Ontario Medical Association is taking aim at wrong target

TheStar.com – Opinion – Ontario Medical Association is taking aim at wrong target
October 06, 2009.   Tom Closson, President and CEO of the Ontario Hospital Association

Most health-care experts and providers agree that physicians, nurses, nurse-practitioners and pharmacists work best as members of an interdisciplinary team, and to the fullest extent of their training. It appears that the Ontario Medical Association (OMA), which represents physicians, does not.

Last week, Ontario’s Legislature began hearings on Bill 179, proposed legislation that would allow pharmacists and nurse practitioners to provide an enhanced level of direct patient care. But while many health-care providers welcomed the bill, the OMA’s family practice section launched a high-octane advertising campaign claiming it will endanger the health and lives of Ontarians.

Ontario’s hospitals disagree with the OMA’s view, and we support Bill 179. We believe that all properly regulated health professionals should be allowed to provide the level of patient care for which they were trained.

Moreover, far from being dangerous, we believe the proposals in this bill would improve access to quality health care for patients while allowing physicians to focus their time and talents on more complex cases.

Given its recent history, it is perhaps not surprising that the OMA would oppose the key provisions of Bill 179. The OMA does not support the introduction of nurse practitioner-led clinics – even in parts of Ontario where the services of a physician are often unavailable.

It did not support the creation of Ontario’s wait times strategy and remains skeptical, even though data indicate that wait times for surgery are dropping.

Just two months ago, the OMA released a retrograde “policy” paper that outlines how and why the broader health system should be accountable to physicians, but says nothing of substance about the accountabilities of physicians to anyone else in the health system.

In this context, the OMA’s opposition to Bill 179 is consistent with its pattern of protecting what it believes to be physicians’ “turf,” even if it means rejecting ideas that would improve the quality and sustainability of our health-care system.

The OMA’s ads have inadvertently provoked a long-overdue discussion about the proper roles and responsibilities of Ontario’s physicians in our ever-changing health-care system, and those of the OMA itself.

Ontario’s health-care system has changed dramatically in recent years. We have seen a new emphasis on improving access to patient care, better integrating that care, and holding care providers more accountable for their performance.

The government formed Local Health Integration Networks to foster better health system planning and integration. It expanded the network of family health teams, and created the aforementioned nurse practitioner-led clinics and wait times strategy. It also implemented measures to increase hospitals’ accountability for tax dollars spent, and for the quality and safety of the care they provide.

Ontario’s hospitals worked side-by-side with the government to implement those changes and are now the most efficient and accountable hospitals in Canada. Our hospitals now serve more people, more quickly than ever before, but spend significantly less per capita than hospitals in the rest of Canada. These efforts save the government of Ontario $1.6 billion per year, which it uses to invest in other priorities. The hospital sector’s record indicates a serious commitment to continuous improvement. Shouldn’t the OMA also be up to this challenge?

Ontario spent $736 per capita on physicians in 2008, while all other provinces spent an average of $625 per capita – 18 per cent less. (This gap is expected to widen as physicians’ new contract takes effect.) This disparity, coupled with the OMA’s adamant defence of physicians’ status, has prompted reasonable people to question whether taxpayers are getting the system leadership they deserve from the OMA, particularly during this challenging economic time.

Ontario’s physicians are among the best and brightest in the world, and we are fortunate that they have chosen to practice here. But providing first-class care in the operating room or the examination room is not enough.

Ontarians expect every individual and organization involved in the health-care system to play a leadership role in making that system better, safer and more affordable. Physicians and the OMA must help to lead that change.

Ontario’s hospitals recognize that there are thousands of physicians who are passionately committed to reforming Ontario’s health-care system, embracing interdisciplinary care models, and breaking down barriers to care.

We encourage the OMA’s leaders to listen to those physicians and participate more positively in the sometimes difficult work of changing and strengthening Ontario’s health-care system.

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