In the continuing dispute with the Ontario government, the province's doctors are finding their social-media voice. Unfortunately, that voice is too often shrill, self-indulgent and counterproductive.
Doctors have every right to be frustrated. Like other unionized workers, they are entitled to a negotiated labour deal. Instead, since talks broke down in January, the government has unilaterally cut their fees by 4.45 per cent – with more likely to come.
(Before hackles are raised: No, the Ontario Medical Association is not technically a union, but, for all intents and purposes, it is, because it negotiates a contract on behalf of the province's 33,600 doctors, who pay obligatory dues.)
Traditionally, what workers do when talks break down is withdraw their labour – go on strike. Legally, doctors can strike, though they tend to come out losers when they take to the picket line, the 25-day strike of Ontario doctors in 1986 being the prime example. What the OMA has opted to do instead is appeal directly to the public, primarily through social media like Facebook and Twitter, in a bid to shame the government back to the bargaining table or, alternatively, agree to binding arbitration (which, at this point, would be the most sensible short-term solution).
The social-media campaigns, with hash tags like #CareNotCuts, #oncall4ON and #CodeBlue, are designed to emphasize that cuts in physician fees will harm patient care, and to show that doctors are dedicated and hard-working.
These approaches have not proved to be especially effective. There's a fine line between warning and threatening reductions in patient care, and between highlighting your hard work and whining about your workload and, too often, physicians have veered to the wrong side of that line.
The biggest mistake doctors have made is focusing too much on their fees and income. The average gross clinical payment is $368,000 in Ontario – the highest in the country. While that is gross billings, not take-home pay, doctors, by any measure, make a good living and to claim otherwise is disingenuous.
The public has no problem with doctors being well paid. Still, the profession isn't going to generate much sympathy by whinging about high overhead (it ranges from 0 to 60 per cent, but averages 26 per cent) and lack of pensions (most workers don't have private pensions), and complaining that plumbers make more per hour than they do (because a lot of others, like child-care workers, are badly underpaid).
The reality is that some doctors are overpaid and some are underpaid. There is not so much a doctor shortage as there is a doctor-distribution problem.
The medical profession needs to be willing to correct those disparities in contract negotiations; if it does not, the province's only option is ham-fisted across-the-board cuts, and some targeted fee reductions.
A number of doctors have threatened to leave the province over the fee dispute. That would be unfortunate, but, from a government perspective, there can be only one response: "There's the door."
Threats and blackmail are not legitimate negotiating tools. Neither are personal attacks. And one of the most troubling aspects of the social-media campaigns has been the smearing of Health Minister Eric Hoskins. The name-calling is churlish and unprofessional.
Dr. Hoskins is an elected official, and as such his role is to serve the public, not just doctors. About 60 per cent of all health costs go to labour, so the only way to rein in spending is to control wages (or, in the case of doctors, fees). In a political environment where the public wants ever-more services and ever-lower taxes, governments have to be ruthless.
Ontario's doctors have made taking a hard line, and imposing fee cuts, a lot easier than it should be. They have not made a case for how modest fee cuts harm patient care.
No one can reasonably argue that the current way of paying physicians, complete with a 747-page fee schedule, makes any sense, or that it benefits patients. By skirting that fundamental issue, neither side is looking out for the public's long-term interests.
And, right now, that reflects most badly on doctors, because their sense of entitlement is showing.
André Picard