They can strike but we can’t

It is said that one of the rulers in the old era imposed on some tribes a tax that was collected from them every year—and it consisted of a fleece at the rate of one fleece for every ten head of livestock. This was not accepted by some members of the tribe. They complained and started paying the tribute sometimes—but evaded paying it at other times. After a while a new governor replaced the old one. He was more strict than his predecessor. When he learned that some members of the tribe had complained about the tax, he became furious and ordered an increase in the tax. He made it: a fleece and a lamb for every ten head of cattle, and threatened to imprison anyone who doesn’t pay. All members of the tribe began to pay the new tax regularly against their wish. They wished to return to the previous situation. One of them expressed this by saying: “We didn’t agree on a fleece, and now we agreed on a fleece and a lamb?” Read: Dr. Jabir Jassam: Everyone is a doctor Policy makers thought that doctors are the most costly part of the health system so they tried to find alternatives or additions which cost less in order to save the budget. They started with nurse practitioners who after they were established and their practice became regulated, struck and started a hard negotiation until they got most of what they wanted. They now pay NPs almost the same or even more than they pay most doctors and they work less and see fewer patients. They also thought ophthalmologists were costly too so they licensed optometrists to do much of their jobs hoping this would save the budget too. But we all know what happened recently where optometrists struck and refused to see OHIP patients until they got that significant amount of money from the ministry. I confidently believe that once physician assistants become established and their practice regulated they will also threaten to strike unless they receive a raise in their payments—and they will get it. The same thing will happen with pharmacists, maybe chiropractors, midwives and physiotherapists when they start to also prescribe medications and order tests. They all can strike but we can’t and we honestly don’t want to strike. They all have a union but we don’t. They all have a solid negotiator but do we have one? I acknowledge that adding NPs, PAs and optometrists to the health system was a good step and they are undoubtedly good assets but was there any saving in the budget? Patients still want to see doctors for the same reason which was addressed by NPs and optometrists—which means the payment might be double for the same patient and for the same reason. Policy makers perhaps—though highly likely—wish they had agreed to pay to doctors only but it is too late. I could almost hear one of them whispering: “We didn’t agree to pay doctors, now we have to pay doctors and the rest.” Dr. Jabir Jassam is a family physician in Ottawa.

They can strike but we can’t

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