OECD forecast for Canadian economy and More Administration..HUH?
A physician who holds a fairly significant position in an academic teaching centre recently commented in the Ottawa Citizen, August 26, that he feels that primary care needs to be better organized. One solution he proposes is to explore primary care pilots that include paying physicians significant sums for administrative work.
He also thinks it would be a good idea to have family doctors fall under the purview of the Local Health Integration Networks so that family doctors would be given the infrastructure to meet regularly and discuss how to address patients who don't have family doctors.
His premise included the concept that existing physicians could somehow arrange to divide the existing orphan patient population. He is reported to have said:
"..if we each take however many, we solve the problem."
Although this physicians' ideas are noble in intent, it is important to realize that government is not the only way to be organized and that there are existing structures already that allow for communication and organization amongst physicians. These include existing groups of doctors working in real life clinics as well as virtual groups of doctors who may practice separately but who communicate regularly and who must organized themselves to provide care for their patients without being told by government bureaucrats how or when to do their jobs.
Trouble is that some physicians are not particularly interested in being involved in meetings outside their day to day duties. Whether this is apathy or self-preservation is up for discussion. But the idea that we need more administration comes at a strange time when productivity of physicians in new models is being questioned. The argument goes that other countries are doing better than Canada in organized primary care but the reality is that to be brought up to OECD standards for physicians per capita, we would need 26,000 more physicians in Canada today. Hate to tell you this but it ain't going to happen anytime soon.
However, as we move to new models of primary care, often driven by policy and not evidence, it becomes increasingly clear that the government agenda is to budget and control.The likelihood of adding more administrative funds instead of patient care funding is not very realistic when we seem to have a black hole for health care dollars that don't necessarily get to patient care.
We are already lacking the physician resources and even nursing numbers to cover the coming needs. Losing more doctors to administrative work hardly seems reasonable to me let alone spending more on administration when the loads of paper work (real or virtual) threaten to crush us mentally and even take a physical toll.
What does this have to do with the OECD lowering forecasts for the Canadian economy, you ask?
Well, if the outlook for growth for Canada's economy is as dire as predicted by the OECD..less than one per cent and less than half of that of the US economy.....the 0.8% growth just isn't going to allow for much more health care spending, at least I hope not on more "administration".
While some doctors like the one mentioned seem to believe that more administration is the answer, others like the new CMA president, Dr. Robert Ouellet, don't agree. His comments in the Toronto Star September 3 indicate that he believes movement away from spending on increasing administration is needed and that the role of private care alongside a universal system is quite complementary. Bravo.
At least someone can look past the mountains of administration and see the patient. There is hope.
Please feel free to comment as always and even to continue the previous comments from the other journal entry. I don't want to cut anybody off!
Merrilee Fullerton
100 Comments
Reader Comments (100)
Family doctor shortage still a 'serious' situation
Laura Drake, The Ottawa Citizen
Published: Tuesday, August 26, 2008
Though the number of Ontarians who say they don't have family doctors is dropping, it still stands between 663,000 and 879,000 people, according to a poll released today by the Ontario College of Family Physicians.
"It could have been much worse. There is progress that has been made," said Dr. Renée Arnold, president of the college.
"However, the message here is that the shortage is serious. ... Those people deserve a family doctor."
Dr. Arnold pointed out that people without family doctors are forced to use other elements of the health care system instead. The poll showed that 83 per cent of those without family doctors use either walk-in clinics or emergency rooms when faced with a medical problem or question.
"Those individuals who do not have a family doctor are really in some ways being neglected from a health promotion and prevention perspective," said Jan Kasperski, chief executive of the family-doctors group.
Dr. Arnold said this is especially concerning for the roughly 250,000 people over the age of 50 without family doctors since they are the people most at risk of developing chronic illnesses that require early detection and management.
Jacques Lemelin, chairman of the University of Ottawa's department of family medicine, said the provincial government has been doing its best to combat the problem by increasing the capacity of medical schools.
"Our own department will increase by another 50 per cent by the next three to four years and we can't go any faster than that," he said.
To further address the issue, Dr. Lemelin said, he'd like to see the primary-care sector better organized.
Currently, family doctors are not under the purview of Local Health Integration Networks, the province's regional health-planning authorities.
Dr. Lemelin said he'd like to see that change so family doctors in each network would be given the infrastructure to meet regularly and discuss how to address patients who don't have doctors.
"Let's say in the Winchester area they get together and they got some data and they say 'In our area we're 200 doctors ... and we have 1,000 orphan patients, so if we each take however many, we solve the problem.'"
The college is also in favour of creating area "orphan patients" registries, Dr. Arnold said, having pitched the idea to the provincial government earlier this year as part of the solution.
Additionally, she said, the college would like to see the provincial government provide more support for family physicians who teach, since increased medical school enrolments for family medicine mean roughly 30 per cent of the province's family doctors will need to teach in some capacity.
Finally, the college would like family doctors to have more access to other health care disciplines, such as nursing, for their practices.
Ms. Kasperski said she was heartened by the poll results that showed public support for family doctors.
The poll of 654 Ontario adults was conducted by telephone for the college by Harris/Decima and is considered accurate within 3.8 percentage points, 19 times out of 20
and here is the piece from the Toronto Star which was sent to me and here is the link:
http://www.thestar.com/comment/article/489323
from the Toronto Star
Mixed private-public system best for Canadian patients TheStar.com - Opinion
- Mixed private-public system best for Canadian patients
Health-care debate should be based on improving treatment not political
ideology
September 03, 2008
Dr. Robert Ouellet
When I began my term as Canadian Medical Association president last month, I
expected some criticism and knew that not everyone would agree with my views
on what needs to be done to improve our health-care system.
I did, however, hope that we could have a rational, fact-based debate on how
best to improve patient care. Unfortunately, rhetoric, fear and deliberate
misinterpretation are once again being used to beat down any legitimate
attempt to go beyond the status-quo.
Yes, I am part-owner of a number of private radiology clinics in Quebec.
Yes, I have a mixed practice (public/private), as do most of my Quebec
radiology colleagues.
Yes, I believe there can be a greater role for the private sector in
Canada's health-care system.
This does not mean that I want to see the public health-care system weakened
or destroyed. It doesn't mean that I want to see "American-style, two-tier"
health care here in Canada. And it doesn't mean that I believe money and not
malady should determine the quality of care Canadians receive.
In 1987, when I was head of the radiology department at my hospital, I was
told it would be at least two years before the hospital could purchase a CT
scanner, despite heavy demand.
This was clearly unacceptable and severely compromised patient care, so I
joined with some colleagues to buy the equipment and the hospital began
referring publicly funded patients to us.
Ten years later in 1997, I opened one of the province's first private MRI
clinics. Again, we served patients from public hospitals – including my own
which, by the way, didn't buy an MRI unit until 2002.
The driving force behind all of these efforts was not profit, nor some
ideological attachment to the free market. It was the fact that our patients
were not getting the care they needed and wouldn't be for years. As a
result, my colleagues and I stepped in to provide it.
Some of my patients do pay out of their own pockets. I make no apologies for
that. In Quebec, MRIs performed outside of hospitals are not publicly
covered. However, most residents are reimbursed 80 per cent through private
insurance, so the net cost to them is about $130 for an MRI exam.
It's also a small price to pay to free up space on the public waiting list.
While emergency cases are – of course – seen immediately, the average wait
for more routine MRI exams can stretch as long as six to nine months. If the
20 MRI clinics currently operating in Quebec weren't there, can you imagine
how long the wait would be?
There is, however, a role for the private sector in our health-care system,
because it exists now. Private companies do blood tests paid for by the
public purse. Governments, through organizations like Workers' Compensation,
are the private sector's best customers. And, more than 70 per cent of all
Canadians have some form of private insurance – usually through their
employer – that covers what medicare does not.
This is the current Canadian reality. It makes little sense to deny it. We
need to be open-minded and look to places like Europe for guidance on how
best to mesh the public and private. They can work together, and advances in
one do not have to come at the expense of the other.
The CMA also believes that our health system has become too focused on
administration and not focused enough on providing efficient care. Right
now, most of our hospitals get lump sum budgets at the beginning of the
year. This sets up a strange paradox where patients are actually a drain on
hospital finances and there is no incentive to provide care.
We think that patients should be at the centre of health care in Canada and
that funding should be based on efficiency, effectiveness, effort and, above
all, results. The current monopoly needs to be broken down and an element of
patient-focused competition introduced.
At the same time, we will aggressively defend the need to have a health-care
system that is sustainable and fair. A system where all Canadians have
universal access to quality health-care services, regardless of their
ability to pay.
In conclusion, I have to ask those who say renewal is not needed whether
they think it is acceptable that we ranked last in comparison to most
European countries when it came to value for money? Is it acceptable that
patients are stuck deteriorating while on wait lists? Is it acceptable that
5 million Canadians don't have access to a family physician?
The CMA doesn't think it is acceptable and I doubt most other Canadians do
either. I think it is time for some bold thinking. I think it's time to act.
I think it's time to build a health-care system that serves patients and not
simply the political views of self-appointed health-care pundits.
Rather than preaching a dogmatic approach to system change, let's instead
take a practical approach that builds on our sound principles of equality
and fairness, while ensuring access to health-care services for all
Canadians.
Dr. Robert Ouellet is president of the Canadian Medical Association.
http://www.theaurora.ca/index.cfm?sid=167285&sc=298
http://www.thenewamerican.com/usnews/health-care/327-examining-healthcare
"Actually, because most of the proposed solutions - particularly the many variants of socialized medical care - have been tried somewhere in the world and found wanting, the true solution is becoming very clear: get government out of medical care. Such a statement probably sounds odd to many Americans, who have been led to believe that market failures and corporate and physician greed are the causes of our country's current healthcare woes. But few beliefs could be further from the truth.
It is a common misconception that the United States has a "free-market" system. As Dr. Jane Orient, the executive director of the Association of American Physicians and Surgeons (AAPS), pointed out in her January 8, 2007 article in TNA entitled "Fractured Healthcare": "Government already pays about half of all medical bills" and controls access to healthcare with over "100,000 pages of regulation." Add to that the fact that even routine doctor visits are often covered by health insurance (insurance that limits the doctors whom one may visit and the terms of access) and the idea that the United States has a free market - where consumers have choices and can choose their doctors and level of care - is laughable. The solutions become clear when one analyzes what has worked elsewhere in the world and what has not."
I smell smoke but hear fiddling......
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"psychoanalysis of ritualistic behavior elucidates the human construction of and adherence to a bureaucratic form of organization as the outcome of the obsessional neurotic's actions in securing himself against anxiety about losing control"
http://www.jstor.org/pss/3791022
It's the people.
"It's the MOHLTC fault there aren't enough doctors. They need more money becuase they work so hard."
The MOHLTC has aggressively work with our partners, the OMA and the CPSO, to address the issues of health care providers.
We have supported the plans of the OMA to develop Family Health Teams and Family Health Groups. We are pleased that so many providers have joined these groups of teams that will assure that all Ontarians who want to join these primary care networks, can. More are being developed now. We believe that by working with our partners, the OMA, the CPSO , and your local health integration network, further improvements are going to continue to assure access to care.
In addition, we have aggressively expanded the number of positions in all medical schools, and have been the only government to support, and fully fund, the opening of a new medical school in Ontario - based in Sudbury and Thunder Bay.
We have developed our specialized regional care centres - lead by our committment to Cnacer Care Ontario, which has opened more highly specilaized centres of excellence in more local communities.
As these new members of Health Force Ontario become available, we will continue to ensure that options to provide care to Ontarians remain open.
But, seriously now, folks..
I've been the Administrator for two academic departments of Family and Community medicine in my past and a CHC.
First question: If the academic departments are hiring new medical staff to meet the increased teaching demand caused by the addition of new residents, are they also taking on new patients? My guess is, not many.
Second question: How many clinical sessions on average per week are full-time medical faculty now doing? When I got out of that business, three was the average, and four met with major complaints. Everyone complained all the time about how busy they were, and some were, in fact, busy. I'm sure they all FEEL busy...
Third question: Are the academic departments still in the habit of "churning" a certain percentage of patients and rejecting some patients on the grounds that they're too complex for teaching purposes?
Now, I'm not really knocking the academic departments; they have their own specific cultures, teaching needs, and patient requirements. But, if I were to look to absorbing the "orphaned" patient population -- I mean patients who really don't have a doc, not those who have a doc but can't get to the doc when sick (thanks MOH and FHT's for that population, presumably some of the 83% in that statistic Dr. Arnold tossed off) -- let's have the academic departments lead the way!!!
Second, we have over 60 CHC's in this province, most of whom are not overburdened with patients although often overburdened with staff resources. One way of increasing their cost-effectiveness might be to winnow out the higher-risk "orphaned" patients, and direct them to the local CHC. But, I can tell you right now that's never going to happen.
Second, that we don't have enough docs to go around is not the profession's fault, but everyone seems to be treating the matter as if that is the case. And in some cases that's true; we all know "cherry pickers" and "lazy boys" -- every profession has them. But, in this connection, let's factor this in: In my neck of the woods, a full-time practice is considered around 1,100 patients. There's some stupid provincial number of 1,379, I think, that represents the supposed "standard" ratio of patients to docs. Let's take the "full-time" non-academic docs whose pratice size falls below that, and let them be the first recipients of the real "orphaned" patients. Docs whose patient load is 1,500 or more shouldn't be in the "orphaned" mix unless they want to be and can manage it.
So, Dr. Arnold, stop apologizing to the public for a situation you did not create! Just do what you can do to help out. The whole solution does not depend on the docs!
That docs should have more money for "administration". Just what does that mean exactly? And is the doc necessarily the only or the right choice? A doc doing administrative stuff is not seeing patients, if that is what this is about. And if I were going to pick someone to better organize primary care -- which the Restructuring Commission should have looked at in the first place as different contributors have acknowledged -- I would definitely have the doc in that mix, but the primary care nurses are the ones who really know what's going on in nitty-gritty detail both with the patients and the "shop" clinical "systems". I know I'm not the first to point that out. But it's true.
That the LHINs take over primary care. I'm not even going to go there. There's a recipe for disaster.
OK. I've got spreadsheets to do. I'm gone for today.
LHINs are still requiring HSAAs to be signed within budget allocated, which means in many cases cuts in services and close beds. But LHINs will not agree to that, so more PEER reviews and takeovers.
When advised that if LHINs could please take the ALCs out of hospitals and place them somewhere, hospitals could balance and minimally reduce service, LHINs do not take action.
WHAT...I say WHAT are the LHINs here for?? They are useless.
Potential system implosion just on the horizon...or....Liberals to pump in more $ when they hear about potential fall out.
This is the worst I have seen in 25+ years, including Rae and Harris Days.
Thanks now I feel better and I can go and cancel some surgeries due to not enough beds (ALCs) and 25 sitting in our ED with no beds.
The thing of it is though, in budgetary terms, that is, the dirty little secret, the ALC's may block beds but they cost less to service. Less strain on the accounting bottom line (and let's leave the true economic cost out of it).
In our neck of the woods, if just 10 of the primary care docs that joined FHT's and gave up their community work (in the nursing homes, retirement homes, and after hours clinics) each took back just 30 beds each, we could reopen beds for ALC's that need to move out. Opening approved but unimplemented beds is harder because there aren't enough nurses, never mind docs to cover them.
On another note, student nurses now graduating from our universities are talking of nursing in terms of career, translate "bedside care is for lesser forms of professional life."
I think I'll just stay young forever.
Agreed ALCs cost less. We have created a Unit (converted an acute care unit) and are staffing like a nursing home.
Unfortunately, the rest of the ALCs are spread around Med, Surg, Rehab, CCC. It is much more difficult to adjust staffing on these units because of the rest of the patients - never mind unions, layoffs etc. Then if they leave, you have to re-staff back to what it was supposed to be.
This keeps up, we will be half nursing home. We currently have 65 ALCs in here. Can you believe that - 65 ALCs and everyone (LHIN, CCAC, us) agree they are really truly ALCs.
Sheesh!! Cancelled 5 surgeries today and 5 more tomorrow to ease the ED burden for the w/e
We knew that when we carted him off to the hospital after his vague complaints then coffee ground vomitus that he had some kind of GI bleed and sure enough the scope got done and he is awaiting a bed......things went along smoothly after we managed to get the triage nurse to notice that his pulse was thready, he was diaphoretic and as white as a ghost...and of course once we got access, my brother and I happened to know most of the emerg docs on duty and the ICU doc on call so that helped immensely....
The money pouring into the hospitals is apparent but the waves of white hair filling chairs and beds everywhere is truly amazing...It is one thing to see it out in the community and quite another to see all the hospital full to the rafters. As I pointed out to my mother, the rate we are spending is enormous and we are nowhere close to cresting with the elderly until about 2025---almost 20 years away.
Just imagine what it will be like then coupled with the slightly younger generation with their obesity and diabetes and premature joint degeneration.
It isn't looking pretty..and I don't care how much prevention we do......the wave is coming and if you think we need more ALC beds now, just imagine what we are going to need in another decade or so.
Last thing we need is a pile more Family Heatlh Teams with doctors seeing fewer patients and working fewer hours.
Makes me shudder.
Now if we can get dad home before he gets C. difficile or some other bacterial beast we shall be happy.
As I say to patients, don't complain about being sent home earlier than you'd like-just be happy that you can walk out.
..
"Why did I have to wait 12 hours in the Emergency Department - we need more doctors now!"
The MOHLTC, with your local health integration network and the OMA, has developed a priority strategy to help address the rapid changes that can be seen in the need for emergency care. Additional resources have been provided that do address the need of our emergency departments. Monitoring has shown dramatic improvement in our emergency departments overall ability to deal with the rise and fall of need that occurs in emergency situations. In addition, Health Force Ontario has provided needed services when requested.
The MOHLTC looks forward to the additional solutions that each local health integration newtwork is developing to address these needs in your community. Together , your community LHIN, and the OMA are assuring your continued access to needed care in our publicly funded accessible health care system
Public Tactic Number 4.....NOT!
Your comment makes me think of the concept of central queuing......a central queue makes no difference in the overall volume of patients being treated...what makes the difference is that the acceptance of a central queue strategy brings with it more funding.
Same with Emerg, same with Neurosurgery...but as I pointed out in my earlier post, the time is quickly approaching when a bucket of cash isn't going to put out the multiple fires that are smoldering. It is only a matter of a few years.
What will government do then?
Reminds me of a recent speech by a US politician who said (I'm paraphrasing):
Beware of a government that gives you everything because that same government has the ability to take it all away.
How true.
Absolute dependency is never very good for your health or your character.
We really feel bad for everyone caught up in these situations.ALCs are not in the right environment for their needs, it is awful having to cancel someones surgery (stressful enough getting psyched up for it and then having to do that again), surgeons losing income - none of it is right, but reality.
The way we run the Hospital nowadays reminds me of my days in industry.
We have "production" meetings first thing each day. How many beds available, coming available, what surgeries scheduled, hows ICU, whats in ED etc. Then we make decisions on what we can provide for the day.
And for the surgeons, it's not about loss of income they are complaining. It's wasted time, deferral for patients whose surgeries should not be deferred, inroads on the critical mass of cases they need to keep up their technical skills and research, a critical mass of experience for their residents, I could go on...
A bit of humour. The Chief of Urology complained to the Canon Pastor at the Cathedral one Sunday and asked if he couldn't so something by way of God's help, I guess. He said the CP just smiled at him and said something like, "Sorry, I'm only in sales."
Speaking with tongue planted firmly in cheek, do you think its time to revisit the lessons (but not necessarily the practices) documented in Goldratt's "The Goal"?
We will not be changing the goal of a centrally controlled publicly funded system under central control. This is a income redistribution plan that works under our control. We do know what is best for you.
Public Tactic #5
"I can't find a family doctor and it's the government fault"
Record number of patients and providers have been linked through the Family Health Groups and Family Health Teams advocated by the OMA and supported by the MOHLTC. More teams are being regularly formed so that patients can find care through these teams. With the newly trained physicians, nurse practitoners, and other health professionals supported by the resources applied through the MOHLTC, it is hoped that all Ontario citizens who wish stable primary care access will enroll in these services.
For those who have not yet successfully found care, your Local Health Integration Newtwork will be pleased to assist you.
"More teams are being regularly formed so that patients can find care through these teams."
We cannot get an answer out of the MOHLTC about where the process for the development of rural FHT's has gone, it being the case that the application process was supposed to be immanent about a year ago. We are curious to see what is on offer and whether it's enough to make us want to drink the "kool aid." Not impressed so far.
www.waittimes.blogspot.com
www.waittimes.blogspot.com "
Thanks Ian....I agree fully.
Things got tight at the hospital today and he was discharged home rather suddenly after receiving two units of blood yesterday. Anyway, three doctor children to assess and cart him back if necessary.
I think we begin to expect these things at a certain point.
Anyway, interesting to see the level of care that exists on the floor. They do try but are run off their feet.
Having worked at a small community hospital in the past I can say that the collegiality seems to be preserved in that kind of scenario.
In the larger teaching hospitals the sub-specialties seem to peripheralize family medicine although I expect this would be denied as purposeful.
I'm waiting to see how the specialists cope with delivering primary care as our family doc numbers continue to dwindle or as access continues to dwindle...which it will.
In fact, I believe there will be a 1-800 number that anyone can call, to get them on the orphan patient queue, where they will be prioritized, and actioned accordingly.
But please don't call back, to inquire about your progress in this queue. We'll let you know...
Federal-provincial positionings are now job one.
All other issues are not priorities. Multiple meetings are being held today to readdress political agendas that have now open.
First, how to use the federal elections to open the money flow to Ontario. Briefing books are being prepared.
Which is what it's all about, ain't it?
MFO: What are the chances the GG advised Mr. Harper to obey his own legislation? That now is not a good time?
"Should fall under the purview of the LHINs"...gag!!
Every time the pointy headed reorganize primary care so that it is ostensibly "better", primary care suffers and deteriorates.
If all those pointy headed that try to constantly reorganise primary care jumped off a cliff, holding hands, in unison, primary care delivery would improve within seconds.
The further away the meddling political class is from the patient/doctor interface the better it would be for all concerned....it was they who drank from the hallucinogenic Barer Stoddart report and acted on it resulting in the doctor shortage.
I could not help noting a political advert for the Federal election blaming Harper for the doctor shortage and the orphan patient problem...the Huzpah of the Rae's to blame onto others the consequences of their mal decisions in applying the Report, slashing medical school placements, residency positions and the imposition of the damnable 'Social Contract' with its Rae days.
A pox on all the Parties were Health care in Canada and Ontario are concerned.
I'll vote for the Party that advocates the least 'improvements', the least 'reorganisations, the most decimation of the overwhelming bureacratic burden that over shadows the tottering health care systems.
Remember that the main cause of problems are solutions to previous problems which were the result of solutions to previous perceived problems that were the result of...
Two issues are now present, for sure, that were not present Friday.
1. The word "recession" is now used in open conversation.
2. The Federal conservative-provincial Conservative fight is heating up, and is the primary issue.
Try Ron Paul of Texas. He's your guy.
Problem is if we all did that, the political junkies would get their way.
I'm in the same boat again, but at the federal political level. I can't bring myself not to vote. Maybe this time, I'll try just spoiling my ballot.
The major strategy will be the Ontario as "poor province" issue. Every effort is being devoted to get more to flow from federal coffers to provincial coffers.
Remember current premier of Ontario hasn't got anywhere left to go, politically, except to federal role.
Amazing how quickly things can flip.
OMA contract - now put to bed. Will be fair and reasonable in light of money available and federal election. Any "fight" in public, will not gain "brownie" points on a political level so clearly we can put the public strategies in the files.
Internal polls show Ontario going PC (?backlash against provincial liberals or outcry against declining economy).
hmmm...the college overstepping its jurisdiction? You don't say.....
He may want to revisit that "poor Ontario" strategy lest he find himself without a chair when the music stops.
http://www.theglobeandmail.com/servlet/story/LAC.20080909.CAMPBELL09/TPStory/TPComment/?query=
I read somewhere that the percentage of Canadians who think that health care is the top priority is rising...not declining as this piece would indicate.
As for voting....the public seems to choose more restraint in the form of Conservative governments when the economy is going down the tubes...and a Liberal government when the economy is in good shape. I guess even the public figures out that one cannot spend ones way out of economic trouble.
And I see that Michael Rachlis is giving a talk at the CMA leadership forum..reason enough for me not to go.
Well we are now back in the bunkers working on the federal-provincial election stuff. It is THE priority.
We have to fix the strategies that assure a provincial liberal win in 4 years using our positioning with the federal PCs as a strength not a weakness.
Do we sell Ontario as "poor" Ontario and threaten the Fed PCs now, or do we play it cool. This is the real politics!!!
Regardless, means the OMA contract is toast until after mid October - can't give a raise or not give a raise until we know who and how the federal election goes. Wouldn't look good to give a 4% increase if Ontario is "poor"; wouldn't look good to give a 0% increase if the Feds are "topping" us up. Sorry, looks now like Nov/Dec on that contract. More later.
http://www.torontosun.com/news/canada/2008/09/10/6719016-sun.html
People ask - why do we respond so aggressively to federal elections -
It's because they control more money than we do, and we want access to it. As a result, we deal with our support to get the money - we have to decide whether to support them getting more seats (for which we accept funding) or whether we are better off fighting them getting more seats because we believe the next government will give us "more".
It is financially tough right now and the fastest access to the tax pool is supporting the government in power.
Governments survive by the use of tax resources and we need more.
Canary:
That deal was stuck in the "good" times. We are trying to get out of it by putting a deadline on it, but will honour it if signed.
New deals (OMA) are being discussed in a diffferent finnacial environment. No one wants to use the "recession" word but ........
The pointy headed in the NHS have instructed that their Polyclinics will have 3 nurses for every FP; the exact opposite ratio to that FPs have at present in the UK with 1 nurse for every 3 FPs....it isn't hard to anticipate some of the unintended consequences of these latest pronouncements from high...it isn't hard to anticipate that Ontario will slavishly follow suit, 3 nurses that don't exist due to government induced shortages for every 1 FP looking to escape from the Polyclinic madhouse.