Chair's Report - Spring 2024

Dear colleagues,

Serving as chair of Ontario’s Anesthesiologists (OA) for the past two and half years has been a privilege, and I am grateful for the trust you placed in me. I am as passionate as ever about the work we do as anesthesiologists, the service we provide to patients and our role across the health system.

Your section is your voice when it comes to negotiations, matters of tariff and compensation, and engaging with system players who influence our work. For that reason, we need a strong OA section. An association that will stand strong in its representation of our interests and the interests of our patients. It’s much more challenging for us to take care of our patients if we don’t feel secure or valued.

Our Vision and Mission speak to this. Our Vision is for anesthesiologists to be leading partners, delivering the highest standards of innovative, safe, and sustainable patient care. Our Mission is to advocate for and represent the best interests of our members and to strengthen our leadership role within the health system. 

I would like to reassure you that the executive understands very well that we are no further ahead in terms of remuneration than we were a decade ago. This is not acceptable. Our primary goal has been to protect your financial well-being, which we understand is our members’ number one priority. As a recent example of our efforts, we recently sent a letter to OMA’s CEO and Board Chair asking them to publicly advocate for increased remuneration for all physicians, including anesthesiologists and to bring attention to the anesthesiologist shortage and the need for further investment in Anesthesia Assistants and Anesthesia Care Teams.

As you know, every four years, the Ontario Medical Association (OMA) negotiates a Physician Services Budget (PSB) agreement with the government. The total amount gets divided amongst all specialties through the CANDI (Comparison of Adjusted Net Daily Income) formula. This has made it impossible for us to make meaningful increases to our billing codes and unit fee, and in reality, we have fallen behind.

Before, during and after the pandemic, the government has cited many reasons for not being able to pay doctors more. Budget pressures are not going away. If we rely only on the OMA for our increases through negotiation, the next decade does not look much better for us. We must actively hold the OMA to task on representing Anesthesiologists and specialists and for us to consider exploring ways outside of the OMA to influence the government.

When I wrote my first Chair’s Report in the fall of 2021, I expressed that we could not afford to be overlooked or be an afterthought when policy decisions are made that impact our ability to carry out our work. The players in the system need to recognize who we are and appreciate our value for us to be able to effectively fight for the monetary and non-monetary resources we need. To set us up for success and achieve our goals, we felt that it was important to focus on and strengthen five areas: Section Governance, Tariff and Compensation, Advocacy and Engagement with key Health System Players, Patient Care and Member Services, and the Ontario Anesthesia Meeting (OAM).

I will briefly summarize the progress we have made in each of these areas over the last couple of years.

Section Governance
- Strengthened executive leadership by recruiting members-at-large to represent diversity in practice and geography to complement the elected executive.
- Solidified oversight of policies and processes and embedded executive leads into our operations.
- Through the Beyond the Mask Campaign, we have attracted many volunteers to our working groups and committees.
- On-boarded Stephanie Field, our Executive Coordinator, and created an annual work calendar to ensure consistency in our workflow.

Tariff/Compensation
- Advocated for fee increases and stressed the increased burden on physicians during Negotiation Task Force (NTF) meetings.
- Submitted strong and strategic proposals to the Physician Payment Committee (PPC) based on member feedback.
- Responded successfully to multiple threats to our funding allocation from other groups related to the most recent PSB. One brief example is when Anesthesiologists practice and submit billings for subspecialty work such as Critical Care, Chronic Pain or Interventional procedures, the funding for that work comes from the anesthesia funding envelope. When those subspecialties propose an increase in their fees, it negatively impacts our funding distribution. We were able to successfully limit the impact on our allocation on several occasions.
- We provided feedback to the Relativity Advisory Committee (RAC) to limit the effects of relativity adjustments against us.

Advocacy and Engagement with Key Health System Players
- Successfully advocated within the OMA for the expedited re-establishment of the Surgical Network as an avenue of advocacy for perioperative services.
- Advocated within the OMA on matters important to Anesthesiologists including compensation and expansion of Anesthesia Care Teams as a model of care.
- Re-booted the Beyond the Mask campaign to increase our profile within the health system.
- Hired part-time administrative support, Lindsay Kneteman, to assist with communications and social media presence and engagement.
- Various aspects of our work have garnered media attention on TV, radio and print on several occasions. Media is starting to reach out to us directly on issues related to anesthesiology.
- Significantly increased our interactions with MPPs and government staff across many issues including:

Brought attention to the critical Anesthesia Health Human Resource (AHHR) issues via the AHHR Working Group, which brought together anesthesiologists across the province to create a Position Paper and Background Paper highlighting Anesthesiology as a medical role and to advocate for maintaining a physician-led model of care.

Mobilized quickly and collaborated with the government during the height of the pandemic when we had regional shortages of epidurals and other equipment, to ensure that our members had the equipment needed to provide care.

Participated in budget consultations with Finance Minister Peter Bethlenfalvy.

Promoted the need for more Anesthesia Assistants and Anesthesia Care Teams and conveyed our suggested solutions to the surgical backlog.

Advocated for a series of changes to advance Environmentally Sustainable practices.

Patient Care
- Leveraged our expertise to provide advice on patient care (specifically the opioid epidemic, epidural catheter shortages, anesthesiologist shortages, and sustainable anesthesia care).
- SolvingPain.ca, which launched in June 2021, continues to feature evidence-based pain management best practices for over 50 common surgeries. The site aims to reduce the escalating opioid and pain management crisis in Canada through safer opioid prescribing practices and better pain control practices.
- Our Anesthesia Health Human Resources working group developed our Position Statement: Anesthesia Human Resources and a Background Paper, which as mentioned previously have attracted media and political attention.
- Our Environmental Sustainability Working Group has:

Developed new Environmental Sustainability resource pages on the OA website to guide implementations in hospitals.

Contributed to the first-ever environmental guidelines in the CAS Guidelines to the Practice of Anesthesia.

Collaborated with CASCADES on their Sustainable Perioperative Care Playbook.

Presented to several hospital groups on eliminating desflurane and greening the OR.

Developed a Circular Economy position statement, which garnered political and media interest.

Member Services and the Ontario Anesthesia Meeting
- Returned to an in-person OAM and revamped the program to elevate the quality of content presented. In 2023, we had over 100 more attendees than the previous year and one of our largest turnouts ever!
- Ensured geographic representation of speakers from all academic hospitals as well as rural and remote areas.
- Continued to run successful and engaging Leadership Development and Resident Transition to Practice days.
- Updated and promoted the Leadership Development Grant program.
- Continued to highlight the work our members are doing through blog posts.
- Our social media presence continues to grow allowing us to connect to audiences across multiple platforms to highlight the work we do and demonstrate our value.

We have more clearly defined our brand and we continue to raise our profile through public education, social media, media relations, and direct engagement with various health system players, including government.

As an association, we must push ourselves to think differently and consider innovative ways to advocate for additional funding in order to improve our working conditions. Increasing the number of Anesthesia Assistants and expanding Anesthesia Care Team (ACT) models is one avenue we continue to emphasize. Ensuring safe and sustainable work environments with reasonable compensation is key. Many of our colleagues have chosen to retire early or reduce their practice. Fair compensation and a healthy work environment would narrow the HHR gap by reducing attrition of practicing anesthesiologists; this needs to be accompanied by other long-term solutions to stabilize our workforce.

To effectively advocate and achieve these goals, we need your continued support. This work cannot be done without your paid membership support and involvement, ideas, and feedback. We have held our dues at $300 for many years. Raising our fees and increasing the number of members who pay could ensure funding to hire experts, build proposals and help us get them to the right people and tables. If we want to succeed, we must not only pressure the OMA to represent our interests, but we must be effective advocates for ourselves.

As I move into the past chair role, I look forward to what the next executive will accomplish. Once again, it has been very rewarding serving as your chair. I have done everything I can to elevate our profile, advocate for the work we do and position us as leaders. We have set up a solid base. Let’s take what we’ve done and build on it. Let’s think bigger. If you have thoughts or ideas on how we can further succeed, please share them with us.

Sincerely,

Dr. Rohit Kumar
Chair, Ontario’s Anesthesiologists, A Section of the Ontario Medical Association