Taking the OMA to task

When the Ontario Medical Association (OMA) systematically undermines the wishes of its own membership, and its elected physician leadership, we should all be greatly concerned about the future of Ontario’s medical profession. Years ago, Ontario’s physicians were sold on governance transformation within the OMA as a means of advancing the physician agenda, but my lived reality within the OMA speaks a different story, and as we approach another round of “idea prioritization” (more below) by the OMA’s Priority and Leadership group this coming May 6, it’s high time that the backstory to the entire process was told. For starters, you should know that as an elected physician leader within the OMA since 2016, I’ve worked tirelessly for years to advance the interests of our membership, and I’ve been dismayed at the extreme difficulty associated with advancing the physician agenda at the OMA. Read: What might a 'National Registry of Physicians' mean for national licensure? The following is written using my own history within the OMA, particularly the General Assembly Steering Committee (GASC), and the real struggle to be heard within an organization that in my view is focused on corporate interests first, and physician interests second. This story, dear colleagues, is my commitment to you. It is a story that must be told. Let’s start with the most recent correspondence to the OMA’s Priority and Leadership Group (PLG) from our GASC Chair, Dr. Veronica Legnini, as an example of OMA governance gone awry. For those unfamiliar with the process, OMA’s physician membership recently sent in a list of 59 ideas that they would like the OMA to take action on. OMA’s priority and leadership group will go through a ranking process on May 6, with the ideas categorized as related to either “Advocacy,” “Issues and Policy,” or “Compensation.” The PLG group goes through a ranking process and ultimately the top idea in each category is assigned to its associated panel (i.e., the Advocacy panel, the Issues and Policy panel or Compensation panel) for further discussion and action. Here is the correspondence: “Idea Removal: In reading the materials, you will note that the idea around the creation of an ombudsman for the Physician Health Program has been removed from the ranking exercise. Further discussions with staff identified active work already underway on a similar idea that will be addressed before panels and working groups can be convened to scope and provide recommendations. We want to ensure we make the best use of your time during the meeting and focus on ideas that will advance member priorities and support the profession without duplicating efforts. This late change has identified a gap in process that the steering committee will improve upon in future iterations in terms of early identification of ideas that conflict with work near completion.” Read: Navigating purgatory with Ontario's proposed fee deal There are several problematic aspects to the OMA’s removal of an idea submitted by an OMA member. The first is that the removal occurred absent discussion or input from the OMA Priority and Leadership group, who should have the final say with regards to whether the idea should remain in the ranking process or not. I view the role of GASC as one of being duly responsive to the wants and needs of the PLG/membership and providing guidance where necessary—not changing the process at whim without input from the larger group. It is inappropriate to call this a mere “gap in process.” It is an undemocratic removal of a member’s thoughts from a prioritization process that was meant to advance membership involvement, not systematically undermine it. Surely PLG could have been advised of any potential duplication of work, and the matter of removal left to a vote by the group so that another idea could be considered in its place? So, let’s talk about the second issue: is this truly a duplication of work? I have personally sought to advance the Physician Health Program by advocating for the development of a peer-to-peer support network that would be supported by the OMA’s peer support program. A similar idea presented to a break-out room last year prompted a similar OMA refrain that “work was underway,” and when I further explored the matter (in 2022) it turned out that at best the OMA was planning a single pilot of a peer-to-peer support group sometime this year, and even that work was at the request of an external organization not the PLG. If the OMA has “active work underway,” they should surely present it to PLG for discussion as to whether that work truly presents a duplication of work, or whether the creation of an ombudsman would be complementary to it—not simply remove the idea without input or consultation. The actions of the OMA in this regard are simply undemocratic. Unbeknownst to most PLG delegates, the OMA has been taking similar undemocratic action with regards to the idea prioritization process absent discussion, input, or comment from PLG for quite some time. The first example of non-democratic intervention was the advancement of “one idea per panel.” This was presented by corporate OMA to GASC essentially as a fait accompli for GASC’s rubber-stamped approval. I did not approve it as I strongly felt that membership should be heard, and action taken in response to their concerns, with appropriate discussion with the PLG group. When subsequent discussion did occur with PLG delegates, the proposal to entertain more than one idea per panel was promptly shot down by the GASC Chair. Further examples of undemocratic interventions by corporate OMA in the work of 125-democratically elected PLG delegates are replete. At our November 2022 Advocacy panel meeting we were advised that the OMA has arbitrarily set a one-year timeline for effecting the idea that was under consideration at that time, that there were budgetary constraints associated with effecting the idea, and that the OMA planned to task the associated Advocacy working group with the production of a report for perusal by the OMA Board. Constraints, fiscal or otherwise, are reasonable but my point is that all of this occurred without advance discussion about timelines, budget, or outcomes with the Advocacy panelists, the GASC or the PLG—and all these constraints had the practical effect of corporate OMA curtailing the outcome of a democratically prioritized idea. Presumably, each panel is tasked with overseeing the work of its associated working group, but we weren’t even allowed to discuss the terms of reference that would logically guide the work of the working group that we were overseeing. I imagine a similar situation is unfolding with the work of each panel, and all of it greatly concerns me: what is the future of the wishes of our membership, and those of the PLG delegates elected to represent them, if the OMA can simply change the rules of the game in its favour? What is the process for making these decisions at the OMA, or are they really made in the OMA corporate back room? I care passionately about advancing a better healthcare system, one that works for doctors, patients, and all our associated care providers.But it’s difficult to advance that better system when my work, and when all the work of our hard-working PLG delegates, is systematically undermined by constraints from the OMA without the basic courtesy of an advance conversation between physician leaders and the OMA about what those constraints actually are. Ontario’s physicians and Ontario’s patients deserve better from the OMA. Colleagues, it’s time to demand better treatment from our own representative: demand that the OMA explain its back-room decisions, demand that the OMA seek more comprehensive input from physician leadership, and demand a more transparent, democratic, decision-making process at the OMA. Ontario’s doctors, and indeed the entire healthcare system, are counting on you to hold the OMA accountable for its actions. Dr. Sharadindu Rai is a family physician in London, Ont., and member of The OMA’s General Assembly Steering Committee, Priority Leadership Group and Advocacy Panel, as well as District 2 vice-chair. All opinions are his own.

Taking the OMA to task

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