call for negotiations to be conducted in public. However, when they involve matters such as access to physician services, it seems reasonable that both the government and the OMA should reach out to interested communities and organizations to get their perspectives and respond to their needs. While confidentiality is important to the bargaining process, it shouldn't trump the democratic and participatory values that underlie our public healthcare system.

Members of the NOW Alliance aren't asking for a reserved seat at the bargaining table. They do, however, see an urgent need for broader input to the process. But how would this work in practical terms?

One suggestion would be for both the OMA and the government to announce their respective goals and objectives before the bargaining begins. This would allow the public to scrutinize both parties' intentions and the success of the outcome.

Another possibility would be to integrate a mechanism that enables consultation with community and public groups. Healthcare policy issues and proposed initiatives would be referred to a forum representing broader public interest. Non-binding recommendations could then be returned to the bargaining table, where their financial implications for physician compensation and conditions of employment can be settled.

If the OMA and government are going to emerge from behind closed doors every few years with an agreement that vitally affects the health of Ontario's citizens, it's essential that some community involvement should be allowed � before the deal is done.

� Steven Barrett

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