OMA policy positions
The OMA shapes and influences provincial health-care policy through amplifying physicians’ voices on policy issues that matter to the profession.
We deliver on this mandate by:
- Monitoring emerging issues based on insights from members and research
- Developing evidence- and physician-informed policy positions and thought leadership
- Maintaining partnerships with external stakeholders, including relevant associations, ministries, government and professional or regulatory bodies
- Engaging with members on a regular basis
- Identifying health promotion and health education policy and positions to raise awareness and promote greater control over health and its determinants for patients
This committee supports the OMA in developing its policy agenda by sharing and advising on emerging issues and supporting in the identification/prioritization of issues.
- Dr. Audrey Campbell
- Dr. Travis Carpenter
- Dr. Cheril Clarson
- Dr. Atul Kapur (past chair)
- Dr. Jesse Pasternak
- Dr. David Schieck
- Dr. Kevin Wasko
Burnout is a system-level issue that impacts many physicians in Ontario and was exacerbated by the pandemic. Learn how the OMA is working to address this important issue.
Through the Ministry of Health-OMA bilateral Burnout Task Force, the OMA has had the valuable opportunity to reinforce the potential to improve the efficiency and effectiveness of Ontario’s health-care system through reduction of administrative burden for physicians.
Ontario physicians identify administrative burden as one of the leading causes of burnout, which affects the vast majority of doctors. The Canadian Medical Association’s 2021 National Physician Health Survey found that physicians spend more than one extra working day – 10 hours a week – on administrative tasks. Further, burned out doctors are decreasing their workloads and retiring earlier, leaving the sustainability of the health-care system at risk.
The OMA’s results from the 2020 and 2021 member burnout surveys were published in the prestigious journal BMJ Open. Findings show that following one year of the pandemic, high levels of burnout among Ontario physicians had increased from 28 per cent in March 2020 to 34.7 per cent in March 2021, with female physicians and physicians under 35 more likely to experience burnout in 2021. This publication supports the findings of the OMA Burnout Task Force’s 2021 white paper.
The OMA’s Burnout Task Force was struck in 2019 to identify the contributors to burnout, advocate to the Ontario government, co-ordinate with stakeholders to address and inform issues related to burnout and develop system-level recommendations on burnout prevention.
To support this work, the task force surveyed physicians in 2020 and 2021. According to the surveys, just prior to the pandemic, 29 per cent of Ontario physicians had high levels of burnout with two-thirds experiencing some level of burnout. By March 2021, these rates had increased, with 34.6 per cent of Ontario physicians reporting high levels of burnout and almost three-quarters reporting some level of burnout.
The OMA released a white paper calling on the Ontario government to address burnout, recommending the top five solutions:
- Reducing and streamlining documentation
- More work-life balance through flexible work arrangements
- Making digital health tools a seamless part of physicians’ workflow, including by ensuring different systems can speak to each other
- Support for physician wellness at their workplaces
- Fair and equitable compensation for all work, including administrative work that cannot be reduced
The COVID-19 pandemic significantly impacted the lives, health and well-being of Ontarians and individuals throughout the world. The OMA developed policy papers on ensuring a safe, accessible and equitable COVID-19 vaccination framework in Ontario and how the province needs to adapt to the “new normal.”
Drug shortages in Canada are not new, but they are being amplified by the COVID-19 pandemic. Shortages of drugs can be catastrophic for patients, causing treatment delays, increased suffering, financial burden and an increased risk of overdose and underdose. Because an adequate drug supply is critical for high-quality health care, the OMA and other health-system partners have issued warnings and called for immediate action.
To prepare its white paper, A Remedy for Canada’s Drug Shortage Dilemma, the OMA consulted with stakeholders at the provincial and national level. The paper summarizes best practices, builds on ongoing work and highlights opportunities for improvement. The OMA recommendations are based on lessons learned from the first wave of the pandemic, which did not overwhelm Ontario hospitals. Taking immediate action to address drug shortages is now more important than ever, as projections indicate increased cases and hospitalizations during wave two of the pandemic.
In the white paper, the OMA recommends that Canada increase domestic production of essential drugs and that all levels of government work together to ensure a sufficient stockpile of essential medications during the COVID-19 pandemic.
The white paper also identifies a series of recommendations on:
- Redistributing or reallocating unused drugs
- Using substitutions and alternatives
- Using an ethical decision-making framework regarding drug allocation
- Enhancing communications
- Temporarily expanding drug programs
- Developing and implementing a comprehensive drug-monitoring system
Bold and innovative solutions are required to comprehensively address the complex issue of drug shortages. Success will require the full partnership, attention and commitment of key stakeholders at the provincial and national level, in collaboration with governments.
The COVID-19 pandemic has significantly impacted the lives, health and well-being of Ontarians and individuals throughout the world. There is a light at the end of the tunnel, as Health Canada has begun approving safe and effective COVID-19 vaccines for distribution.
This is only the beginning. Ontario must begin preparing now to deliver vaccines in a safe, equitable, and accessible manner once they are widely available. In the white paper, Shining a Light at the End of the Tunnel, the Ontario Medical Association provides guiding considerations that must be addressed in developing Ontario’s vaccine strategy.
To ensure a safe, equitable and accessible COVID-19 vaccination framework in Ontario, the OMA has identified a series of recommendations related to each of the following themes:
- Defining priority populations
- Vaccine distribution and administration
- Integrated information systems, surveillance and monitoring
- Public education and vaccine hesitancy
The recommendations in this white paper have been informed by the insights and expertise of Ontario’s physicians and by consultation with key health-system stakeholders.
Patient-centred care has become an increasingly critical concept among researchers, decision-makers and health-system planners. The COVID-19 pandemic has highlighted the need for patient-centred care, due to the disproportionate impact of this disease on different populations.
The white paper, Patients’ Views of the Canadian Health-Care System, by the North American Observatory on Health Systems and Policies prepared for the Ontario Medical Association, provides insights into the health-care experiences and desires of patients and caregivers across multiple health and life stages.
Across all life and health stages, five broad themes were identified. Patients have a desire for:
- Personalized (person-centred) care.
- Information on resources available and how to navigate the system.
- Choice in treatment, care setting and/or care provider.
- Holistic care and non-medical supports to overcome barriers to accessing care.
- Care co-ordination and care continuity.
As the number of COVID-19 cases in Ontario continues to rise, tackling the pandemic is a shared responsibility of both the system and individuals. It is essential to plan and implement strategies for the next phases of COVID-19 and adjust to Ontario’s evolving “new normal.”
The white paper, A Prescription for Ontario: Maintaining Vigilance as We Learn to Live with COVID-19, prepared by the Ontario Medical Association, provides recommendations for the Ontario system and Ontarians to minimize the spread of COVID-19 while also tackling the ongoing backlog of medical services. The recommendations are based on lessons learned from the first wave of the pandemic and principles for going forward.
Below are key system and individual recommendations. Read the white paper for additional recommendations.
Ontario’s doctors recommend the system:
- Adopt a strategy to address COVID-19 flare-ups early. This may include local short-term, non-essential closures
- Prepare and deploy mobile rapid response teams so trained personnel can identify and contain COVID-19 flare-ups through clinical support, testing, contact tracing and isolation
- Use pop-up testing to bring COVID-19 assessment capacity to hot spots and vulnerable communities as well as support mobile response teams in those communities
- Identify COVID-19 hospitals in each region to allow non-COVID-19 hospitals to ramp up clinical activity and address clinical backlog
Ontario’s doctors recommend individuals:
- Get tested if they have COVID-19 symptoms or come in contact with someone who has a confirmed case of COVID-19
- Wear a face covering or mask in all indoor public spaces and outdoor spaces when physical distancing may be difficult
- Continue with proper hygiene practices, including hand-washing
- Avoid closed spaces, crowded places and close-contact settings
- Download and use the COVID Alert App
- Continue to seek care for non-COVID-19-related conditions, including mental health concerns
- Get a flu shot when they become available
- Balance the benefits to your mental, social, developmental, physical and financial well-being against decisions that may put you and/or others at risk
- Create a plan for managing essential needs, should you need to self-isolate
The OMA regularly develops policy positions on key health system topics. Learn more about these key recommendations.
The OMA submitted a response to the Standing Committee on Social Policy on Bill 283, Advancing Oversight and Planning in Ontario's Health System Act, 2021.
The OMA has supported the involvement of physician assistants in the Ontario health-care system for many years. We value the contribution of physician assistants to increase access to primary care and emergency department services across the province. The OMA also supports the regulation of physician assistants through the College of Physicians and Surgeons of Ontario (CPSO). Self-regulation is important to ensuring safe, quality care within a clear accountability framework.
Physicians and physician assistants have worked collaboratively and successfully for many years. The current model of delegation, where physicians temporarily transfer their authority to physician assistants and physicians remain accountable and responsible for patient care, works well.
The language in Bill 283 contemplated a different care delivery model, where physician assistants would be given independent authority to perform a controlled act when ordered by a physician. This is different from the current delegation model where the physician has final responsibility for patient care. In the OMA’s submission to the Standing Committee on Social Policy, the OMA recommended maintaining the current model of care delivery. This recommendation was accepted, and an amended bill was passed on June 3, 2021.
The move to integrated care by way of Ontario Health Teams (OHTs) represents some of the most rapidly evolving health-system reform that Ontario has experienced in more than a decade. As COVID-19 continues to place pressure on the health-care system, the OMA is recommending that lessons learned from the pandemic should influence the ongoing development of OHTs.
The white paper, Early Learnings and Recommendations for the Evolution of OHTs, prepared by the OMA, focuses on what is required for OHTs to succeed and how COVID-19 should inform their future development. The recommendations are based on evidence and experiences from other jurisdictions and lessons learned.
The OMA paper says that COVID-19 highlighted:
- The popularity of virtual health-care, which should be expanded permanently; however, virtual care cannot replace in-person care, which is required for such services as immunizations
- The importance of real-time access to a sharing of patient information across primary, acute and long-term care and community and social services to increase efficiency in the delivery of care
- The need for OHTs to be supported with appropriate infrastructure, digital health tools, administration and funding
- The importance of physician leadership to the success of OHTs
As the medical profession becomes increasingly gender-balanced, pay equity has become an issue of increasing concern. Despite a significant amount of research on pay equity, until recently, relatively little was known about the pay gap in medicine, particularly in Canada.
The Ontario Medical Association’s governing Council instructed staff in 2019 to “initiate a thorough study of the sources and magnitude of physician-gender pay gaps in Ontario.” The OMA was the first provincial medical association to undertake such work.
A July 2020 report, Understanding Gender Pay Gap Among Ontario Physicians, was the first report in Canada to estimate a billings gap among a large physician population (31,481 physicians, who accounted for nearly all practising physicians in Ontario). [Editor’s note: The information in this report is from July 2020. Read the study published on Sept. 21, 2021 in JAMA Network Open.]
The report found that female physicians, on average, bill 13.5 per cent less on a daily basis than their male counterparts. The cause of such a prominent gap in billings remains perplexing, especially given the fee-for-service nature of most physician work. Research is underway to try to determine the causes of the gender pay gap.
Address intersectional relativity
Female physicians are underrepresented in the higher compensated specialties. The impact of this underrepresentation on the gender pay gap is significant. An Ontario study by Cohen and Kiran (2020) examined differences in payments across specialties and found that gender composition was correlated with the average clinical payments received. In the EPR report, about two-thirds of the explained portion of the GPG was explained by the distribution of physicians across different specialties. Therefore, addressing intersectional relativity has the potential to significantly reduce the gender pay gap in Ontario.
Address fee relativity
The other key aspect of addressing the GPG, especially as it relates to intra-sectional gender equity, relates to fee relativity. This concern takes two main forms. First, there are examples where a service provided predominantly by female physicians is remunerated substantially less than a comparable service provided predominantly by male physicians. Second, there are some concerns that female physicians spend more time with patients and/or treat more complex cases than men but are remunerated at the same rate. The most appropriate method to address these issues is through a revision of the Schedule of Benefits. This may include evaluating fee codes in terms of their time, complexity, intensity, etc., so that a similar service is remunerated the same regardless of physician gender. Related to this, the definition and remuneration of fee codes should be further differentiated (e.g., based on time and complexity) to ensure that similar services are paid the same.
The membership survey results (despite the low response rate of two per cent) suggest the need for greater awareness of the GPG issue, particularly among male members. For example, only 34 per cent of male respondents agree that a gender pay gap exists (compared to 84 per cent among female respondents) and only 14 per cent of males are very concerned about the gender pay gap (compared to 75 per cent among females). This gender-biased response may be due in part to lack of awareness of the existing evidence on the GPG. Specifically, several recent studies document a significant GPG among physicians, and this body of evidence needs to be better disseminated among OMA members in a targeted awareness campaign.
New research: Referral networks
Gender-biased views on the GPG may also be related to a lack of solid, Ontario-based evidence on some key potential causes of the GPG. One such example is the impact of referral networks, for which there is some U.S. evidence, but further research is needed to understand the problem in Ontario and devise Ontario-specific recommendations. This issue represents the immediate next research topic on the EPR research agenda, given its perceived importance in addressing the GPG and given that the EPR has access to data required to conduct this research rigorously.
Long-term care homes
The COVID-19 pandemic exposed significant gaps in the long-term care sector. In response, the OMA developed recommendations to address health-care system issues to make long-term care homes safer.
Residents and staff at long-term care homes have been particularly vulnerable to COVID-19. Uncertainty during the initial wave of the pandemic included unclear and changing guidance, confusion about moving between long-term care homes and shortages of personal protective equipment. Wave two of the pandemic has also had devastating impacts on long-term care residents and staff. As of late 2020, 63 per cent of all deaths due to COVID-19 in Ontario were in long-term care.
In July 2020, the provincial government launched Ontario’s Long-Term Care COVID-19 Commission to investigate how the virus spreads in long-term care homes, how staff and families were affected and the adequacy of measures taken by the province and others to prevent, isolate and contain COVID-19. The commission will also provide guidance on how to better protect long-term care residents and staff from future outbreaks.
The OMA has supported the work of the Commission through two submissions. The first submission, in October 2020, provided interim guidance and immediate strategies to address the pandemic. The second submission, provided in December 2020, analyzes issues that have challenged the long-term care sector and identifies recommendations for improvement.
The Commission’s final report is expected to be delivered by April 30, 2021.
The OMA Interim Guidance to Ontario’s Long-Term Care COVID-19 Commission contains 14 recommendations regarding resident care and well-being, infection prevention and control, and physician leadership.
- prioritizing COVID-19 testing for residents, staff and essential visitors in long-term homes
- ensuring everyone caring for residents in those settings has an adequate supply of personal protective equipment and training on how to use it properly
- expanding virtual health care and mobile teams to provide specialized expertise and on-the-ground support to long-term care homes when needed
- grouping and isolating long-term care residents with COVID-19
- making sure long-term care homes have enough staff and that they avoid non-essential movement of staff between homes
- making sure long-term care residents have safe access to essential visitors, caregivers and other social supports to protect their mental health and avoid the devastating impacts of social isolation
- having more and earlier conversations about advance care planning
The OMA Second Submission to Ontario’s Long-Term Care COVID-19 Commission contains 31 recommendations on health-care system issues affecting long-term care, including medical management for COVID-19, access to specialized care, public health and infection prevention and control, human health resources and long-term care delivery. An OMA-led survey of physicians who work in long-term care homes or deliver care to residents in long-term care homes informed the submission.
- establishing a chief medical officer of long-term care for Ontario
- providing the physical space in homes to allow for quarantine for positive residents
- ensuring long-term care homes have adequate supplies of PPE for all staff and adequate training for staff related to infection prevention and control practices
- ensuring that staff are appropriately trained and equipped to support advanced care planning and provision of end-of-life care in long-term care homes
- accelerating the target completion of the commitment to provide each resident with average daily direct care of four hours per day per resident by 2024-25 to 2022-23
Response to the proposed Phase I Regulations Under the Fixing Long-Term Care Act
The OMA submission in response to the proposed Phase I Regulations Under the Fixing Long-Term-Care Act contains 11 recommendations that focus on the roles of medical directors and attending physicians as well as the palliative approach to care in long-term care. An OMA-led consultation of the OMA’s sections on Long-Term Care and Care of the Elderly and Palliative Care informed the submission.
Mental health and addiction care
The OMA, based on consultations with members and key system stakeholders, has developed a series of white papers outlining recommendations to enhance the delivery of mental health and addiction care in Ontario.
Approximately three-quarters of Canadians rely on their primary care provider to address their mental health needs, but there are longstanding system gaps that must be addressed to enhance the ability of primary care doctors to deliver mental health care. The OMA and the Primary Care Collaborative (an alliance of primary care organizations that joined together to collaborate on strengthening primary care as we move toward recovering from the pandemic) identified in a policy paper that the following policy actions are necessary to ensure greater support for primary care providers and improve care in this crucial area:
- Enhance primary care capacity to offer treatment locally by funding and establishing interprofessional care teams with expertise in treating moderate to severe depression and anxiety
- Improve the ability of primary care providers to connect their patients who have moderate to severe depression and anxiety to local services by leveraging and expanding the navigation service, Health Connect Ontario
- Expand access to harm reduction services, such as supervised consumption sites
- Implement an Indigenous-led mental health and wellness strategy
The OMA made recommendations to address the existing gaps in mental health and addiction care in a paper called Responding to a Mental Health and Addiction Tsunami. The paper, which focuses on improving the mental health of children and youth, seniors, those who provide care and marginalized communities, outlines more than 20 immediate priorities and calls on the government to:
- Accelerate and evolve the rollout of the province’s psychotherapy program to provide equitable access to high-quality therapy for all Ontarians, given the cost of private therapy is out of reach for many
- Expand the number of supervised consumption sites and other harm-reduction initiatives
- Fund all Ontario hospitals to ensure that all emergency departments offer dedicated on-site mental health resources 24/7
- Report on and regularly update mental well-being indices and the emergence or exacerbation of mental illness and/or addiction and death from suicide and overdose
- Increase access to public health nurses and social workers in schools for early intervention
- Prioritize in-person learning at school only when it is safe to do so, based on sound public health evidence
The Ontario government is establishing a new online market for internet gaming and recently released a discussion paper titled A Model for Internet Gaming in Ontario that outlines the government’s preliminary thinking on key aspects of the iGaming model.
Many individuals in Ontario gamble, and the majority do so without causing harm to themselves or others. However, a minority (about 2.5 per cent) of Ontarians suffer from problem gambling or gambling addiction, a serious health issue with significant implications for gamblers and their families.
The OMA submitted recommendations to the government, suggesting that it conduct a health impact analysis that examines the effects of gambling and incorporates a harm reduction approach in the implementation of online gambling in Ontario.
Physicians play a fundamental yet often inexplicit role in addressing mental health and addiction issues in Ontario. The OMA’s white paper, Recommendations to Strengthen the Role of Physicians in Mental Health and Addiction Care, provides recommendations to improve care through strengthening the role of physicians in delivering these services.
The OMA recommends that the health-care system needs to:
- Formalize and make explicit the roles of various providers in mental health and addiction service delivery and identify the roles that are most effectively, efficiently and safely performed by physicians
- Match the supply, distribution and utilization of physicians to address the specific mental health and addiction needs of patients that are best served by physicians
- Establish and implement standards for equitable, connected, timely and high-quality mental health and addiction service delivery throughout the province
- Support mental health and addiction leadership training for physicians
- Enable specific leadership opportunities for physicians in Ontario Health Teams’ design and implementation to strengthen mental health and addiction care
- Promote physician leadership within the Mental Health and Addictions Centre of Excellence
OMA responses to legislation and regulation
Ontario’s Minister of Health introduced Bill 60: Your Health Act 2023 on Feb. 21, 2023. The OMA prepared an analysis to support members with an overview of key relevant provisions.
The OMA will be participating in public consultations on the bill and will be providing member-informed recommendations to the ministry, including a formal submission.
Wait times for many common surgeries and procedures were too long before the pandemic, and COVID-19 made them longer. Physicians are seeing patients sicker than they ought to be because of serious conditions that went undetected or untreated during the pandemic. Read the OMA’s policy recommendations and advocacy on reducing wait times for surgeries and procedures.
The need to address the surgical backlog is urgent. Ontarians’ health is deteriorating due to a significant backlog of surgeries and procedures built up during the pandemic.
In a proposal for the Ontario government, Integrated Ambulatory Centres: A Three-Stage Approach to Addressing Ontario’s Critical Surgical and Procedural Wait Times, the OMA is calling for immediate attention to eliminate the pandemic backlog of health-care services and the creation of a new model of care called Integrated Ambulatory Centres.
Integrated Ambulatory Centres
Integrated Ambulatory Centres would safely provide additional lower-complexity procedures and surgeries typically provided in hospitals in community settings. Patients could safely receive more day surgeries and procedures typically provided in hospitals in Integrated Ambulatory Centres, enhancing hospitals’ capacity to deliver more care requiring a hospital setting. Shifting appropriate day surgeries and procedures to Integrated Ambulatory Centres could improve the experience for patients by providing faster access to surgeries and procedures, lower infection rates, while providing anticipated efficiency gains of approximately 20 to 30 per cent.
Integrated Ambulatory Centres represent the most significant ambulatory care modernization in more than three decades since the creation of independent health facilities. To ensure integration with the overall health-care system, these proposed centres would work in close partnership with, or be part of, local hospitals.
For the current system to evolve into this integrated future state, the proposed model outlines three stages that span five to eight years, each designed with system stability in mind.
Stage 1: Expand capacity (2022-23)
- Continue expanding and leveraging existing capacity in the system to reduce the backlog of surgeries and medical procedures
- Provide targeted funding with clear ties to increased volumes and high priority areas
- Test new partnerships between relevant independent health facilities and hospitals
Stage 2: Launch Integrated Ambulatory Centres (2023-25)
- Introduce new legislation to create a fit-for-purpose quality and safety framework for new Integrated Ambulatory Centres
- Establish single-intake systems for surgeries and procedures to improve faster access to care while maintaining patient choice
Stage 3: Faster access to care (2026-2030)
- Integrated Ambulatory Centres are established and continue to expand
- Relevant independent health facilities will transition to Integrated Ambulatory Centres in a phased manner
- Ontario’s five health regions and Ontario Health Teams deliver care that integrates ambulatory care with primary care, rehab, home and community care
To develop these recommendations, the OMA commissioned Santis Health to lead consultations with key system stakeholders.