Tag Archive | "Advocacy"

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Views from Across the Rubicon: The Rejected Physician Services Agreement

Posted on 28 September 2016 by Adam Kovacs-Litman

crossing-rubicon

August 14, 2016 marks a turning point for the history of health care in the province of Ontario. 63.1% of Ontario Medical Association (OMA) members rejected the Liberal government’s proposed Physician Services Agreement (PSA) and in so doing voiced their vehement disagreement with the trajectory of health care in Ontario.

This is not meant as a criticism of the PSA even though it is an agreement that is certainly worthy of our criticism. It is worth recognizing the many rational reasons physicians had for voting for the proposed agreement. The Liberal Government of Ontario’s rejected PSA was beyond disastrous. It was bad for the health care system and economically untenable. It intentionally underfunded health care at a rate lower than health care growth and would have necessitated longer wait lists, clinic closures, doctor relocations to other provinces and countries, and the delisting of medically necessary services. It also would have significantly cut individual physician salaries on a progressive basis over four years after accounting for inflation. With all that said, I’m still surprised that the PSA failed to pass. The agreement was despicable in objective terms, but still managed to provide stability and predictability in its sadism. Rejecting the agreement once again puts Ontario’s doctors at the mercy of the Liberal Government, a government that has shown its willingness to engage in unilateral action, even at the expense of Ontario’s doctors, tax payers and patients. The Liberal Government will likely impose an even harsher version of the rejected PSA and pass bill 210 (the ironically named “Patients First Act”) unamended. Bill 210 is punitive in nature and cripples the ability of health practitioners to manage their own practice while grossly expanding the scope of powers of the Minister of Health.

After comparing these two options, voting “for” this agreement seems maddeningly reasonable. The Ontario Government assumed that physicians would vote in alignment with their self interests and begrudgingly vote in favor of the devil they knew. What Ontario’s doctors gained by voting against the PSA is not something that is tangible. Rejecting the PSA was our profession’s confessional – it was our moral absolution. We will not be complicit in the erosion of our health care system. We are its champions and we will stand and defend it.

The word “advocacy” gets thrown around a lot in medicine and is a concept that those within the profession are perhaps overly familiar with. “Advocate” is one of the six cardinal roles that the Canadian Medical Association (CMA) identifies for physicians and “advocacy” is a deeply ingrained tradition of medicine. Physicians strive to advocate for their patients whether it’s by raising awareness for mental health, providing refugees with medical care, helping patients get access to the medications they need or just providing Ontarians with humanity and excellence in medical care. Rejecting the PSA is advocacy on a system level.

The rejection of the PSA marks a philosophical stand against the dismantling of health care that comes at great personal and professional cost. The Ontario Government likely crafted this agreement so that they could obtain the coerced consent of the medical profession and use it to legitimize further and continued cuts to health care. The language of the agreement would have made physicians responsible for increases in health care utilization, which some have compared to making firefighters financially liable for the number of fires they have to put out. This would have given the government political ammunition to blame inevitable future increases in health care expenditure on physicians. Signing the PSA would have made further advocacy considerably more difficult. It would have transformed would be advocates into hypocrites. This was an agreement that in its essence demanded silence in exchange for a slight reduction in the immediate rate of health care cuts. The Liberal Government tried to manufacture consent and it failed.

I hope that the freedom to continue to meaningfully advocate against harmful pieces of legislation is worth the heavy price that was paid. The medical profession is in an extremely precarious position and will no doubt face some trying times ahead. I hope that our rejection of the PSA is proof that we cannot be broken and that we will continue to advocate even in the face of continued propaganda and retaliatory measures.  Ontario’s doctors must serve as a check against the Ontario Liberal Government and their apparently willful destruction of our health care system.

There will come a time when we look back and reflect on the events that led to the creation of our modern health care system. In 1946, Tommy Douglas introduced the Saskatchewan Hospitalization Act, which became the model for health care across Canada. In 1984, the Canada Health Act introduced universal health care across the nation. In 1991, the OMA agreed to become a closed shop organization with mandatory membership. In 2016, the OMA rejected the Province’s Physician Services Agreement. August 14, 2016 was a day of significance.

Ontario’s doctors have crossed the Rubicon.

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What’s Stand Up for Health?

Posted on 01 November 2015 by Amanda Sauve

What’s Stand Up for Health & Why is it in our curriculum?

Health Canada recognizes 14 determinants that influence the health of Canadians including income, education, employment status, race, and gender identity, to name a few. As a student body we are familiar with social determinants of health, but often find learning their relevance in the classroom to be didactic and to put it bluntly, boring. A practical way to help students learn about these important issues is “Stand Up for Health,” an immersive simulation that gives participants a better understanding and appreciation of the social determinants of health. During the simulation participants are placed in the role of low income Canadians and must interact, make choices, and solve challenges within their given set of social circumstances. This provides students with exposure to some of the tough decisions made everyday by Canadians, and offers an opportunity for us to see through their perspective. The objective is to help us better develop the skills to empathize with patients, to identify healthcare limitations, and start conversations on how we can advocate for improved healthcare for all Canadians.

Stand Up for Health has recently gained recognition in medical education. It has been played at Ontario Medical Students’ Weekend (OMSW) 2014 & 2015 and the 2015 Canadian Federation of Medical Students (CFMS) Annual General Meeting in Windsor. Most recently, it has been integrated into undergraduate medical curricula at both Western and the University of Toronto. We’re hoping to permanently implement the simulation in our curriculum (for the 2020’s and beyond!)

If you (2018s or 2019s) would like more information or are interested in becoming a game facilitator (officially termed “change agent”), please contact Amanda Sauvé (asauve2018@meds.uwo.ca)

 

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Indigenous Health in Medical Education

Posted on 22 October 2015 by Maddy Arkle

As a Métis medical student, Indigenous health is a topic close to my heart. Indigenous populations of Canada (which includes First Nations, Inuit, and Métis peoples) have unique health barriers and concerns largely based on historical, geographical and social factors. In order to address the specific health needs of Indigenous peoples, many medical schools have begun recruiting Indigenous students and incorporated Indigenous health into medical school curriculum.

I was part of a fantastic group of students from medical schools across Canada that authored a CFMS policy paper titled “Indigenous Peoples and Health in Canadian Medical Education” (link posted below).

The motivation behind this paper was a desire to encourage and assist Indigenous students in pursuing medical school. We also saw a need to address the exposure of Indigenous health topics to medical students and faculty with a focus on cultural safety. There are many difficulties and barriers faced when addressing Indigenous health. Every medical school has responded to these issues differently. This paper provides a national standard and clear direction for the future of Indigenous health in medical education.

Here is a summarized version of the paper’s recommendations:

  1. Increase Indigenous medical student recruitment (in a culturally safe way)
  2. Develop admissions policies that are equitable for Indigenous students
  3. Include mandatory, culturally safe Indigenous health curricula during pre-clerkship
  4. Implement experiential learning* modules into pre-clerkship
  5. Involve Indigenous health in clinical electives
  6. Support Indigenous health-focused extracurricular activities
  7. Prioritize employment of Indigenous physician leaders, Elders, and support staff within medical
    faculties.
  8. Ensure Indigenous cultural safety competency in all educators and support staff.
  9. Increase accountability to local Indigenous communities

*Experiential learning involves learning through experience. Here it involves acknowledging the difference and value of Indigenous perspectives, knowledge and cultural practices.

While many of these recommendations seem obvious, they have not all been addressed by all Canadian medical schools. The CFMS officially adopted this policy paper at their Annual General Meeting (AGM) in Windsor in September, so now the real work will begin! This is a small but mighty step toward advancing and improving medical education surrounding Indigenous populations. Read the full policy paper here: http://www.cfms.org/attachments/article/1370/Indigenous_Health_in_MedEd_AGM2015.pdfhttp://
www.cfms.org/attachments/article/1370/Indigenous_Health_in_MedEd_AGM2015.pdf

Finally, a very special thank you to Ryan Giroux (CFMS National Officer of Indigenous Health), Amanda Sauvé (Local Officer of Indigenous Health-Western), and the other team members Max, Reed, Danielle, and Kelita who put a tremendous amount of effort into this paper and who continue to advocate for Indigenous health across the country.

– Maddy Arkle (Meds 2018, Local Officer of Indigenous Health-Western)

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OMSA Leadership Summit and Lobby Days

Posted on 17 April 2013 by Jimmy Yan (Meds 2015)

About a week ago, the Ontario Medical Student Association hosted it’s 2nd Annual Leadership Summit and Provincial Lobby Days over the weekend of April 6-8th. It was an opportunity for medical students across the province who were interested in the process of government and health care policy (AKA those who are secretly health care systems enthusiasts) to network, learn a few things about healthcare in Ontario, and then work in teams to actually lobby the provincial government on an issue that reflected medical student concerns from all 6 Ontario med schools.  Continue Reading

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The 4-1-1 on Medical Student advocacy on Parliament Hill

Posted on 05 February 2013 by Jimmy Yan (Meds 2015)

The first weekend of February is usually quite a special weekend. No I’m not talking about Ground Hog day here. It’s special because it is generally the time when medical students coast to coast in Canada assemble (much like the Avengers) on Parliament Hill in the 613 (that’s Ottawa, yo) to lobby for political action and greater advocacy. It’s an event that is hosted and organized by the Canadian Federation of Medical Students.

This year, I was part of the Schulich delegation to this CFMS Lobby Days. As such, I’m going to be sharing with YOU the big Cole’s notes of this weekend. I realize that advocacy is an area that is pretty ambiguous during our years of medical training, so I hope that this experience of advocacy work (while by no means the only type of advocacy experience), helps shine some light on how medical student advocacy can work.

So first things first: Ottawa is cold. WAY. TOO. COLD. Especially for a balmy wuss of a Vancouverite like myself. Quickly after arrival at Ottawa, I realized why all the politicians still use Blackberrys: 20 seconds after exposing your bare fingers to operate a touch screen and the beginnings of frost bite start setting in. Truth.

Another immediate impression: try avoiding to schedule the hotel for all your delegates at the same “Official” hotel of Winterlude, the massive annual winter festival in Ottawa during the same period. Essentially the hotel we were staying at was completely overbooked between tourists, med students, even a wedding party.

No. We did not crash the Wedding.

So our first day, Saturday, consisted of just getting settled in and meeting the other delegates. I noticed a lot of familiar faces, I guess these circles are pretty tight knit. Should be something I can expect moving forward. Back in my undergraduate days of student union politics the term we used was ‘hacks’. Well, it’s funny seeing so many med student political ‘hacks’ too. It was doubly funny running into Tahara, a 3rd year at UBC, who was a political hack with me back when we were members of the UBC student union council.

As a side note, this was the first time I got to skate on the Rideau Canal. While it was definitely a fun experience, and OMG MAPLE TAFFY IS DELICIOUS, $16 for a 2 hours of skate rental is definitely a bit expensive.

During the second day, the delegates spent 8 hours of the Sunday night and afternoon being trained on how to approach MPs and what exactly was the best way to frame our concerns and the Ask we are lobbying for (without getting into too many details, our Ask this year focused on improving the level of research and information at the national level on how to project future health human resource demands). There was a variety of speakers from different realms of political experience, and several workshops to practise. In the end of it all, we learned some valuable lessons on advocacy, communications, student leadership, and self-development.

These included points such as:

  • An MD is not an auto leadership indicator, it simply is an opportunity to become a leader
  • One of the best things a person could possibly do as a leader is to surround themselves with smarter people
  • If you want something done efficiently, force a lazy person to do it
  • No mistake or ‘inadvertent’ complexity in a piece of federal policy is done so simply by accident
  • There are differences between simple, complicated, and complex
  • Everyone likes to chirp Mac. Even Mac grads will deliberately go out of the way to beak the Mac medical experience

With all these, and many more points discussed, we were ‘trained’ to disperse and conquer the Nation’s capital.

Monday consisted of over 70 separate meetings between students, MPs, Senators, and Ministers’ Aides. It was very astounding to see the amount of activity that was happening. While I only had 3 meetings, I kept on running into students off to conduct their own sessions. We were everywhere.

Another thing that was astounding: the cold. It got windy. Damn.

Two other shocks, that really shouldn’t have been shocks, came during the day was how prevalent Twitter use among politicians was, and how many security check points I had to go through. I guess Obama made Twitter cool for every politician because they were much more prolific on the social media front than many of the students. The issue about security made sense. I mean it was the nation’s capital. I guess protecting it every now and then would be expected.

Overall, my experience with how our Asks were received was pretty positive. I had a wide range of MPs to speak to, from all the different parties. They all seemed to be on the same page regarding improving health human resources and getting the ball rolling on figuring out what the long term needs of Canadian patients would be. Despite all the grandstanding and overt displays of theatrics in Question Period, the MPs were all very willing and happy to hear from young minds talking about concerns that could impact the health of many citizens.

I guess it’s easy to forget or overlook the fact that many of these MPs started their roles out of desire to serve their constituents and to improve things in their ridings…based off the understanding of what needs to be fixed. In a lot of the way, it’s similar to the way physicians operate. We both are service leaders, and often the second word in that label ‘scares’ the public from approaching us. However, when speaking to the MPs, it became quickly easy to  see that what was really happening was merely two people forming a relationship and starting a dialogue.

So what’s the big deal with Lobby Day weekend? Despite the cold (for the 3rd time yes I know), it was a great experience. Getting to see the capital was a great privilege, as was the opportunity to meet and work with some of the brightest medical student minds from across the country. However, where the real value lies is in seeing how simple the whole advocacy process works. It’s about just getting out there and speaking your mind to someone you would like something out of. It shouldn’t be too difficult, after all, we all went through FIFE.

I highly encourage any student out there with the slightest interest in learning more about the role of politics and health care policy on the practise of physicians to considering coming out to the next set of Lobby Days as they happen nationally next year at the same time, or provincially under the OMSA in April.

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