It’s ‘just too easy’ for doctors to steal. That’s why opioids are vanishing by the fistful in B.C.’s Lower Mainland

[ad_1]

He just needed a little relief.

A decade ago, Michael was one of only three doctors on call in a remote community hospital in British Columbia. As a result, he had to be available pretty much all the time.

The vast majority of narcotics that have gone missing in recent years from Lower Mainland hospitals are attributed to three incidents in 2017 and 2018 at Vancouver General Hospital, where staff were found diverting opioids for years.
The vast majority of narcotics that have gone missing in recent years from Lower Mainland hospitals are attributed to three incidents in 2017 and 2018 at Vancouver General Hospital, where staff were found diverting opioids for years.  (Illustration by Perrin Grauer)

“It was a small hospital, but it wouldn’t take much to make you busy,” Michael explained.

“If just one person came in with a stab wound requiring a chest drain and a hemothorax, that would make you busy. … One suicide attempt requiring (a patient) to go on the ventilator, that means you’re busy all night because there’s not a lot of other staff to help.”

At the same time, Michael’s marriage was beginning to fracture. Feeling he had little support to lean on, he started looking for a reprieve from the stress.

“I started taking capsules of various opiates that patients had given me over years and I had them just lying in my office,” Michael said. “I used them to sometimes give out to patients if they couldn’t afford them.”

Read more: ‘I was an impaired nurse’: Three nurses who battled addiction welcome dramatic shift in approach to discipline and treatment

The drugs that were prescribed for patients but never taken — or drugs returned to him by family members of patients who died — should have been accounted for and destroyed with witnesses, as required by the Controlled Drugs and Substances Act. Instead, they were “diverted,” the term used by the medical community to describe theft of narcotics for personal use.

“It was just too easy,” Michael said. “They were just sitting in the cupboard.”

The doctor’s real name is not being used to protect him from potential legal trouble. The Star verified his standing with the B.C. College of Physicians, which lists his medical licence as temporarily inactive; he is now in his second attempt at recovery.

“It started foolishly,” said Michael. “I promised myself I wouldn’t become addicted, but I did.”

Michael’s past shows how easy it can be for a medical professional to become addicted — but also how easy it is to steal controlled narcotics without getting caught. No one would miss a couple of pills, he thought, and he was right.

More than three years after a Vancouver General Hospital aid died of an overdose, resulting in government promises to crack down on the theft of narcotics from hospitals, Health Canada documents obtained by the Star show the problem of missing drugs persists across the Lower Mainland.

Between 2015 and April 2018, the Health Canada documents show hospitals in the region reported more than 7,800 units of various narcotics missing.

Answers are few and far between — prosecutions even more so.

Most disappearances, nearly 85 per cent of the incidents on record, were categorized as “unexplained.” Of the few cases labelled “pilferage,” or staff theft, not one has been reported to police. In fact, only four per cent of all the drug disappearances were ever reported to law enforcement.

The vast majority of the missing units — about 5,000 — are attributed to three incidents in 2017 and 2018 at Vancouver General Hospital, where staff were found to have been stealing opioids for years.

Much of the rest came from St. Paul’s Hospital, where 600 vials of hydromorphone were “lost in transit” in 2015, and the Pharmacy Distribution Centre, where about 900 missing hydromorphone tablets were recorded as a tabulation error in 2017.

The figures, encompassing a jumble of different drugs, obscure the scale of the losses. When converted into a rough measurement called “milligrams of morphine equivalent” — a benchmark used to assess potency when patients are prescribed multiple drugs at once — those five cases at Vancouver General, St. Paul’s Hospital and the Pharmacy Distribution Centre represent a loss of 71,137 milligrams of morphine. That’s equivalent to 15,800 Tylenol 3 tablets or enough morphine to knock out 49 horses.

As shocking as the numbers are, pain-management expert Dr. Owen Williamson says they likely represent only a sliver of all the drugs that actually go missing.

“They may be the tip of the iceberg,” said Williamson, president of the Pain Medicine Physicians of B.C. Society. “There are just so many ways people can divert that stuff.”

Health Canada records won’t reflect how much is actually going missing, he said, because of the way drugs are tracked. Most tracking systems assume that drugs dispensed for a particular patient are actually received by that patient. That isn’t always the case.

In operating rooms, Williamson explained, it can be easy for staff to draw more liquid narcotic than necessary, swap it into a second syringe and take it home. He’s also seen cases of staff at nursing homes dispensing used fentanyl patches to patients and keeping the fresh ones for themselves.

“Wherever you have opioids, you’ll have people who are inventive at diverting it,” he said.

Kerri O’Keefe was one of those people. The 36-year-old hospital aid died in August 2015 after injecting an anesthesia drug she stole from Vancouver General — the end of a long pattern of theft.

As reported in the Vancouver Sun, which covered the case, the Ministry of Health responded by directing health authorities across B.C. to improve the security and tracking of pharmaceuticals.

In 2017, the provincial government announced $5 million in additional funding for the B.C. Centre on Substance Use for research on addictions care. Part of that funding went toward new hospital training and monitoring programs for drugs at risk of theft.

It’s unclear what effect these changes may have had, as acts of pilferage are rarely recorded as such.

The Health Canada records contain more than 250 cases, accounting for all of the drugs known to be missing from B.C.’s Lower Mainland. Only 12 of those cases were officially reported as pilferage.

In one case, a Ridge Meadows Hospital nurse in Maple Ridge found a box of morphine vials that had its bottom cut open. The vials had been emptied, and the package was resealed and stashed on a shelf behind other similar packages. The official cause was “unexplained.”

At Chilliwack General Hospital, nursing staff found a vial of fentanyl with a needle hole in the rubber plug. Though this was considered a “potential diversion situation,” it was recorded as “unexplained.”

Surrey Memorial Hospital experienced “multiple losses” of hydromorphone, oxycodone and morphine from the in-patient medical unit over the course of 18 days. All “unexplained.”

Each Health Canada record includes a section detailing steps the hospital plans to take to prevent future losses. Some of the losses resulted in changes to security procedures, like requiring double signatures on paperwork, changing locks, installing security cameras or switching to more secure automated dispensing machines.

At Langley Memorial Hospital, for example, a nurse was removed from the workplace after admitting to repeatedly slicing open blister packs of hydromorphone, stealing the drugs and replacing the capsules with an unknown substance.

Between 2015 and April 2018, hospitals in the Lower Mainland reported more than 7,800 units of various narcotics went missing.
Between 2015 and April 2018, hospitals in the Lower Mainland reported more than 7,800 units of various narcotics went missing.  (Illustration by Perrin Grauer)

However, just as many of the records do not spell out significant changes to security practices. Often the plan is for staff to be more vigilant.

An opioid diversion expert who reviewed the documents says important precautions that could prevent these thefts aren’t being followed, in large part because the losses are being misclassified as “unexplained.”

“It’s insane,” says John Burke, president of the U.S.-based International Health Facility Diversion Association. “Almost all of these indicated diversion … It’s horrific, in my opinion.”

After a career in policing, including a decade running the Cincinnati Police Department’s Pharmaceutical Diversion Squad, Burke retired and founded Pharmaceutical Diversion Education Inc., which provides education and consulting work on drug diversion for hospitals, law enforcement and the pharmaceutical industry.

Shown a copy of the Health Canada data, Burke said it’s clear to him the majority of these cases are not accounting errors or simple discrepancies.

“Guess what? Somebody’s stealing,” Burke said.

“Somebody diverting in this scenario, this is a smorgasbord for them. They’re going to realize that as long as they don’t get caught in the act, they’re probably going to be OK.”

In a statement, Health Canada said it collects these reports from all pharmacies across the country, including from private businesses and public hospitals. The department “evaluates reports on an aggregate basis to identify trends and identify patterns of diversion.”

For example: “This could include an assessment of which products are being reported as lost or stolen, in what frequency, and if there are geographic differences in reported diversion.”

If Health Canada detects a worrying trend, it may work with hospitals to determine the root cause. It does not conduct investigations and leaves the decision to report to police to individual hospitals.

But Michael’s case, which took place outside the Lower Mainland, illustrates a problem with this approach. The narcotics he diverted would never show up in Health Canada data because they were never recorded as a loss.

“They would not have been reported missing because they would have already been dispensed to a patient,” Michael explained.

Burke said that, based on his research in the U.S., those doing the thieving are careful to cover their tracks.

Some hospital patients will be given prescriptions for painkillers on an as-needed basis, like with morphine, for example. If a patient is in pain, they can request another dose that a nurse can administer without needing to go back to a doctor for a new prescription.

“So a nurse could go in and document that they gave a patient a shot (of morphine) when they really didn’t,” Burke explained.

“Or they can do what we call splitting a shot — giving half to the patient and half to themselves … None of those are going to show up (in the data) because they’re going to make it look like everything is kosher.”

Michael said he wasn’t anywhere near that devious. He said he never lied to his colleagues about his opioid use; he just wasn’t upfront about it.

As he began to realize he was addicted, he considered confiding in his colleagues — but doing so would have required them to report him to the B.C. College of Physicians or be put in legal jeopardy for keeping his secret.

Eventually, keeping that secret himself became too much.

“I needed to get some help,” Michael said. “It was getting to the point where things were just … it didn’t feel good. I used to dream about it. I felt terribly guilty. I just needed that monkey off my back.”

In 2011, he turned himself in to the college, which he said immediately suspended his licence and launched an investigation into whether his patients’ care had been compromised.

Michael said his opioid use was relatively light — a capsule in the morning and again in the evening — and that the college’s investigation found his patients had never been put at risk. The college itself would not comment on Michael’s case nor its investigation, citing privacy concerns.

But aside from protecting his patients, Michael said the college also protected him from himself, insisting he get a lawyer and connecting him with addictions treatment and supports. He went on leave, got into recovery and began working the Narcotics Anonymous steps, all with the backing of the college.

Michael's story also shows how easy it can be for a medical professional to become addicted. Statistics Canada says opioid addiction has killed more than 9,000 Canadians in the past three years.
Michael’s story also shows how easy it can be for a medical professional to become addicted. Statistics Canada says opioid addiction has killed more than 9,000 Canadians in the past three years.  (Illustration by Perrin Grauer)

Michael said his case was never reported to the police.

Burke said that in the U.S. some hospitals actually have armed law-enforcement members as part of special opioid diversion teams. As he sees it, every instance of narcotics being stolen is a crime that should be reported to police.

But Michael questions that approach and the criminalization of addiction overall. Statistics Canada says opioid addiction has killed more than 9,000 Canadians in the past three years. For people like him, it is hard enough to come forward and seek treatment even without the threat of prosecution hanging above their heads.

The B.C. College of Physicians agrees.

“Most likely, if the college was made aware of a physician stealing narcotics for personal use, it would consider it a health matter rather than a disciplinary matter,” Susan Prins, director of communications, wrote in an emailed statement.

If a physician fails to comply with a treatment and monitoring plan laid out by the college, their status would remain “temporarily inactive,” Prins said. If they ultimately refused altogether, they would be considered for disciplinary charges and could ultimately lose their medical licence, though Prins said that has never happened in the history of the college.

“If the situation involves a theft, the decision to report to the police would be up to the victim of the theft, e.g. the clinic or health authority,” Prins wrote.

Records show that Vancouver Coastal Health (VCH), the health authority that reported the greatest losses, chose not to report any of the cases to the police — except one obvious smash-and-grab job not perpetrated by staff.

Stacy Sprague is the director of employee wellness for VCH. She said her organization takes roughly the same approach as the College of Physicians, preferring intervention over criminalization.

“We really do care about folks who are struggling with this,” Sprague said. “If people are diverting (narcotics), obviously there’s a lot going on there.”

Sprague said VCH uses a “health-care focused” program specially designed for working with people who are used to being caregivers, not someone in need of care.

That type of approach is what helped Michael. Recognizing it was OK to be both a doctor and a patient at the same time was difficult, he said, in part because society tends to put medical professionals on a pedestal.

“Anybody can fall victim to this,” he said. “There is no immunity. People who are addicted come from all walks of life. Physicians are the same as anybody else.”

Jesse Winter is an investigative reporter based in Vancouver. Follow him on Twitter: @jwints

[ad_2]

Source link

قالب وردپرس

Saskatchewan’s privacy commissioner finds doctors snooped in Humboldt Broncos patient records

[ad_1]

Saskatchewan’s privacy commissioner has found eight people inappropriately gained access to electronic health records of 10 Humboldt Broncos team members involved in a bus crash last April.

Sixteen people were killed and 13 were injured in the crash between the junior hockey team’s bus and a semi trailer at a rural Saskatchewan intersection.

« Due to the high-profile nature of the crash, eHealth Saskatchewan understood the risk of snooping, » said a report from information and privacy commissioner Ronald Kruzeniski.

The report said the health agency began monitoring the profiles of the patients — which include lab results, medication information and chronic diseases — three days after the crash.

The wreckage of a fatal crash outside of Tisdale, Sask., is seen in April. A privacy report says medical records of crash victims were inappropriately accessed by people in the health care system. (Jonathan Hayward/The Canadian Press)

« Between April 9, 2018, and May 15, 2018, eHealth detected eight users of the viewer, mostly physicians, accessed without apparent authority the profiles of 10 patients. »

The report shows eHealth reported the breaches to the privacy commissioner on July 5.

Privacy commissioner ‘disappointed’

Kruzeniski said he’s disappointed that the seven doctors and an office manager inappropriately looked at the records.

« This has been a major tragedy in our province and I’m disappointed that people got tempted, » he said in an interview with The Canadian Press on Monday. « Now that it’s happened, it’s my job to work with others through education and legislative change [to] make the system work. »

His report, which has been posted online, detailed the privacy breaches.

In one case, an employee of a medical clinic examined the health information of three people involved in the collision.

The office manager admitted she consulted the records because « her family members had heard one of the individuals had died and she wanted to verify the information; she thought another individual was a patient … [and] she wanted to verify a detail that was reported by the media about one of the individuals. »

The report said the employee’s access to eHealth was suspended and she was given further training, but she has since resigned from her job.

Another case involved a doctor at a Humboldt clinic who viewed the records of two people, including one who was a patient prior to the crash.

« Dr. D wanted to know what injuries the individual sustained, if the individual received care or if it was an instant fatality, » said the report. « For the other individual, it explained Dr. D was concerned. »

3 emergency care doctors among those reviewing patient records

Other cases included three doctors who provided emergency care at the Nipawin Hospital and who reviewed patient records of those they treated.

« They believed they were in the individuals’ ‘circle of care, »‘ said the report.

The privacy commissioner said the province’s Health Information Protection Act does not address circles of care so the doctors were no longer authorized to access the records.

Another case saw a medical resident view the information of three patients because she wanted to get closure on the cases, which is not an acceptable reason.

During the monitoring period, two other medical residents were found to have looked at the records of one of the people involved in the crash when the residents were reviewing the records of dozens of patients with a particular illness.

Monthly privacy audits recommended

In his report, Kruzeniski has made a number of recommendations to eHealth — including that it conduct regular monthly audits for the next three years of the physicians who inappropriately gained accessed to information.

Kruzeniski also recommended that the organization comply with a need-to-know principle rather than a circle-of-care concept and that it develop a solution to force users of the system to regularly review their training.

[ad_2]

Source link

قالب وردپرس

Family doctors can no longer claim ritzy drug dinners as professional training

[ad_1]

Canadian family doctors can no longer earn educational credits for attending swanky drug dinners, where pharmaceutical companies wine and dine physicians at some of the country’s most upscale restaurants.

The change, part of larger efforts to protect the integrity of the continuing medical education doctors are obligated to take, is outlined in a new report released by the College of Family Physicians of Canada to its more than 38,000 members.

Although doctors can still choose to attend the dinners, they will not receive credits.

“Our view is that (the dinners) are basically marketing evenings,” said Dr. Jeff Sisler, who oversees medical education programming for the College.

“We’re trying in that decision to discourage members from that kind of learning, and remind them that it is not viewed by the College as appropriate continuing professional development.”

In Ontario, physicians are required to attend continuing medical education to keep their licence in good standing.

Read more:

Drug companies wine and dine family physicians

Critics have long said that in providing professional development, pharmaceutical companies are disguising a sales pitch as education, and doctors are encouraged to prescribe a sponsoring drug maker’s product over other options.

A 2016 Star investigation exposed questionable practices at some of these dinners, where everything from the speaker to the food and wine was bankrolled by the drug company. In Toronto, the soirees included a three-course meal at Sassafraz in Yorkville.

At more than one dinner, the Star found the speaker recommended a medication to treat certain conditions — the medication made by the same company that funded the event. In the days following a company-sponsored dinner lecture on managing symptoms of irritable bowel syndrome, a rep from the pharmaceutical company visited the clinic of one of the doctors who attended with samples of its latest product.

The new report reveals that the College’s professional development department received nearly $80,000 from the pharmaceutical industry in the 2017-2018 fiscal year. The money came from fees drug companies paid to have their educational programs reviewed and certified.

Since tightening the rules last year to no longer certify educational events put on by drug companies, the College expects that amount of direct revenue from industry to drop to zero, the report said.

“That’s been a big change for us,” one prompted by concerns of a “high risk (of bias),” Dr. Sisler said.

But that change does not mean medical education will be completely free of industry money.

Pharmaceutical companies can still give money to groups putting on the educational events, though new restrictions put in place by the College and other doctor organizations bar the sponsoring drug makers from participating in choosing a speaker or developing the presentation.

In 2017-2018, 31 per cent of the applications to have an event certified by the College declared some kind of funding support from drug companies, the new report said.

Dr. Sheryl Spithoff, a family physician at the Women’s College Hospital in Toronto, said the College needs to go further and not accredit any educational event put on by a group funded by industry.

“We know that when the pharmaceutical industry funds physician education, it leads physicians to prescribe drugs more often, and prescribe less appropriately,” Dr. Spithoff said

“What we really want to stop is to stop the influence,” she said. “The only way to change that appears to be stopping the funding.”

Dr. Sisler said the College, however, continues to support “a mixed model” of funding for professional development.

“There is no direction or intent at the moment to move to a time when pharma support is not permitted period. That isn’t the way things are moving at the moment,” he said.

Jesse McLean is a Toronto-based investigative reporter. He can be reached at jmclean@thestar.ca. Follow him on Twitter: @jesse_mclean

[ad_2]

Source link

قالب وردپرس

Réforme du mode de scrutin: attention aux «spin doctors»

[ad_1]

Dans sa chronique de jeudi dernier intitulé « La chape bleue », Michel David a écrit au sujet du projet de réforme du mode de scrutin promis par tous les partis politiques, sauf le Parti libéral du Québec, que : « M. Legault n’a pas eu l’imprudence de Justin Trudeau, qui s’était engagé à ce que l’élection fédérale de 2015 soit la dernière à être tenue sous le mode de scrutin actuel. Il a simplement promis qu’un projet de loi visant à introduire un élément de proportionnelle dans le système serait présenté dans la première année de son mandat ».

Or, cette affirmation qui, de toute évidence, vient de certains spin doctors du milieu politique est inexacte. Pour avoir été au coeur des discussions depuis 2016 entre les gens de la Coalition avenir Québec, du Parti québécois, de Québec solidaire et du Parti vert, et pour avoir été l’auteur du texte de l’entente qui a été signée par les chefs de ces partis en mai 2018, je peux dire que l’engagement électoral sur la base de six principes implique trois éléments essentiels :

le remplacement du mode de scrutin actuel par « un système proportionnel mixte compensatoire avec listes régionales, semblable à celui étudié et avalisé par le Directeur des élections dans son avis de décembre 2007 »;

l’élection des députés selon le mode de scrutin proposé « à partir de la 43e législature », soit à partir de l’élection générale de 2022;

pour cela, « dépôt du projet de loi au plus tard le 1er octobre 2019 ».

Certains personnes opposées à la réforme laissent entendre depuis quelque temps que l’engagement du gouvernement Legault se limite à un dépôt d’un projet de loi dans l’année suivant l’élection du 1er octobre 2018, comme si la partie du texte de l’entente transpartisane citant l’objectif inscrit d’élire les députés lors de la prochaine élection générale selon le nouveau mode de scrutin ne liait personne.

Soutenir une telle interprétation est faire offense à l’intelligence de toutes celles et de tous ceux qui ont participé aux discussions et qui ont appuyé l’entente de bonne foi. Peut-on penser un seul instant que les autres partis et nous, du MDN, aurions accepté un texte qui n’aurait été qu’une promesse de déposer un projet de loi sans engagement de le faire adopter dans un délai bien précisé ?

Cela dit, nous savons, puisqu’ils nous l’ont dit à plusieurs reprises de façon convaincante, que plusieurs élus et conseillers politiques de la CAQ ont la même interprétation que nous, du MDN. Ces gens désirent que leur gouvernement passe à l’histoire comme celui qui aura conclu positivement un débat amorcé chez nous depuis 1900, débat qu’avaient promis de régler dans le passé René Lévesque, Bernard Landry, Jean Charest, Mario Dumont et Françoise David.

Dans son texte, Michel David indique aussi que l’entente intervenue n’a pas tout attaché dans ce dossier et qu’il reste des modalités du modèle proposé à choisir. Il faut savoir que ces modalités sont très importantes, car elles pourraient déterminer si la promesse faite sera vraiment respectée ou si on se retrouvera avec un système qui n’aura de proportionnel que le nom.

Partis signataires

Concernant ce choix fondamental des modalités, le MDN est en contact depuis la dernière élection avec tous les partis signataires de l’entente et tous, y compris la CAQ, reconnaissent le rôle stratégique de facilitateur de notre organisation. Lors de son Discours inaugural à l’ouverture de la session parlementaire, le premier ministre Legault, qui a promis trois fois durant la campagne électorale qu’il ne ferait pas un Justin Trudeau de lui-même, a réitéré son engagement. Il a toutefois ajouté qu’il était nécessaire qu’il y ait un consensus autour de la loi envisagée. Selon les représentants gouvernementaux, ce consensus est d’abord et avant tout le maintien de l’entente politique entre la CAQ, le PQ et QS qui, ensemble, ont recueilli 70 % des suffrages exprimés (75 %, si on ajoute les voix accordées au Parti vert, au NPD-Québec et au Parti conservateur du Québec). Au MDN, nous savons très bien que chacun de ces partis et les autres qui ne sont pas à l’Assemblée nationale ont au départ des vues plus ou moins différentes sur ces modalités. Donc, pour que la suite des choses soit positive, tous ces partis (et surtout ceux présents au Parlement) sont engagés dans une dynamique de discussions et de négociations pour l’adoption d’un texte de loi qui signifiera, au bout du compte, une réelle avancée pour une représentation parlementaire plus juste, plus équitable et plus conforme à la volonté populaire.

Parmi les 125 députés actuels de l’Assemblée nationale du Québec, 95 ont porté les couleurs de partis qui ont promis que le dernier scrutin marquerait la fin d’une longue période durant laquelle le respect du choix d’une majorité de l’électorat n’a pas été au coeur de notre démocratie représentative. Maintenant, l’heure est venue pour ces femmes et ces hommes d’être des personnes d’honneur et de respecter leur promesse commune !

[ad_2]

Source link

قالب وردپرس

Ontario seeks to cut pay for family doctors, but MDs dispute claim they make too much for too little work

[ad_1]

The provincial government wants to claw back how much it pays thousands of Ontario family doctors and force them to put in longer hours, arguing they are averaging $400,000-plus annually for what amounts to part-time work.

Doctors are up in arms over the proposals and charge that the government has got it wrong when it comes to their workload. They warn if they are hit with another pay cut — on top of one imposed four years ago as well as an ongoing compensation freeze — patients will pay the price because family physicians will be driven from the field.

Dr. Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, said she worries deep cuts being proposed by the province will make if difficult for patients to find family doctors.
Dr. Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, said she worries deep cuts being proposed by the province will make if difficult for patients to find family doctors.  (Rene Johnston / Toronto Star)

“I’m worried that the deep cuts being proposed will make it near impossible for people to find a family doctor, and that will have repercussions for the whole health system,” family doctor Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, wrote in an email.

The two sides have been arguing their cases before a board of arbitration, which completed seven months of hearings Sunday. The Ontario Medical Association contends the government has built its case upon faulty findings by the provincial auditor.

The arbitration board is tasked with resolving an almost-five-year-old contract dispute between the government and the OMA, which represents the province’s 31,000 practising physicians.

Read more:

Province eyeing creation of ‘super health agency,’ sources say

Schism within government on how to deal with the Ontario Medical Association puts premier and health minister at odds

MDs question motives, results of vote by specialists trying to break away from OMA

The government’s proposed changes to family medicine (also known as primary care) are among the most controversial issues the board has been asked to weigh in on as part of its deliberations over the size of the physician services budget. Ontario now spends more than $12 billion — or 10 per cent of the entire provincial budget — on doctors.

The three-member board is expected to come down with binding decisions this spring, ending phase 1 of the arbitration process.

Phase 2, expected to be even more contentious, will address how to divvy up the pot of money among some 35 specialty groups.

All of this is happening at the same time the province is undertaking a massive restructuring of the entire health system. Next week, the government is expected to announce the creation of a new “super health agency” to replace more than 20 smaller agencies. Sources say the super agency will oversee primary care.

The 5,300-plus family doctors facing the prospect of pay cuts comprise about half of Ontario’s roughly 11,000 practising primary care doctors. They work in more than 800 group practices across the province, known as “family health organizations,” or FHOs.

FHOs were developed in 2007 to improve primary care — for example, by increasing access through after-hours availability — largely through changing financial incentives for doctors.

Twelve years later, the government argues it has paid for improvements in care, which have not materialized and that the price is too high to expand this model further.

In the past, family doctors were paid mostly through fee-for-service, which saw them reimbursed for every service rendered. There is an inherent incentive in the fee-for-service model to have high-volume practices; the more services provided, the more money made.

But under FHOs, doctors derive the bulk of their income through “capitation,” a form of compensation that reimburses them a set amount for each patient signed up with them — no matter how many times a patient is seen or even if a patient is not seen. The amount varies according to a patient’s age and health.

Three-person board of arbitration tasked with resolving OMA contract dispute: Ron Pink, OMA nominee, left, Bill Kaplan, board chair, centre, and Kevin Smith, health ministry nominee.
Three-person board of arbitration tasked with resolving OMA contract dispute: Ron Pink, OMA nominee, left, Bill Kaplan, board chair, centre, and Kevin Smith, health ministry nominee.  (Rene Johnston/Toronto Star)

In 2016/17, the average FHO doctor (with 1,300 patients) made $406,390, according to the government’s written submission to the arbitration panel. That compares to $214,015 for a family doctor paid fee-for-service.

(Physician compensation is not the same as income. From their compensation, FHO doctors have to pay for overhead costs such as staff salaries and rent. Arrangements vary from practice to practice, with the health ministry, hospitals and local communities also pitching in for non-physician expenses.)

Some fee-for-service family doctors and specialists have even taken to social media to argue that their FHO peers are paid too much.

The government’s submission states that FHOs have become so popular, the number of doctors working in them has surged by 154 per cent since 2008/09. To contain costs, the ministry says it was forced to limit their growth starting in 2012.

The government is now seeking to cut the pay of FHO doctors by an average of 9 per cent each, or about $33,600. That would be on top of a cut of 2.65 per cent the province imposed in 2015, as well as a compensation freeze in place since 2012.

In making its case, the government relies heavily on the 2016 provincial auditor’s report, which states that FHOs have not proven their worth. FHO doctors were paid $522 million more in 2014/15 than they would have received if they were paid fee-for-service, according to the report.

That was, in part, because they were paid for 1.8 million patients rostered with them, even though they did not actually see those patients, the auditor wrote.

“The $522 million is significant, as it indicates that the physicians were not providing core primary care services as often as they should be (or expected to be) and/or that base capitation payments are excessive,” the report reads.

The auditor found that an average FHO doctor works only 3.4 days per week.

The province made significant investments in FHOs, but “most objectives (were) not met,” wrote the auditor, charging that they failed to increase access to care, quality and continuity of care and cost effectiveness.

FHOs have not delivered on commitments to provide after-hours care, the auditor said, adding they have also not done much to shorten wait times for primary care.

Many patients get their primary care elsewhere, including walk-in clinics, other family doctors and hospital emergency departments, meaning the province is paying twice for these patients to be treated, according to the report.

The auditor concluded by urging the province to review how much it pays these doctors to ensure taxpayers are getting good value for money.

In addition to seeking pay cuts, the province wants more work and accountability from FHO doctors. The government wants the average physician to put in a 36-hour work week.

“It’s a very expensive model to deliver primary care physician services and it is not performing optimally,” government negotiating team member Bob Bass told the arbitration board on a recent hearing day. “From the government’s perspective, significant change is required to both moderate the costs and improve the quality.”

But the OMA says the government has built its case on bad information from the auditor who failed to understand how they work.

OMA lawyer Howard Goldblatt said the government is more intent on prescribing or dictating a solution without really diagnosing the problem.
OMA lawyer Howard Goldblatt said the government is more intent on prescribing or dictating a solution without really diagnosing the problem.  (Supplied photo)

“It was done by accountants, not by doctors,” OMA lawyer Howard Goldblatt told the arbitration panel, referring to the auditor’s report.

“The government is more intent on prescribing or dictating a solution without really diagnosing the problem,” he continued.

The OMA wants the government to join it in studying FHOs so that any decisions taken are based on what it contends is accurate information.

The auditor erred by calculating the workload of FHO doctors based on the number of patient visits, the OMA charges.

It stands to reason many patients would have fewer appointments, given one reason for creating FHOs was to move doctors away from high-volume, fee-for-service practices, the OMA argues. Financial incentives were changed to encourage doctors to deal with multiple conditions in a single visit rather than call patients back for multiple visits.

(Depending on the doctor, those working in fee-for-service family practices may also deal with multiple conditions in a single visit.)

The auditor also failed to take into account the fact FHO doctors are more likely to communicate with patients via email and phone since their pay is no longer based on face-to-face visits, the OMA adds.

Then there is all the paperwork that comes with working in a FHO, noted Kiran who practices out of one in downtown Toronto. Because FHOs provide full-service family medicine, there is much administrative work associated with appointments, tests and referrals, she explained, adding that FHO doctors also spend time communicating with other providers in a patient’s circle of care.

“This work is what can lead to burnout and frustration, and is not accounted for in the government’s proposals,” she wrote in her email.

Kiran and the OMA warn the proposed changes to family medicine will drive doctors back to practising high-volume, fee-for-service medicine.

“Family doctors would be forced to see a ludicrously high volume of patients in-person each day,” she said. “For patients, this would likely mean shorter appointments, less flexibility to bring up multiple problems in a single visit, and less flexibility to call or email your doctor about an issue.”

The OMA points out another reason for introducing FHOs was to address past shortages of family doctors by making family medicine more attractive. The proposed changes threaten to turn back the clock on those gains, doctors argue.

In a written brief submitted to the arbitration panel, the OMA used strong language to warn of dire consequences if the arbitrators and government get it wrong:

The ministry’s proposals have “the potential to cause huge destabilization in primary care … The very real risk to patient quality of care and provider well-being cannot be ignored.”

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

[ad_2]

Source link

قالب وردپرس

New Urgences-Santé protocol in Montreal, Laval lets doctors declare death from a distance – Montreal

[ad_1]

Urgences-Santé doctors in the territories of Montreal and Laval will soon be able to declare deaths from a distance.

Starting Jan. 14, paramedics who are on the scene of a death at a home or in public places will be able to call doctors to request a death certificate.

READ MORE: New Year’s Eve was the busiest night of the year for Urgences-Santé

The organization notes that this service has already been established in several regions of Quebec with the goal of improving the efficiency of services to families.

WATCH BELOW: Montreal ERs are overcrowded






“Our primary mission is to provide quality emergency paramedical care to Laval and Montreal residents,” said president and CEO Nicola D’Ulisse.

READ MORE: Female patient stopped by police after driving off with ambulance in Montreal

This improvement includes reducing the amount of time families have to wait for a doctor to visit the scene of a death before the body can be sent to a funeral home.

“The idea behind this new protocol is to use the right resources in the right place at the right time,” said D’Ulisse.

“The paramedics are already on the scene, and they are qualified to make the death report at a distance. This change in practice enhances the role of our paramedics while optimizing resources.”

WATCH BELOW: Baby delivered at home during Montreal winter storm






Urgences-Santé notes that its paramedics will also be able to support the family during difficult times.

READ MORE: Mock car crash by Laval police teaches speeders to slow down

“By April 2019, Urgences-Santé’s 1,000 paramedics will be trained to record deaths,” the organization stated.

The change in protocol is in collaboration with the Quebec College of Physicians and the Fédération des médecins omnipraticiens du Québec.

© 2019 Global News, a division of Corus Entertainment Inc.

[ad_2]

Source link

قالب وردپرس

Are steak and cheese healthy? Doctors group says Canada’s Food Guide is wrong on diet

[ad_1]

Pushing aside a makeshift podium in the modest hospital at CFB Trenton, Dr. Barbra Allen Bradshaw says she told a crowd of army nurses, doctors and dietitians that “Canada’s Food Guide is making you sick.”

Eating a diet high in carbs and low in fat, like the nation’s food experts suggest, isn’t the way to a healthy heart or physique, she said. “It’s bad advice.”

Allen Bradshaw, a pathologist from Abbotsford, B.C., is part of a group of doctors from across the country who have been on a crusade to change the way Canadians are told to eat.

For the past two years, she and her colleague Dr. Carol Loffelmann, an anesthesiologist in Toronto, have spent much of their free time travelling the country, urging colleagues and regular Canadians alike to eat fewer carbohydrates than what’s recommended by the government and indulge in fat from sources such as steak and cheese — even if that flies in the face of conventional wisdom.

It’s all they can do as they wait to see whether Health Canada will heed the message from their grassroots campaign.

Since 2016, the women, who founded Canadian Clinicians for Therapeutic Nutrition, a national non-profit, have lobbied the government, with letters, an Ottawa meeting and a parliamentary petition signed by nearly 5,000 Canadians, to reconsider the diet advice they believe Health Canada plans to deliver in the next iteration of the Food Guide, which is due out in early 2019, according to a Health Canada spokesperson.

Allen Bradshaw and Loffelmann, who works at St. Michael’s Hospital, say some of the new recommendations may not be based on the most current, relevant scientific evidence and could continue to make Canadians overweight, reliant on medication and suffer from diabetes, fatty liver disease and metabolic syndrome.

In an email to the Star, Health Canada said that as the new advice is finalized, it is also updating its evidence base with the latest nutrition science and that too will be released to the public in early 2019.

“The Food Guide has benefited from the input of many stakeholders,” the email said. “We are taking all feedback into consideration.”

Over coffee on a recent morning in downtown Toronto, the women, who met online, said the coming recommendations, which are based, in part, on evidence reviews released by Health Canada in 2015, will likely tell Canadians to limit added sugar and encourage them to eat whole, rather than processed foods. Those are good things, they said.

But, they said, Health Canada continues to hold strong on evidence that’s outdated and incomplete. For instance, they said some studies show that diets low in saturated fat, from sources such as beef and butter, are associated with heart disease.

But the jury of science is still deliberating on the full impact of saturated fat on health and so, the women said, in those cases and others, the Food Guide should remain “silent.” Or, conduct a rigorous, independent review of the research.

The women’s crusade began several years ago with their own, quiet struggles to lose weight.

After giving birth to her second child, Loffelmann dutifully followed the diet advice, informed by the Food Guide, that she learned in medical school. She ate whole grains, substituting whole wheat for white pasta, and leaned off the butter. Heeding the guide’s deeper advice to move more and eat less, she took up high-intensity exercise. But over time, her waistline expanded.

On the other side of the country, Allen Bradshaw, who was on the same kind of diet, struggled to lose weight and overcome gestational diabetes during her third pregnancy.

Independently, the two women began a search for answers diving deep into the scientific literature. What they found was that much of the Food Guide’s advice was not supported by the most current science.

So they started experimenting. Eating the opposite of the country’s nationally sanctioned advice by indulging in full fat yogurt and ditching the bowls of rice and pasta, they both lost weight. And stopped feeling hungry all the time.

The two took to the internet, sharing their successes with a small group of mom physicians across the country, who, to their surprise, were receptive. The small group grew as the women shared their results. Over time, they heard from doctors across Canada who began prescribing the same type of anti-food guide diet to their patients.

“All of a sudden, doctors are seeing their patients get off medication, losing weight and their markers of disease are dropping and their disease is going away,” Allen Bradshaw said.

That was a turning point for the women.

Armed with a letter signed by 190 physicians, they sent it to Health Canada in 2016, saying that in the 35-plus years since the government entered the country’s kitchens, the population has grown fat and sick.

Their letter urged the bureaucrats, who were at that point relying on evidence available in 2014, to consider the most current studies available. The letter added: “Stop using any language suggesting that sustainable weight control can simply be managed by creating a caloric deficit.”

The response was a form letter. The women answered it with a more detailed version of their initial correspondence, this time citing the current, relevant studies and signed by 700 medical professionals including doctors, nurses and pharmacists. They received a deeper response from federal Health Minister Ginette Petitpas Taylor.

It said her ministry was relying on “high quality reports with systematic reviews of associations between food and health” from federal agencies in the U.S. and around the world. And that it continued to monitor for more evidence.

After more of a back and forth, the physicians were invited to Ottawa for a meeting with Health Canada.

It was a warm May morning this year when the women, along with three others, including Dr. Andrew Samis, a critical care and stroke physician from Kingston, Ont., stood outside the parliamentary building that houses Health Canada’s headquarters. They took a deep breath. Within minutes, they were spirited to a boardroom.

Over two hours, they explained their position, including, Samis said, that science on saturated fat remains incomplete and the government should reconsider the evidence it uses and how it evaluates what evidence to use for its recommendations.

He also told the bureaucrats, including Hasan Hutchinson, director general at Health Canada’s Office of Nutrition Policy and Promotion, that Canadians, a multicultural lot, should be given several diet options, rather than a one size fits all. To varying degrees, he said, the research supports five legitimate diets, including plant-based, low fat, Mediterranean, ancestral paleo — fruits, vegetables and lots of protein — and keto, meaning low carb, high fat. Samis said: “We felt they were really listening.”

But shortly after the meeting, Samis heard Hutchinson on the radio plugging the old, tired advice. “It was disappointing,” he said.

The group’s last attempt at persuading lawmakers was a parliamentary petition signed by 5,000 Canadians and presented on Sept. 26 in the House of Commons urging lawmakers to conduct an external review of the evidence before unleashing new, potentially harmful advice on the public.

With that, the doctors have been left to wait. And spread their message in webinars and talks large and small across the country.

At CFB Trenton, Allen Bradshaw, who spent 14 years in the Canadian army as a medic, drank in the atmosphere and relished the nostalgia of her time in the reserves, where she assisted army doctors in tending to injured soldiers. The crowd, she said, ate up her anti-diet advice especially the edict that society has to stop blaming patients who follow the Food Guide and fail to lose weight, she said. “It’s not their fault.”

Michele Henry is a Toronto-based investigative reporter. Follow her on Twitter: @michelehenry

[ad_2]

Source link

قالب وردپرس

‘Burned out’: Saskatoon cancer doctors reveal reasons for departures

[ad_1]

After working nearly every day for 13 years, Dr. Christopher Giede doesn’t really know what to do with all of his free time. He plays the electric guitar and feeds his pet sheep, but he can’t stop worrying about his cancer patients.

Those concerns creep into his dreams: « Are his patients being cared for in his absence? Do they feel he abandoned them? »

In September, the 55-year old gynecologic oncologist went on medical leave.

« I’m physically unwell and can’t carry the load anymore, » Giede said, during an interview at his home near Saskatoon. « There has been a lot of psychological stress in the past couple years, and that has not helped with the physical stress. » 

The only other gynecologic oncologist in Saskatoon, Dr. Anita Agrawal, quit her job in December. She told CBC News that she was « burned out » and tired of asking for support. She accepted a job in Ontario. 

The situation in Saskatoon is being repeated in other smaller cities across Canada. 

Kingston, Ont., and Sherbrooke, Que., for example, have had a difficult time recruiting and retaining gynecologic oncologists, especially in the midst of a national shortage due to retirements, disability leaves, international competition, and growing demand from an increasing patient load, according to the Society of Gynecologic Oncologists of Canada.

Specialists are often drawn to departments in major centres with larger teams and more resources. In both Calgary and Winnipeg, for example, there are five gynecologic oncologists on staff and each is only on-call every fifth weekend. In Toronto, 21 specialists share the workload.

‘You feel in peril’

Saskatchewan is losing three of its four gynecologic oncologists by June of next year; two in Saskatoon and one in Regina.

Dr. Anita Agrawal says a lack of manpower and support made it difficult to maintain the level of care for patients that she wanted to provide. (University of Saskatchewan)

A gynecologic oncologist is a highly-trained specialist who treats ovarian, cervical, uterine, and vulvar cancers. 

It’s a unique specialty in that gynecologic oncologists not only perform complex surgeries, they also shepherd women through the entire treatment process with post-operative chemotherapy and care.

« We become very attached to our patients, and vice versa, they become attached to us, » Giede said.

Ovarian cancer patient Kimberly MacKinnon received treatment from both specialists, and isn’t comfortable with locums being flown in to Saskatoon from Ottawa to handle her case.

« How well do they know my case? It’s devastating, and frightening. You feel in peril, » she said.

Workload issues

In October, the Saskatchewan Cancer Agency sent patients a letter notifying them that Saskatoon was losing both of its specialists; Dr. Giede was on an indefinite leave and Dr. Agrawal was leaving her practice in early December.

A subsequent statement from the Saskatchewan Health Authority said the specialists were leaving for « personal reasons. »

That’s misleading, both doctors contend, because their reasons are work-related. 

Giede said they’ve been asking the health region to hire a third gynecologic oncologist and add other clinical support for at least six years. He warns that the province’s pledge to « aggressively recruit » replacements is ill-fated unless workload issues are resolved.  

‘It feels like someone opened a trap door beneath me, and let me fall through,’ said ovarian cancer patient Kimberly MacKinnon. She is upset about the departures of two gynecologic oncologists in Saskatoon whom she trusted. (CBC News)

Pleas for help

Each year, another 240 women are diagnosed with reproductive cancers in Saskatchewan. The wait time for a hysterectomy for cancer is roughly four weeks, on par with Ontario, according to health ministry data from both provinces.

The prairie province is in a chronic quandary over staffing enough specialists to avoid burn out. Its small population of 1.12 million people only warrants — in theory— a certain number of specialists in any field.

Yet, patients are spread over vast distances and timely access often requires service in both Saskatoon and Regina. Specialists need a certain critical mass to maintain a work-life balance.

When Giede accepted a job in 2005 as Saskatoon’s only gynecologic oncologist, he was on-call 24 hours a day, seven days a week. The arrival of a second gynecologic oncologist, Dr. Anita Agrawal, in 2008, provided some relief.

Still, the two doctors shared what they called a « one in two » ratio workload — meaning, each had to be on-call half of each month, on top of their normal clinical practice. If one took vacation, the other covered 24/7. 

Dr. Christopher Giede said treating gynecologic cancers is ‘intense work’ that requires respite. (Bonnie Allen/CBC News)

It wasn’t unusual for Giede to be called out of bed in the middle of the night to see a feverish chemo patient in the ER, catch a few hours sleep at the hospital, then perform a four-hour radical hysterectomy that day. 

« I could tell when we were both getting tired when we would argue over who was working more. And it was a silly argument because we were both working more than a full-time position, » Giede said. « We needed each other, and we need to work well or we would have collapsed long ago. »

As academic physicians, they were also expected to do research, teaching and administrative work.

‘You’re breaking bad news all the time’

The doctors started sending emails and letters requesting a third gynecologic oncologist in 2012. Their frustrations intensified when, that same year, the health region didn’t hire an eager young doctor who had been born and raised in Saskatoon and was seeking a job in the city.

« I love Saskatoon, and that was drawing me there, » Dr. Sarah Glaze told CBC News. She confirms she had multiple meetings with the university and health region, but with no job offer, she ultimately found work in Calgary.

Giede was particularly disappointed that health officials wouldn’t create a position for her, when it’s proven that homegrown doctors are more loyal.

Health officials argued that the number of patients didn’t justify adding a third specialist.

Magic number of 3

A recently published report on national best practices, called the Pan-Canadian Standards for Gynecologic Oncology, states that the magic number in any centre is a minimum of three gynecologic oncologists. That reduces surgeon fatigue and improves patient care.

« Physician burn-out is a huge problem, » said Dr. James Bentley, president of the Society of Gynecologic Oncologists of Canada. « If you’re down to two people for a long time, it’s very wearisome. We’re dealing with people who are sick, you’re breaking bad news all the time, long surgeries, complicated chemotherapy regimes. It’s not straightforward stuff. »

In Ontario, a hospital must meet that benchmark of three gynecologic oncologists on staff to be designated a Gynecologic Oncology Centre by Cancer Care Ontario.  

Dr. Christopher Giede feeds his pet sheep on his acreage south of Saskatoon. He’s on indefinite leave with disability benefits. (Bonnie Allen/CBC News)

Moncton, Halifax, and St. John’s all staff three gynecologic oncologists, but it has often proven challenging for those smaller centres, and others in Canada, to retain that number of specialists. 

There are 101 gynecologic oncologists operating in Canada, with about 85 clinical positions, as reported by the national society. Many of them only see patients part-time, and also work on research, teaching or administrative duties. 

In Giede’s case, he was expected to oversee resident physicians on top of a full patient load.

Aggressive recruitment

In 2015, the health region finally granted permission to hire a third specialist. However, Giede said, three years in a row, a potential candidate has rejected their job offer because of the work environment. 

Saskatchewan Health Minister Jim Reiter has directed the health authority « to do whatever they need to do to aggressively recruit » new gynecologic oncologists.

A job advertisement promises $467,000 – $587,000 annually, plus a $30,000 signing bonus with a three year return-of-service commitment.

The health authority is also offering to sponsor two gynecologic oncology fellowships, at roughly $200,000 each, in return for service in Saskatchewan — just as it did for Giede nearly two decades ago.

« When you have a homegrown doctor, there’s a stronger likelihood that they’ll stick around, » Reiter told CBC News. « Longer term, we think that’s going to help with retention. »  

Saskatchewan’s Health Minister Jim Reiter sat down face-to-face with Dr. Giede to listen to his concerns. (Mike Zartler/CBC News)

Giede said he is proof that the fellowship incentive is not enough, « if you then allow the person who you trained to get burned out. »

In a face-to-face meeting with Reiter, Giede made a pitch for a minimum of three gynecologic oncologists in both Saskatoon and Regina, as well as clinical associates, locum backfill, and first responder support from within the cancer agency.

The health minister confirmed that there is no plan to centralize services in just one city, and that a formal review of the program will take place shortly. Recommendations could lead to change in the program’s structure and staffing number.

‘We’ve been holding on’

This past summer, Giede’s neck pain flared up to the point he was popping anti-inflammatory pills, lying down at work, and heading straight to bed when he got home. 

Both Giede and Agrawal said they held on as long as they could, and didn’t plan their departures together.

« Our goal was to provide the best care that we could with all we had in us, despite the environment, » Agrawal said.

Giede will only return to the operating room if both his health, and the work environment, improve.

« Nobody wants a temporary fix. I’m confident that message has gotten out there. »

[ad_2]

Source link

قالب وردپرس

Doctors back at the table with province as arbitration resumes

[ad_1]

Arbitration hearings between the province and doctors have resumed following an aborted attempt by the government to pull the plug on the process.

Negotiating teams for the health ministry and Ontario Medical Association met at a downtown hotel Tuesday, picking up where they left off before last week’s sudden and controversial move by Premier Doug Ford’s office to bring binding arbitration — underway since May — to a halt.

Doctors have been without a contract in Ontario since March 2014. Arbitration hearings with the province continue on Wednesday.
Doctors have been without a contract in Ontario since March 2014. Arbitration hearings with the province continue on Wednesday.  (Dreamstime)

Doctors have been without a contract since March 2014. The ensuing period has been tumultuous, marked by ugly infighting among doctors, a defeated ratification vote, a turnover of the OMA executive, a failed bid by the new Ford government to reach a negotiated settlement and then, last week, the province’s sudden withdrawal from arbitration and subsequent flip-flop.

The hearings are important because of the large amount of taxpayer dollars spent on physicians and because significant decisions are made about the provision of health services to patients.

The OMA, which represents Ontario’s 31,000 practising physicians, had the floor much of the day Tuesday. Its lawyers — Howard Goldblatt and Steven Barrett — countered earlier arguments put forth by the province.

Goldblatt said Ontario’s physician services budget should grow by 3.6 per cent for each of the next two years, an amount in line with previous increases.

Ontario currently spends more than $12 billion annually on doctors, or 10 per cent of the entire provincial budget.

The province maintains than an annual hike of 1.9 per cent should be enough to cover the added demands on the health system from a growing and aging population.

But Golblatt said that does not take into account extra monies needed to cover the cost of caring for more patients with chronic and complex health needs. As well, extra funding is required to pay for a growing physician workforce and new technology.

The province maintains $200 million could be saved annually by cracking down on the provision of unnecessary and inappropriate services, for example, diagnostic tests that patients do not require.

Under phase two of arbitration between the OMA and the province, set to commence next year, the issue of “relativity” is going to be addressed. Relativity refers to large pay gaps between medical specialties.

The highest paid include what are known as the “Big Three”: radiologists, cardiologists and ophthalmologists. According to government data, their compensation soared between 1991/92 and 2015/16:

  • Diagnostic radiology went up by 163 per cent to $561,053.
  • Ophthalmology jumped by 128 per cent to $649,433.
  • Cardiology increased by 95 per cent to $549,572.

During this time, inflation rose by 66 per cent.

When relativity is addressed, these three medical specialties stand to lose compensation to their lower-paid peers, including geriatricians, pediatricians, infectious disease specialists and psychiatrists.

In what appears to be an effort to head off that eventuality, physicians from the Big Three have been trying to break away from the OMA so they can negotiate their own contract with government.

Spearheading this effort is radiologist Dr. David Jacobs. In addition to being vice-president of the Ontario Association of Radiologists, he is a supporter of Ford’s.

Though this group represents only 5 per cent of doctors, the government cited the break-away efforts as the reason to withdraw from arbitration. The government said it had doubts about the OMA’s ability to represent the entire profession.

Numerous sources have told the Star it was Ford’s office that made the call to withdraw from arbitration, over the objections of Health Minister Christine Elliott and some backbenchers.

The government reversed the withdrawal decision after labour law experts charged it was illegal and physicians responded in anger.

The arbitration hearing continues on Wednesday.

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

[ad_2]

Source link

قالب وردپرس

How Ontario’s doctors lost faith in Doug Ford — and each other

[ad_1]

Ontario doctors are mad.

Mad at the last Liberal government.

Mad at the present Progressive Conservative government.

Mad at the Ontario Medical Association.

Mad at their fellow doctors.

Mad at themselves.

Or mad at all of the above.

Doctors do God’s work looking after patients. But they have not been looking after themselves on the labour front of late, which is most maddening of all.

After going for years without a contract, many MDs grew to hate the Liberals in power, prompting the membership to reject a 2016 agreement negotiated by their OMA leaders at the time. Dissident doctors pined for a Progressive Conservative government that promised a good-faith negotiation — with arbitration if necessary.

“The Liberals created a toxic relationship with our doctors by making unilateral decisions,” the premier’s spokesperson declared after the Tories took power. “Doug Ford is committed to respecting Ontario’s physicians and fixing the relationship.”

Be careful what you wish for. Hoping for healing is not enough.

The Tories took Ontario’s doctors for a wild ride this week. Despite Ford’s personal promise to respect physicians and protect the process, the premier’s office pulled the plug: It would no longer be legally bound by binding arbitration. A lawyer’s letter abruptly declared the process dead and buried. The government tried to dismiss its own appointee to the three-member arbitration panel the next day.

Just like that. Promise made, promise broken.

Read more:

Ford government to return to arbitration with Ontario doctors

Tories cut cultural funding, revamp tribunals in scramble for savings

Schism within government on how to deal with the Ontario Medical Association puts premier and health minister at odds

The OMA exploded. Doctors went ballistic. Labour lawyers were apoplectic, accusing the government of not only losing its way but flouting the law.

Both sides are prone to grandstanding in labour negotiations, walking away from the bargaining table or unleashing ultimatums. But aborting arbitration, after agreeing to abide by it, is not part of the playbook if it violates a formally agreed legal framework.

The Tories’ self-serving explanation was that the OMA is now riven by divisions, and could no longer be counted upon to deliver its members if they ever reached a deal. In short, the government declared non-confidence in its bargaining opponent.

As outlandish as that assertion might be in law, it is not outrageous in reality. For it is a fact that the OMA, in a previous incarnation, reached a tentative agreement two years ago with the previous Liberal government, only to fumble the ball.

It was a compromise, as all negotiations are. But the OMA executive, having sealed the deal, couldn’t sell the deal to its members — in short, it couldn’t deliver.

Dissident doctors, led by the best-paid specialists (who resisted taking a haircut so that lower-paid general practitioners could catch up), whipped up opposition to the deal. They won the vote, defeated the deal, and ousted the OMA’s old leadership on the promise of getting a better bargain after the next election.

While the doctors were playing tough, another group of professionals took a different tack: Ontario’s teachers’ unions, who are no slouches in contract negotiations, opted to take the best deal they could get from then-premier Kathleen Wynne, who wanted to avoid pre-election labour strife.

Teachers took the money and ran — before time ran out on the election clock, and before the province’s fiscal situation deteriorated. Doctors, by contrast, rejected their own deal, rebelled against their own organization, and turned against each other.

A civil war among physicians has culminated in a secession attempt by highly paid specialists who want to create the “Ontario Specialists Association,” or OSA, to rival the OMA. The latest round of internal warfare provided the pretext for the government to opt out of binding arbitration — escalating the conflict to a nuclear war.

The stakes are high for doctors and patients, politicians and taxpayers. MDs get more than $12 billion a year — roughly 10 per cent of the annual budget at a time when the Tories are retrenching.

Having accused the Liberals of fostering a “toxic relationship,” Ford has personally poisoned the well by going back on his word. Perhaps the premier could not resist exploiting the weakness of a faction-ridden OMA — an organization that never missed an opportunity to miss an opportunity with the Liberals, reposing its faith in Ford for a panacea on pay.

By week’s end, the Tories had done another U-turn. Facing ferocious pressure from doctors, or perhaps a second opinion from their lawyers, the government undid its ultimatum — and agreed to arbitration again.

Just like that. Promise made, promise broken, promise remade.

No doubt doctors are hoping for healing again. But we should all have learned by now to be careful what we wish for.

Martin Regg Cohn is a columnist based in Toronto covering Ontario politics. Follow him on Twitter: @reggcohn

[ad_2]

Source link

قالب وردپرس