by MELISSA McGINLEY
In a November 13th emergency meeting, Ontario's College of Physicians and Surgeons withstood government pressure to discipline striking physicians when it unanimously rejected a request from Health Minister Jim Wilson to include "withdrawal of medical services" in its definition of professional misconduct.
The decision follows months of feuding between Ontario physicians and the government, which resulted in a physician protest in early November. Negotiations between the two parties broke down when the government tried to force new medical practices into northern rural areas by refusing billing numbers in urban centers. In response, physicians issued an ultimatum: either abandon the plan to move doctors North and reduce government limits on income or face a cessation of non-emergency medical treatment. The doctors stated they would begin by refusing to see new patients, whom they would advise to call the government and complain.
The job action prompted Health Minister Wilson to send a letter to the College of Physicians and Surgeons, the self-regulating body for Ontario physicians, urging it to adopt new regulations that would explicitly punish physicians for withdrawing medical services, counseling other physicians to withdraw services, or limiting the type of medical services rendered. Wilson hinted if the College would not comply, the government could overrule the College and outlaw the job action.
During the college's emergency meeting, held to discuss the minister's request, several members expressed outrage at Wilson's blatant attempt to use the college as a political tool. "This request limits free speech. Will the minister next make it illegal for the public or the press even to protest?" asked David Walker, a physician representing Queen's University on the council. "I think it smells of Big Brother," declared Rene Fortin, Sudbury member, "It has to be an indicator to all other groups in society as to the ruthlessness of this government."
Dr. Helen E. Gordon, President of the College of Physicians and Surgeons, clarified its position in a Nov. 13th letter to Wilson. She stated the college had unanimously declined his proposed regulations, "not out of any lack of concern for the current situation, but with real concern for the long-term effects that misusing the regulations of the College in this way would have on the important principles of accountability and autonomy." Gordon stated the college already has the tools to deal with people who do not provide emergency care to patients, and it would continue to investigate complaints against these practitioners. However, Gordon warned the government should accept accountability for the public's health. "The only long-term solution to the present dispute lies with negotiations between the parties," she wrote.
This position, though generally well-received, has generated some criticism from the public and press. One reporter asserted, despite the college's outrage, Wilson does have the right, by law, to tell doctors what to do. Another newspaper stated, "the council has given doctors its tacit permission to keep raising the stakes--it didn't even set a limit on how far it was prepared to let the doctors go."
Physicians, on the other hand, are pleased the college did not bow to political pressure. "Heavy-handed arbitrary threats [are] not the way to solve the problem. We are recommending to our members to continue job action because we think this is the only way to get the attention of the minister to return to the negotiating table," said Dr. Gerry Rowland, Ontario Medical Association president.
Minister Wilson has given no clear indication of what he plans to do next. Immediately after the college rendered its decision, he issued a statement that he respects the decisions made by the college. "The government remains committed to reaching a negiotiated settlement with the province's physicians that addresses years of physician frustration and is in the best interests of Ontario's citizens," he said.