FEBRUARY 15, 2004

The push to negotiate more
MDs for rural Ontario

The NOW Alliance of doctors and municipalities
thinks it has a better idea

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."

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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