Posted on June 5, 2017

Coalition Outlines Concerns

Last week, the Coalition of Ontario Doctors (Coalition) outlined its concerns regarding the tentative binding arbitration (BA) agreement the OMA recently signed with the Ontario government.

Over the weekend, more physician groups went on record opposing the tentative BA agreement. As an OMA member, you will have your chance to support or reject the BA agreement at a vote that will be held during a general meeting of members on June 17, 2017.

Several components of the BA agreement are worrisome and remain not clarified by the OMA as of today. These include:

Important Questions on the tentative BA Agreement That Must Be Answered

  • Why does the BA agreement perpetually entrench the OMA as the bargaining agent for all Ontario physicians with no alternative representation mechanism if this BA model does not work out?
  • How does the OMA plan to manage conflicts within the profession that will arise from it playing a co-management role with MOH of (withthe Physician Services Budget?
  • Why are the Mediation/Arbitration roles combined in the same Chairperson, versus having the roles divided to ensure greater transparency?
  • Why have you given prominence to income relativity for arbitration while being silent on other issues of key interest to such as the projected PSA budget for the next 4 years?

OAC believes the OMA must resolve these concerns before we can recommend to our members supporting the BA agreement. The OAC encourages all members to get informed by going to the OAC website in the lead up to the June 17th vote.  Here you will find the latest developments on the tentative BA agreement. 

Stay informed. Keep in touch.

Posted on January 22, 2017

OAC’s 2017 Pre-Budget Submission: Making Heart Disease a Priority in 2017 and Beyond

Making Heart Disease a Priority in the 2017 Ontario Budget and Beyond

2017 Pre-Budget Submission to the Standing Committee on Finance and Economic Affairs
January 20, 2017



Heart disease is a leading cause of death and illness in Ontario.

Across the country, heart disease kills more women each year than all forms of cancer combined.

Congestive heart failure is the single commonest reason patients go to emergency rooms and are admitted to hospital in Ontario, where their care is very expensive and can be difficult to carry out in an efficient and timely manner due to recent funding cuts to hospital beds and health care resources.

It is estimated that up to 80% of heart disease is preventable by quitting smoking, eating a healthy diet, getting active and maintaining a healthy body weight.

Despite these statistics, the Ontario government has no co-ordinated, province-wide strategy to address heart disease and its ravaging effects on Ontario patients & their families, provincial health care expenditures, and economic productivity.

The Ontario Association of Cardiologists (OAC) believes this must change. We are calling on the Ontario government in the 2017 Budget to work with our organization to formulate the Ontario Heart Disease Prevention and Treatment Strategy. Key elements must include:

  • Restoring the cuts to hospitals that have recently (i.e. since 2012) decreased the number of cardiac care beds and cardiac resources in Ontario;
  • Strengthened investments in Ontario’s outpatient cardiac care infrastructure to support patient access to care close to home whether it be in the hospital or cardiologist office;
  • Support for the Auditor General of Ontario’s 2016 Annual Report, which recommended collaboration with Ontario’s cardiac care specialists (OAC) to ensure that the province’s limited health care resources are spent appropriately and maintain high standards of cardiac care;
  • Improved e-health integration initiatives to optimize the delivery of high quality cardiac care services in the community and hospital environments; and,
  • A co-ordinated multi-stakeholder plan that includes disease prevention, patient education, and cardiac care service delivery aimed at reducing overall incidence and expenses related to heart disease in Ontario.

As physicians who specialize in diagnosing and treating heart disease, Ontario’s cardiologists provide cost-effective care every day that is crucial to saving lives and improving the quality of life of thousands of patients with heart disease.  Recent cuts to health care funding and cardiac services are making this more difficult to deliver each day and if not reversed increased cardiac death and illness will occur.

The OAC would welcome the privilege to partner with the provincial government to develop and implement the Ontario Heart Disease Prevention and Treatment Strategy.

About the OAC

The OAC is a voluntary professional organization that represents the majority of academic (i.e. hospital-based) and community (i.e. clinic and/or office-based) cardiologists in Ontario. Founded in 1995, the OAC’s mission is to protect, maintain and improve the current high standard of cardiac care for Ontario patients across the province and ensure the cardiologists who deliver the care are fairly remunerated for these services.

The OAC is an advocacy leader for Ontario’s cardiologists and their patients. It exists independently of the Ontario Medical Association (OMA) to ensure the voice of cardiology is heard regarding issues that affect the care of cardiac patients in Ontario. While all cardiologists in Ontario are required to be members of the OMA, the OMA does not provide its Section on Cardiology with the support or infrastructure to allow it to act as an effective advocate for cardiac patients. The OAC fills this gap. Without its ongoing advocacy program, the continued high standard of cardiac care in Ontario is at risk.

Current Cardiac Care Landscape

Ontario’s once strong and co-ordinated system of hospital-based and outpatient cardiac care has come under significant strain in recent years due to arbitrary unilateral government cuts to cardiac care services. Table 1 outlines the drastic reductions that have been made since 2012 in the absence of consultation with Ontario’s cardiologists.

 Table 1: Ontario Government Budget Cuts Affecting Cardiac Care (2012-17)

Service Description Effective % Cut
 Various (incl. ECG; pre-op echo; cardiac catheterization & others)  Reduction in fees & harmonization of codes  FY 2012/13  10%
Congestive Heart Failure Patient Care Chronic Disease Assessment Code (E078) eliminated for cardiologists treating patients with congestive heart failure April 2015 100%
Echocardiography and Nuclear Cardiology Procedures Two professional fees combined and reduced for various types of echocardiography and nuclear cardiology procedures October 2015 20% of previous P1 fee
Service Description Effective % Cut
All cardiology procedures and services “Across the Board” discount applied to all OHIP physician billings (incl. professional and technical fees) April 2013 (0.5%)February 2015 (2.65%)

October 2015 (1.3%)

Global Billing Cap The government will claw back any OHIP physician services budget spending that exceeds a 1.25% increase over previous year April 2016 Unknown amount

The cuts to cardiology services within the Ministry of Health and Long-Term Care’s physician services budget have forced cardiologists to make hard choices regarding when and where they can provide cardiac care services. Patient access to care is threatened because cardiologists increasingly cannot afford to provide the services that have been promised by the Ontario government and patients have come to expect. Some clinics and offices have closed and patient access to cardiac care is significantly delayed as a result. This is not good for cardiac care. Time is muscle when it comes to delivering cardiac care and this concept needs to be recognized by government.

The OAC recognizes the Ontario government’s desire to meet its balanced budget commitment by the year 2017-18. We agree that the Ontario government should live within its means. What we object to, however, is the elimination of the government’s deficit on the backs of Ontario’s cardiac care specialists and their very sick patients.

In December 2016, Ontario Premier Kathleen Wynne and Finance Minister Charles Sousa called on the federal government to provide annual health care funding growth at 5.2%, a figure that they said was “fair and evidence-based and has been validated by a number of third-parties, such as the Conference Board of Canada, the Parliamentary Budget Officer and the Fraser Institute.”

Yet, what did Minister of Health and Long-Term Care, Hon. Dr. Eric Hoskins, offer in the latest physician services agreement “proposal” to the Ontario Medical Association last month? Annual budget increases of less than half of this amount. Does the government expect physicians to cover budget overages related to immigration and demographic change, costs which are rising sharply and out of their control, themselves?

The government’s attitude and approach to cardiac care has been disappointing. It is leading young doctors to avoid setting up in this province, forcing others who are currently here to leave and inspiring older doctors to retire early. Cardiac care service delivery is at the brink of chaos. Cardiac care must be delivered by the experts, highly trained physicians, who have the knowledge necessary to correctly diagnose and manage the cardiac patient.

Auditor General of Ontario’s 2016 Annual Report

The OAC understands that health care resources are limited and that what is available must be spent appropriately. This is why we brought forward concerns to the Auditor General of Ontario in June 2016 after trying for many months to resolve with the government what we considered to be misspending of public resources in cardiac care.

In the 2016 Annual Report of the Auditor General of Ontario, Ms. Bonnie Lysyk stated: “Concerns of the Ontario Association of Cardiologists (Cardiologists Association) about cardiac-care spending in an open letter to the Auditor General were reasonable.” Specifically, she found that the government overpaid at least $3.2 million between April 2012 and May 2015 for two cardiac rhythm monitoring tests (Holters & loop recorders) that were inappropriately claimed and paid. Moreover, the Auditor General supported the OAC’s concerns over the vast expansion of commercial echocardiography (cardiac ultrasound) labs in Ontario that have been fuelled by an arbitrary change to the physician services budget in October 2015.

Her recommendations were clear. She stated, “To strengthen the oversight of the use of cardiac ultrasound services, the Ministry of Health and Long-Term Care should work with the Ontario Association of Cardiologists and the Cardiac Care Network of Ontario to:

  1. Assess the effectiveness of the Cardiac Care Network of Ontario’s Echocardiography Quality Improvement program intended to deter inappropriate use of cardiac ultrasound services;
  2. Monitor the use of cardiac ultrasound services claimed by facilities, such as those owned by non-physicians, and take corrective actions when anomalies are identified; and
  3. Recover the $3.2 million of over payments to physicians related to cardiac rhythm monitoring tests that were inappropriately claimed.

It is time to stop the arbitrary and unilateral funding cuts focused on achieving a political objective.

Instead, we urge you to think more broadly. It is time to recognize the serious economic and human consequences that heart disease is having in Ontario and develop a new comprehensive and integrated approach to dealing with one of Ontario leading causes of death and illness. It’s time to work with the OAC to develop the Ontario Heart Disease Prevention and Treatment Strategy.

Why Work With The OAC?

Ontario cardiologists are doctors who save lives and improve the quality of life for thousands of patients facing heart disease. In an emergency, they step into a patient’s life suddenly and are trusted implicitly to help. Throughout all patient encounters they listen; ask questions; perform tests; and interpret results. Patients count on their years of training and experience to help them in ways that no one else can.

While cardiologists work in a multitude of settings including hospitals, the majority of cardiologists provide services as independent small businesses through clinics and/or community offices. They do not receive salaries, do not have a guaranteed pension or even a drug or dental plan provided for them. Instead, cardiologists make their income from government payments earned through billing for services they provide, minus the costs of running their clinic or office, which can easily represent 3%.

These costs include, but are not limited to:

  • Staff & Benefits (These costs have doubled in the past seven years)
  • Computers
  • Medical Supplies
  • Medical Equipment (e.g ECG, echocardiography machines, etc.)
  • Rent – Office
  • Insurance
  • Financial Management
  • Continuing Medical Education

In short, government payments to cardiologists are not exclusively income.

Furthermore, unlike other independent small businesses in a community, cardiologists cannot charge for services based on what they cost. Even though they face a growing population from immigration, an aging community and the costs of new equipment, community cardiologists are locked into an inflexible system that expects them to absorb the cost of change and poorly thought out government strategies to reduce the costs of delivering cardiac services. There are stringent rules about what a cardiologist can charge the health care system per patient regardless of the amount of time required to help a particular patient with heart health issues. If a patient requires additional visits to their cardiologist or more time per visit due to complications than the system’s rules prescribe, then the cardiologist is expected to absorb the additional costs. The cardiologist has reached the stage that there is no further room to absorb any additional costs; some services are being cut resulting in restricted patient access to cardiac care in the province of Ontario because of the lack of government funding.

Ultimately, cardiologists provide tremendous value to the health care system by saving lives and improving the quality of life of thousands of patients through their cost-effective services. The time demands can be enormous (late nights, on-call, weekends, emergencies) and the emotional costs of dealing with individual lives and their loved ones is unique.

As the Ontario government develops the 2017 Budget, we ask it to re-examine its treatment of the cardiology profession in the past four years and recognize the crucial role and tremendous value it is delivering to patients and the health care system.

OAC’s 2017 Budget Priorities

Heart disease is a leading cause of death and illness in Ontario. It has an enormous impact on the lives of Ontarians of all ages, living in all areas of the province and comprises a major component of province-wide health care expenditures. Yet, there is no recognition of this from the Ontario government. There is no comprehensive, co-ordinated approach to tackling this disease and the enormous human and economic impacts it is having in Ontario today.

We believe that this must change.

The Ontario government must show leadership on this issue. The future of patients currently living with heart disease and of our cardiac care services in Ontario depend on it. That is why we are calling on the Ontario government to heed our call by working with Ontario’s cardiologists to develop a province-wide Ontario Heart Disease Prevention and Treatment Strategy. Key elements of such a strategy would include:

  1. Restoration of funding to hospitals providing cardiac services to Ontario patients to increase the number of cardiac beds and resources and enable cardiologists to deliver care that meets current international standards.
  2. Strengthened investments in Ontario’s outpatient cardiac care infrastructure to support patient access to care close to home. For example, restoring the chronic care code for cardiologists and internal medicine specialists who treat congestive heart failure patients. This small annual investment of approx. $3 million/year will be revenue neutral if not improve your government’s bottom line as it will help keep many of these very sick patients from having to go to the hospital where the care is much more expensive.
  3. Consistent with Auditor General of Ontario’s 2016 Annual Report, collaboration with Ontario’s cardiac care specialists to ensure that the province’s limited health care resources are spent appropriately and maintain high standards of cardiac care. The Ministry should commit to recovering the $3.2 million misspent between April 2012 and May 2015 and reinvest this in areas of cardiac care that need it.
  4. Improved e-health integration initiatives to optimize the delivery of high quality cardiac care services in the community and hospital environments; and,
  5.  A co-ordinated multi-stakeholder plan that includes disease prevention, patient education, and cardiac care service delivery aimed at reducing overall incidence and expenses related to heart disease in Ontario.


The time has come for the Ontario government to make combatting heart disease in the province a top priority. To do so effectively, it needs to stop viewing cardiologists and cardiac care services as a cost centre within the provincial treasury. No more unilateral cuts. No more demonizing or bullying cardiac care specialists.   Instead, reach out, as per the Auditor General of Ontario’s advice, and work with us to ensure that high quality cardiac care services are provided to patients appropriately all across the province.

In the past, there has been a strong track record of collaboration between Ontario’s cardiologists and the provincial government, which led to the formation of Cardiac Care Network of Ontario and served as a model for Cancer Care Ontario. We believe that the conditions exist for this to collaboration to work again in an effort to ensure that patients with heart disease get the kind of care we all believe they are entitled to and that doctors who deliver the care are appropriately remunerated.

A comprehensive Ontario Heart Disease Prevention and Treatment Strategy is needed. Let’s work together to ensure finite health care resources are spent appropriately in cardiac care so that the best results for patients can be delivered wherever they may live in the province.

For more information, contact:

James Swan, M.D. F.R.C.P. (C) F.A.C.C.
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239


Posted on January 13, 2017

OAC Delivers Message to Ontario Government Re: 2017 Budget

January 9, 2017

OAC President, Dr. Jim Swan, delivered an important message to the Ontario Ministry of Finance and Yvan Baker, MPP, Parliamentary Assistant to the Minister of Finance, in Toronto re: the upcoming 2017 Ontario Budget.

Stop the unilateral funding cuts! Combat heart disease – Ontario’s #1 killer – in 2017-18 and beyond by working with Ontario’s cardiologists to strengthen investments in cardiac care services and improve access to care for all patients.


Posted on December 1, 2016

14th International Winter Arrhythmia School – February 10-12, 2017 – Collingwood, Ontario




Posted on November 25, 2016

5th Annual Toronto Heart Valve Symposium – Saturday, January 14, 2017 – St. Michael’s Hospital, Toronto

Saturday, January 14, 2017

7:45am to 4:30pm

The Allan Waters Family Auditorium Li Ka Shing Knowledge Institute – St. Michael’s Hospital (view map)

209 Victoria Street LKSKI Auditorium, 

2nd level Toronto, ON M5B 1T8

This program is intended for Cardiologists, Cardiac Surgeons, Internists and Residents.

Registration fee: $125.00
Registration close: Thursday, January 12, 2017.

If you have trouble registering, please contact Melinda Jones, Events Manager, at 905-453-8885 x 437 or by email at

Please click here for details.


To appreciate the advances in percutaneous valve therapy and to better understand their place in patient management

To learn newer approaches to the diagnosis and management of tricuspid valve disease. 
To appreciate the limitations of “Valve Guidelines”

To review newer prosthetic valves available to the surgeon and when they might be best utilized.
To review techniques for the surgeon to avoid valve/patient mismatch

To review the challenges presented by young patients presenting with valve disease




Posted on October 6, 2016

OAC Response to Health Quality Ontario re: External Cardiac Loop Recorders – October 5, 2016

October 5, 2016

Dr. Irfan Dhalla, Vice President
Evidence Development and Standards
Health Quality Ontario
130 Bloor Street West, 10th Floor
Toronto, ON M5S 1N5

Re:         Draft Assessment on External Cardiac Loop Recorders

Dear Dr. Dhalla,

I am writing in response to your e-mail of September 15, 2016 which asks for feedback on a draft health technology assessment and recommendation on external cardiac loop recorders for detecting symptoms of cardiac arrhythmia.  Specifically, based on Health Quality Ontario’s (HQO) findings, you have indicated that the Ontario Health Technology Advisory Committee (OHTAC) has recommended that publicly funding external cardiac loop recorders for detecting symptoms of cardiac arrhythmia be discontinued.

As Chair of the OMA Section on Cardiology and President of the Ontario Association of Cardiologists (OAC), I was very surprised to learn of this review and that only a few weeks have been given by HQO to provide input on this recommendation.  It is extremely disappointing that the two largest organizations representing Ontario cardiologists, health care professionals who use of this technology for diagnosing and managing patients with life-threatening cardiac conditions, were not consulted or involved in this review from the outset.

Notwithstanding this, the OMA Section on Cardiology’s Executive Committee and the OAC’s Board of Directors have surveyed cardiologists on their views regarding the proposed recommendation.  It is the collective view of the Section and the OAC that both long-term continuous ambulatory ECG monitors and external cardiac loop recorders continue to have merit in making the correct diagnosis for cardiac patients and each technology has merit in specific patients. Public funding for both technologies should be continued in the province of Ontario for the foreseeable future.

We base this opinion on the following factors:

  • There is no clinical evidence that demonstrates the superiority of long-term continuous ambulatory ECG monitors over external cardiac loop recorders at diagnosing life-threatening cardiac arrhythmias.
  • Clinical data on long-term continuous ambulatory ECG monitors, which is relatively new technology, is lacking and should not form the basis of a decision to discontinue public funding for external cardiac loop recorders.
  • The two technologies are often used for different purposes.
  • The external cardiac loop recorder is a simpler, less labour intensive technology when used for detecting certain cardiac conditions (e.g. paroxysmal atrial fibrillation).
  • External cardiac loop recorders have a strong long track record of use and are widely available to patients across the province. Conversely, the availability of long-term continuous ambulatory ECG monitors is not as wide throughout the province.  Cardiologists in rural and remote areas of the province rely on external cardiac loop recorders to provide patient care services closer to home.  Discontinuing public funding for external cardiac loop recorders will lead to more patients travelling further distances to get the correct diagnosis and receive appropriate care.
  • We note that a cost effectiveness analysis has not been conducted between the two technologies using currently available data. Conducting such an analysis, which would show at what cost long-term continuous ECG monitors detect arrhythmias compared to external cardiac loop recorders, is essential before a recommendation to discontinue public funding for external cardiac loop recorders can be accepted.
  • Many cardiologists do not need the quantification that a long-term continuous ambulatory ECG monitor provides to identify the nature of a clinical event. They therefore use external cardiac loop recorders; however, discontinuing public funding for loop recorders will lead to increased utilization of long-term continuous ambulatory ECG monitors, which is more expensive technology.
  • A committee of the Cardiac Care Network is currently examining the appropriate use of various ECG monitoring devices; we believe that before any recommendation to discontinue public funding for external cardiac loop recorders is made, the work and conclusions of this committee must be taken into account.
  • The OAC recently identified and brought forward to the Auditor General of Ontario its concerns regarding overbilling of long-term continuous ambulatory ECG monitors.  We believe correcting that situation will save significant dollars for the government of Ontario.

The OMA Section on Cardiology and the OAC appreciate the problem that the government of Ontario has identified regarding funding and changes in cardiac monitoring technology services in Ontario. The OAC and the Section on Cardiology have experts prepared to work with you to solve this problem so patient care will not suffer. We are prepared to meet with you now to make sure you understand our position clearly.


James Swan, M.D. F.R.C.P.(C) F.A.C.C.
President, Ontario Association of Cardiologists
Chair, OMA Section on Cardiology
34 Eglinton Ave. West
Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239

Posted on September 29, 2016

UHN PMCC 2016 Education Day in ACHD: Friday, October 14, 2016 @ MaRS Discovery District, Toronto

There are over 160,000 ACHD patients in Canada, and 65,000 ACHD patients in Ontario. With the current trend, the ACHD patient population will continue to grow rapidly.

This education day is dedicated to educating front line cardiac caregivers on up to date diagnosis and management of ACHD and hands on interaction and discussions. Through the Education day, we hope to discuss topics on:

- Shared Care Model with Community Cardiologists

- The ACHD tsunami

- Heart Failure

- Arrhythmias

- Pregnancy

- Pulmonary Hypertension

- Intervention

 Who Should Attend?

- Adult cardiologists

- Pediatric cardiologists

- Cardiology Fellows and Residents

- Allied health professionals


- To recognize Congenital Heart Disease (CHD) as a chronic disease

- To recognize the rapid increase of the Adult Congenital Heart Disease (ACHD) population and the impact on the health care system

- To describe long‐term complications and outcome of patients with simple and complex CHD

- To recognize RED FLAGS in adults with congenital heart disease and to identify patients who need a referral to a quaternary care centre

- To understand a shared care model between community practice and a quaternary care centre for patients with ACHD

To register, click here 

- $75 for non members of the Ontario Association of Cardiologists (OAC),

- $50 for members of OAC, and complimentary for residents

Please make cheque payable to “ACHD Toronto Symposium” & mail it to: Dr. Erwin Oechslin, 585 University Ave., 5N – 519, Toronto ON M5G 2N2

For more event details, visit:


Posted on September 6, 2016

2016 Genetic Aortic Disorders Association Canada Conference (Toronto): Sept. 16 – 17, 2016




60 Leonard Avenue, Toronto

GADA Canada, previously known as the Canadian Marfan Association (CMA), is proud to present its 18th national conference in Toronto, Canada. The conference is co-hosted by the Peter Munk Cardiac Centre (PMCC), University Health Network (UHN) and the University of Toronto

The two-day event features teachings and presentations by leading North American specialists and researchers in the field of heritable or genetic aortic disorders (GAD).

Until 2005, Marfan syndrome (MFS), caused by mutations in FBN1 gene, was the only known genetic disorder presenting with aortic aneurysm and dissection features. Since then, mutations in over 20 new genes exhibiting thoracic aortic aneurysm and dissection (TAAD) have been discovered. Data from clinical cases and the latest research indicates a need for a more specific treatment approach for each of these disorders.

In 2015, the CMA expanded its scope and GADA was established to embrace all known genetic aortic disorders related to Marfan syndrome. We encourage all persons who have been diagnosed with or have a family history of a heritable aortic disease gene mutation, to attend this year’s conference in Toronto.

REGISTER TODAY for this great opportunity to interact with and learn from leading specialists about the latest research, diagnostics and management of aortic health.

Day 1: is dedicated to updating medical professionals about the latest research, diagnostic protocols, and the health management of patients diagnosed with GAD

*** Continuing Professional Development (CPD), Faculty of Medicine, University of Toronto, is fully accredited by the Committee on Accreditation of Continuing Medical Education (CACME), a subcommittee of the Committee on Accreditation of Canadian Medical Schools (CACMS). This standard allows CPD to assign credits for educational activities based on the criteria established by The College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada.

Day 2: is dedicated to informing patients and families affected by GAD. The program consists of presentations and workshops conducted by local and international physicians.

 *** Any family member, including affected and unaffected siblings, attending the conference MUST be registered. Please note that child care will not be provided.

Click Here to print registration form and mail or email as instructed on the form

For questions or help with registration, please call 1-866-722-1722 or  

60 Leonard Avenue, Toronto

GADA’s Board of Directors and Professional Advisory Board would like to thank all of those who were instrumental in the planning and coordination of this year’s Heritable Aortic Disease Conference in Toronto.

We are truly grateful to the members of the Planning Committee and Speakers for their time, talent and support and for the generous contributions from our donors and sponsors.

Posted on August 29, 2016

Coalition of Ontario Doctors: Letter to Hon. Dr. Eric Hoskins, Minister of Health and Long-Term Care

August 29, 2016

Hon. Dr. Eric Hoskins, MPP
Minister of Health and Long-Term Care
Hepburn Block, 10th Floor
80 Grosvenor Street
Toronto, Ontario
M7A 2C4

Dear Minister Hoskins,

Doctors across Ontario read with concern your letter of last Friday to Dr. Virginia Walley, President of the Ontario Medical Association.

We represent thousands of physicians, including family doctors and specialists, across Ontario, from tertiary care academic centres to the smallest rural clinics. Our members, and those who share our views, cast almost 15,000 (14,799) votes against the tentative Physicians Services Agreement which, as you point out, was negotiated ‘under a cloak of confidentiality’ and pressed on the profession in a campaign of misinformation. This was the largest number of votes ever cast in respect of a PSA, a notable event given that the agreement was disclosed without notice and a vote called in the middle of the summer. Shortly after the tentative PSA was disclosed, and in little over 24 hours, over 3,000 physicians from all practice areas across the province signed a petition to compel a general meeting to vote on the tentative PSA, an event that has happened only once before in the history of the OMA.  The doctors who rejected the PSA, and the manner in which it was negotiated were not, as you would like to suggest, high paid specialists. Very far from it, in fact.  They were a deep geographic and professional cross-section of the profession, including thousands of family physicians.  And they rejected it because it was a bad deal for patients and physicians alike.

On August 14, Ontario’s doctors told the Ontario Medical Association and the Government of Ontario that we are tired of the brinksmanship and bullyism that has been the hallmark of this government’s approach to physicians and patient care. We are tired of the relentless bureaucratization of practice, the escalating restriction of clinical autonomy and loss of professional independence embodied in Bill 210.  We are tired of the deliberate misinformation about ‘raises’ which ignore inflation, increasing care needs of an aging population and the demands of immigration. We are tired of being told we must ration the care of our patients to absorb the government’s lack of fiscal discipline.  As professionals who care deeply about the welfare of our patients and the sustainability of our health care system, we expect better from our politicians. While the events of the past six weeks have been difficult, and no one wishes to repeat them, they have also been clarifying.

We urge your Ministry to reflect on the message Ontario’s doctors have sent: we work tirelessly and at great personal sacrifice for the welfare of our patients. We do so under increasingly difficult conditions created by your government including public vilification and unilateral action. We do not wish to debate these issues here.  We would be pleased to have a principled, fact-based, rhetoric-free negotiation towards a fair deal for patients and their doctors cloaked in common sense and respect not confidentiality.

We will work openly and collaboratively as equal partners with the Ontario Medical Association to reach an agreement with the Ministry of Health and Long-Term Care that will fairly serve the patients and physicians of Ontario in pursuit of our common goal of providing the best medical care to the people of Ontario. We hope that you will too and we look forward to hearing from you.


Dr. Kulvinder Gill                              Dr. Douglas Mark

Dr. David Jacobs                                Dr. Sharad Rai

On behalf of the Coalition of Ontario Doctors

Posted on August 24, 2016

Coalition of Ontario Doctors Letter to OMA Board of Directors – August 24, 2016

Wednesday, August 24, 2016

Board of Directors
Ontario Medical Association
150 Bloor Street West, Suite 900
Toronto, Ontario, M5S 3C1

Via email

The Coalition notes the OMA’s August 22 acknowledgment of membership’s deep seated dissatisfaction with the manner in which the tentative PSA was negotiated, disclosed and pressed on membership with a disrespectful communications campaign funded with members’ resources. We note that the cost to membership of the OMA’s “Yes” campaign has yet to be disclosed.

We are therefore not persuaded that membership’s desire for transparency, accountability and renewal are served by the deployment of additional members funds for the engagement of yet another communications consultant with an undefined mandate.

If there is to be a lasting repair of the trust gap created by the events of the last two months, members need to be fully engaged in any review process. Accordingly, the Coalition expects to fully participate in the review process. The identity of the reviewer is to be agreed, must be entirely at arm’s length from the OMA and government of Ontario and its mandate and reporting protocol is to be agreed. Complete transparency and independence must be assured.

Membership is no longer prepared to accept the conduct of OMA business in secret where matters that go to the heart of our Association are concerned.

We would appreciate the courtesy of a timely response to this request.

Yours truly,

Coalition of Ontario Doctors

Concerned Ontario Doctors
OMA Section on Cardiology
OMA Section on Cardio-Vascular Surgery
OMA Section on Diagnostic Imaging
OMA Section on Emergency Medicine
OMA Section of Gastroenterology
OMA Section on Nephrology
OMA Section on Neuroradiology
OMA Section on Neurology
OMA Section of Otolaryngology, Head and Neck Surgery
OMA Section on Chronic Pain
OMA Section on Urology
OMA Section on Thoracic Surgery
Dermatology Association of Ontario
Doctors for Justice
Emergency Physicians of Ontario
Ontario Association of Cardiologists
Ontario Association of Radiologists
Ontario Association of Nephrologists
Ontario Association of Nuclear Medicine