2020 was an awakening in the ongoing struggle against inequity.
Race-based health inequities highlighted the persistence of structural racism in health care. The importance of diverse representation in medicine became glaringly obvious, and the need to address a status quo of inequality became more urgent. The Ontario Medical Association, a membership organization that ‘represents the political, clinical and economic interests’ of Ontario’s physicians’, from family doctors to specialists, is a powerful organization and a major government partner in administering health care.
In response to the 2020 awakening, the OMA released a year end communication stating it is committed to enhancing “equity, diversity and inclusion across all facets of the organization” and to promoting those concepts “including their importance at the societal level.”
But this statement is contradicted by their own actions and policies of the last several years.
Reconciliation, for example, is one of the most pressing matters of our time. Yet, in 2018, the OMA took a major step backward, as the Governing Council summarily defeated a motion submitted by the Ontario Medical Students Association requesting that OMA General Council Meetings open with an acknowledgment and reflection on relationships with Indigenous peoples in Canada. A shift in physician culture towards acknowledgment of Indigenous peoples rights is a fundamental step toward healing. Without this physicians will continue to operate in perpetual structures of racism and exclusion, and health care gaps will not close.
The 2020 pandemic also revealed the intimate links between race, income and health. Research shows that 87 per cent of Indigenous adults in Toronto live below the Low Income Cut Off. Black, Indigenous and other People of Colour (BIPOC) people made up more than 83 per cent of first wave COVID infectionsin Toronto, and they continue to be over seven times more likely to contract COVID than White Torontonians. BIPOC communities are also more likely to live in multi-generational, inadequate or crowded housing. Overcrowded and unsafe factories, employment in health services or personal support or delivery jobs that ensure those with privilege can stay home, account for much of the high prevalence of COVID in these neighbourhoods.
The OMA continues to perpetuate rules and policies which disproportionately impact racialized communities.
The OMA publishes the Physician’s Guide to Uninsured Services: a document that details fees that physicians can directly charge patients. Examples include transferring medical records, providing telephone advice, or phoning in prescriptions.
This 52-page OMA compendium is a remarkably detailed catalogue on how to bill for every conceivable service at a rate equivalent to 2.31 times the value of the 2014 OHIP fee schedule or $411 per hour. The OMA allots exactly 10 lines to the issue of patients’ ability to pay for uninsured services.
Doctors have no training in assessing the ability of patients to pay. The vast majority of doctors have had no experience with living on incomes below the low income-cut off or poverty line. Those who have experienced such poverty left that status long ago. Yet these same doctors are supposed to judge a patient’s ability to pay — patients whose annual incomes are in many cases a twenty-fifth or less of the physician before whom they sit. Patients are compelled to plead poverty in a humiliating interaction with their physician.
Who are these patients who must engage in such unequal bargaining with their physicians? Again, they are disproportionately BIPOC, including immigrants and refugees, who are massively overrepresented in the lower income classes. The OMA’s billing guide is a classic example of structural racism precisely because its effects are felt most by BIPOC communities.
Human rights vernacular is empty talk if the result is entrenched bias and its consequent harm. The OMA creates the culture within which Ontario’s physicians operate. It must tackle head on its own discriminatory practices.
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