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

Posted on August 15, 2016

Coalition of Ontario Doctors: Victory for Doctors and Patients

August 15, 2016

Victory for Doctors and Patients

Ontario doctors stood up for themselves and rejected a deeply flawed PSA, one that was vague, cut funding, and threatened our independence.

Ontario doctors stood up for their patients against a government that continues to undermine our already fragile health care system. The Coalition enthusiastically welcomes the result of yesterday’s vote as victory for physicians and patients, alike.

The Coalition—which campaigned hard, but respectfully for this outcome—thanks every doctor for their support. We are proud to have been your voice and advocate. We will continue to do so.

To those who supported the PSA, we extend a hand of collegial friendship. The OMA belongs to all of us, regardless of how we voted. United, we have the power to make a positive change for the future.

Doctors sent a message that should be heeded by the OMA leadership. The status quo is no longer acceptable.  Trust was missing and doctors demand better. The Coalition will determine its next steps over the coming days.

Posted on August 11, 2016

Terence Corcoran (National Post): Ontario’s minister of monopoly

Ontario’s minister of monopoly

Terence Corcoran | August 11, 2016 | Last Updated: Aug 11 12:01 AM ET


This coming Sunday, Ontario’s doctors will meet and vote on a proposed compensation agreement between their ersatz union, the Ontario Medical Association, and the Wynne Liberal government. It is shaping up as one of the most important events in the modern history of health care in the province.

The new agreement, known as the Physicians Services Agreement, has been superficially portrayed in the media as just another typical labour skirmish over cash between greedy overpaid medical millionaires and do-gooding politicians protecting the public good and the sanctity of universal health care.

Similar confrontations have been raging since the 1980s when the OMA was transformed into a mandatory Rand Formula organization and doctors lost the right to practice outside the system. But this year could — or should — be different. The Sunday vote is much more than a simple decision on whether doctors — along with nurses the only people in the $50-billion government-funded system who actually deliver health care directly to patients — will be paid more or less over the next four years. The answer is less, but that’s not half the story.

The new compensation agreement (negotiated in secret unbeknownst to members before it was announced by the OMA in July) is the high-profile tip of a giant low-profile health-care menace known as Bill 210, legislation that bears the unbearably cute title “The Patients First Act.” The objective, officially, is to improve primary care in Ontario and repair the bureaucratic shambles that currently exists.

Posted on August 10, 2016

Toronto Star: Doctors accuse OMA of pressing members to vote for deal

Doctors accuse OMA of pressing members to vote for deal

Doctors opposed to tentative OMA deal with government step up their fight ahead of Sunday’s vote.

Dissident doctors fighting a tentative contract between the Ontario Medical Association and the government are stepping up their campaign in advance of Sunday’s vote by physicians across the province.

The Coalition of Ontario Doctors held a news conference Tuesday accusing the OMA of trying to “railroad” members into passing the four-year deal with an “aggressive” effort.

“They’ve hired a pricey Bay Street PR firm,” said Dr. David Jacobs, a Toronto radiologist speaking for the coalition.

“It’s been a very one-sided push. We’ve been subjected to telemarketers, robocalls . . . we’re not quite sure why they’re pressing so hard.”

OMA president Dr. Virginia Walley said the association — which recommends members accept the deal as the best bet to avoid more unilateral cuts by the government — wants to make sure physicians are “fully informed” on the details.

“I believe our members will see the merits,” added Walley, who said the contract is the best doctors can hope for while the OMA goes through the court system in a bid to win binding arbitration for future contracts.

The coalition said the OMA is “trying to ram the deal through in the middle of summer vacation” and repeated warnings that the budget for paying physicians won’t keep pace with inflation and population growth.

“This will require physicians to ration care,” Jacobs said, calling for “full funding of growth in the system.”

He also voiced concerns that doctors, whom he acknowledged “make a good income,” will be squeezed on their fees, making it more difficult for them to pay overhead costs for rent, nurses and other staff in their offices.

The coalition maintains the OMA ignored the direction of its members in not getting the government to agree to send the contract dispute to binding arbitration.

Progressive Conservative Leader Patrick Brown said his party supports the push for binding arbitration, saying doctors are “essential workers” like police and firefighters whose contracts go to third-party arbitrators if an impasse is reached in negotiations.

“All options should be on the table . . . including binding arbitration,” Brown said in a statement.

Posted on August 9, 2016

The Globe and Mail: Coalition of Ontario Doctors urges colleagues to reject deal with province

A coalition of Ontario doctors is stepping up its campaign to reject the tentative four-year agreement between the government and the Ontario Medical Association, charging the deal is vague and could result in cuts higher than the $200-million already laid out in it.

The coalition doctors, who are urging their physician colleagues to vote down the deal, are trying to push this message in these last days before a critical meeting Sunday. They say that patient care will be compromised…

Click here to read the full Globe and Mail article.

Posted on August 5, 2016

National Post: Terence Corcoran: Judge rules OMA ‘sneaky’ in bid to have doctors ratify deal with province

The Ontario Superior Court of Justice invalidated the OMA proxy form, concluding it needed to be re-issued with fairer and more balanced language. The the Court released the ruling on Thursday contains hard language raising questions about the OMA’s tactics.

Click here to read the National Post article.