Ontario doctors are ‘right to be upset’ about compensation: New OMA CEO

Kimberly Moran took over as CEO of the Ontario Medical Association (OMA) on Dec. 4, 2023. She is a chartered professional accountant (CPA) by training and has has held leadership roles with UNICEF Canada and Children’s Mental Health Ontario, where she served as president and CEO. Her most recent role was as the president and CEO of the Ontario College of Family Physicians. She spoke to the Medical Post about the challenges Ontario doctors are facing and how she sees the OMA helping.?

Q: What do you think Ontario doctors want to improve about the Ontario Medical Association and how is your organization going to go about that?

Well, I’m, I think, on day 42 now. So I’m just going into my third month but I’ve met with almost 50 physician leaders across different sections and MIGS (medical interest groups) and districts, and I would say almost all have said they want a greater advocacy voice from the OMA. And they also say in the same breath that the staff team here at the OMA are very smart and helpful. So I think I have to put that together really. The staff team are advocating, and they want to be better advocates. I believe that if I can put that together and enable the team to be better advocates, that the goal then is to make sure that our members feel that heightened advocacy. I’ve already started a number of initiatives with the staff team, and I feel actually very optimistic that OMA members are going to feel that heightened advocacy in the short term.

Q: When you say “advocacy” are you talking about advocating for better compensation? My sense is that is the big concern for Ontario doctors right now.?

I think advocacy is a bit broader than just compensation, but I would say that with respect to the matter of compensation, that doctors have a right to be unhappy right now. Their income has not kept up with inflation. But the reason for that is government. They had a cap on wage increases across the broader public sector employees for a number of years. And in the last contract, we knew that the arbitrator was not going to award us any more than the 1% per year. But those days are over . . .. And we’re actively talking to government right now about that: I’m going to call it catch-up for inflation during that period because we have to ensure that doctors’ pay is keeping up with inflation and is reflective of their ability to operate a practice.

I’m a CPA by training so I understand what it’s like to run a business and I know that what our doctors are facing is that their nurses say are asking for an increase or their medical assistants are asking for increased wages. Perfectly reasonable. They’re seeing their colleagues in hospitals get increases. And so we have to make sure that doctors are keeping up with inflation. And so again, I think that doctors have a right to be concerned about that. But the reason for that is this government policy. And so our job right now at the OMA is to get that catch up for the inflation.

Q: When you look at the challenges Ontario healthcare system facing, what do you think the Ministry of Health and Ontario Health should be focusing on?

Well, the OMA has done a really good job on a policy recommendations document called the Prescription for Ontario Doctors Solutions for Immediate Action, which has 11 strategic initiatives that should be included in the upcoming budget because that’s going to make a sustainable and efficient healthcare system.?

But we identified three urgent items, and the first was fixing the crisis in primary care. The second was decreasing administrative burden for all physicians. And the third is increasing community capacity to enable hospitals to discharge patients as soon as they’re ready to the right level of care in the community.?

But I’ll just pause on the crisis in family medicine, and I think that the action that needs to be taken there is increased compensation clearly, investing in team-based care, which we did see an announcement last week for $110 million, which is great, but there’s a lot more needed of that. And (as well) to reduce administrative burden. If we do those things, I think that we can attract family doctors who have left a comprehensive longitudinal care back and encourage students to come into comprehensive longitudinal practice.

Q: While we’re talking about compensation, improving fee and income relativity has been a long-standing problem. Is there anything that you, from the CEO perspective, can say about that? Or is that not your direct bailiwick?

Oh, no, it’s certainly part of what I have to manage in my practice as being a CEO, but I would say that that’s a super complicated issue. I mean, relativity is one of those things that unfortunately pits physicians against physicians. It’s a winner or loser piece. And what I’d like to do—though at 42 days in I have a pretty superficial understanding of the issues but I think as a CPA it gives me a bit of a leg up in understanding these kind of complex numerical things—(is) I want to really get into the details of it so I can understand a little bit better the nuances in the relativity models, the challenges, and how we can have a better lens with physicians.

Because I think that if you go back to the principles, I think that as I understand the last time that we looked at the relativity issues with our general assembly, I think that everybody was agreed on the general principles, but then we get stuck in the specifics. And so what I’d like to do is get myself up to speed on those and see what I can do, and the team at OMA can do a better job of helping to advance the principles behind it, which is really one of equity.

Q: Your last job was president and CEO of the Ontario College of Family Physicians. So how do you balance caring for family doctors’ concerns but also caring for other kinds of specialists?

Well, I think that we need to really understand the needs of all members. Family doctors: theyre a big block, but as you know, there’s multiple different subsections within it, right? Many practice in significantly different models. I mentioned comprehensive longitudinal physicians and that’s where we’re seeing the crisis in family medicine. (But you also have) GP-focus therapy, emergency physicians, et cetera. So even within family doctors, there’s lots of smaller groups within that. So it’s really about ensuring we understand the physicians and what their needs are and acting on those needs. It can’t be a one size fits all solution because I think that makes people feel like their needs haven’t been met. I do think that we just have to understand deeply what members across all the different specialties and models of care are really interested in.?

If we think about the comprehensive longitudinal physicians who are really raising flags right now (well) the number of unattached patients is rising quickly. I mean, we’ve modeled that we think that the number is going to double in the next two years, which is really astonishing, and it’s really driven by immigration for the most (part). That’s the biggest driver. We know we’ve had record levels of immigration. Then the other pieces are retirements, the Baby Boomers are retiring and we’re seeing this rising level of retirements. Then of course, we’re not filling those positions yet again because so many people are saying, well, that’s not a model I want to practice in. So we have to change that. That’s one specific group with a particular issue that’s I would say quite heightened right now.?

But when I talk to other doctors across all the different specialties, I see a range of issues. I spoke to doctors in the long-term care section, and they had particular things that they’re thinking about. The average age of their members is quite, I’m going to say, old. So they’re concerned about, OK, what happens when those doctors retire? Are we going to be able to hire more doctors into this model??

I hear from anesthesiologists where again, they’re worried about shortages of doctors as well. They’re seeing quite a lot of vacancies. And what are the solutions around that? I want to look at each group of doctors and say, “what are the needs and how can we be best advocates for you?” Some is compensation for sure, not all of it’s compensation, and we need to advocate across all those needs for doctors.

Q: I tend to think that PTMAs (provincial-territorial medical associations such as the OMA and Doctors of BC) do three things: They negotiate, they lobby and they do public health awareness. When you think about the OMA, what is the balance between those three things? And is there anything else that I’m missing in terms of the role of your organization?

No, I think that’s kind of a nice umbrella. I mean, I think right now if the members were sitting here, they’d say compensation’s the biggest issue right now. Because we’ve fallen behind because of inflation, and I agree with them. But I think that also there’s other solutions that will help them. So I’m not suggesting that compensation isn’t the priority right now, I would say that we can also advocate on other things as well. Much of what we advocate for will help physicians in their work. Say a centralized referral system or team-based care. The idea there is that in the centralized referral piece, physicians will decrease the amount of work that they have, the number of hours they put in. Or team-based care: they perhaps could roster more patients that way. But either way, we’re freeing up their time to make decisions. So if they want to spend more time with their kids, that’s great. If they want to roster more patients, that’s terrific. Whatever makes sense in their lifestyle. But by doing so, you actually are increasing their compensation. Remember, I’m an accountant, so to me, if I’m able to decrease the number of hours that any physician spends doing their job, then that’s freeing up, again, that’s helping them with their compensation.?

The other reason I think that we need to advocate across (the board) for good healthcare systems or efficient healthcare systems outside of compensation is physicians should have a seat at the table when governments are making policy decisions and important healthcare system decisions. And in order to be at that table, we have to say we’re about more than just compensation. They have to see that we have a broader view.?

Q: When you think about at the direction to pursue you are being given as CEO, how much do you weigh the OMA board, how much do you think it’s input from members and how much is it from physician president of the association that year???

The board gives us a high level roadmap, and we’re expected to execute with the executive team on that. So that to me is the clear, high-level piece I always listen to. But then I have to listen to members every day. So that’s why I meet with section leaders and districts in forums, and I’ve met more than 50 now as I said. I have to keep in touch.

Next week I’m going to Sudbury to listen to members. I have to keep listening to members to understand what those important issues are for them. So it’s both. The board gives me my roadmap, and they’re elected by our members, but at the same time, I have to have my ear to the ground. I have to understand what members are feeling, what the biggest pressures are, what the stressors are, what’s happening in the north, what’s happening in the west. I need to understand all of that. And so I would say that I have to listen to all of those as I do my job.

Q: I am sure you folks see it in your OMA online chats, and we see it when we run articles. Doctors are really upset about compensation issues. So I’m sure you see some, let’s say, forcefully stated opinions sometimes. Is that hard to take or how do you feel about that when you see or hear it?

Well, I think I get it. I mean, if I was in that position, I would feel exactly the same way. I think they have a right to be upset. And I think I bring that passion to, when we’re talking to government, that the catch-up has to happen. We’ve seen other healthcare providers receive that catch-up, such as nurses. We saw the government’s own employees, two weeks ago I think they received their catch-up. It was the teachers the other day I think we saw. So it’s time. And so I think that what I do is I take that passion and sometimes anger coming from physicians, and turn that into sort of the advocacy energy that we use with government.

Q:?A now retired Medical Post reporter, national editor Matt Borsellino, when he saw your appointment notice wondered if you were related to Dr. Ed Moran—‘Big Ed’—who was a CEO of the OMA along time ago. ?I checked with with OMA media folk and you’re his neice! So I wonder, do you have memories of him in the job and do you take anything from what he did in terms of what you do now?

Well, my uncle had the job almost 45 years ago, which is really quite amazing. And he passed a couple of years ago. I was very young when he had the job. I remember a little bit, but I would say I have actually spoken to OMA members who’ve talked to me about working with him and even a couple of our staff members as well. And they told me about the kind of leader that he was bold, compassionate, knowledgeable, fair. And so to me, those are leadership skills and competencies that I want to live up to.