History of the Medical Reform Group: 1979 - 1996
Maturing the MRG
When the MRG was formed the members were almost exclusively house staff
and medical students; by 1985, over 75% of our membership were practising
physicians. By that time the membership included doctors in family practice,
internal medicine, surgery, occupational health, and psychiatry. A number
of MRG members are involved in academic medicine, to a large extent in
areas of clinical epidemiology, public health, and occupational health.
The spectrum of our membership, and the areas of expertise spanned, allows
us to speak with authority both on issues directly related to clinical
practice, as well as areas such as health economics, health technology,
and quality of care.
In looking at the nature and attitudes of the MRG in 1985, the results
of a study of the group is of interest. James McDermid, a graduate student,
approached the Steering Committee and was given permission to survey the
MRG membership. Sixty-seven per cent of the membership responded to the survey.
The most important findings were that 90% of the group felt that its lobbying
function was "very important" in their reasons for joining, and that most
would terminate their membership if the MRG stopped lobbying.
The End of Extra Billing
The test of the maturity and credibility of the MRG came with the intense
political struggle that accompanied the introduction of the Health Care
Accessibility Act. The scene for legislation to end opting out and associated
extra charges for patients was set when, in the spring of 1985, Frank Miller's
short-lived provincial government was defeated. The MRG contributed to this
event by pointing out a contradiction between what Frank Miller was telling
the people of Ontario concerning extra billing, and what he was telling the
provinces' physicians. The issue received front page coverage a couple of
days before the election.
The Conservatives were replaced by a Liberal minority which could govern
only with NDP support. It didn't take the government long to suggest that
they would introduce legislation to end extra billing. In preparation, they
organized a series of public forums to raise awareness about the proposed
legislation. MRG members participated, along with members of the Liberal
caucus, as panellists in a number of these forums. The public forums included
the first of what was to be a long series of exchanges between MRG spokespersons
and OMA representatives and sympathizers, exchanges that were sometimes
acrimonious, and always intense.
The struggle escalated when the legislation, then called Bill 94, was
introduced in December 1985, and the OMA first talked about the possibility
of a strike in response to the legislation. The next few months saw the
issue in the headlines almost every day, with progressively increasing physician
militancy. Initially, the OMA refused to negotiate with the government;
when closed-door negotiation began in March 1986 there was a total deadlock.
The first physicians' rotating strikes began in February. In late May, the
OMA called a full strike of Ontario physicians. When the government was
undeterred, the OMA introduced further sanctions and organized major reductions
in the service of a number of emergency departments in hospitals throughout
Ontario. The legislation was finally passed on June 20, but the strike continued
in full force for another week. Physician support for the strike began to
erode by the end of the month, and the strike was called off in early July.
The MRG was spectacularly effective in presenting its position in support
of the legislation. With each major event in the drama, the media described
both the OMA position and the MRG reaction. This was true of newspapers,
radio, and television. The MRG was included in special news presentations
about the extra billing legislation and the doctors' response (such as a
segment of CTV's "W5"), and our position was presented in major published
articles in the Globe and Mail and Toronto Star (op-ed pieces in both), the
Hamilton Spectator, and the London Free Press.
There were a number of reasons for this success. First was regular contact
maintained by Michael Rachlis and Phil Berger in Toronto, and Gordon Guyatt
in Hamilton, with the media people involved in covering the story. Mike
and Phil were particularly outstanding in co-ordinating our contact with
the media. Second, the steering committee members and other MRG members dealing
with the press were in regular contact (often daily), planning strategy and
ensuring a consistent, logically and politically sound response to ongoing
developments. Third, we had fully researched the issues prior to the legislations
being introduced and were, for example, able to rebut, citing empirical evidence,
the claim that user charges decreased health care costs. Our data base
and the close co-ordination of our response facilitated the fourth major
element in our success: the calm, articulate, and closely reasoned responses
that we were able to offer to the media. This was true not only of the
primary spokespersons (Mike, Phil, and Gordon) but also of others who presented
our position: Don Woodside, Bob James, Mimi Divinsky, Doug Sider, Bob Frankford
and, in London, Barbara Lent.
The impact of the MRG in the struggle can only be a matter of speculation.
However, we destroyed the myth of the unanimity of the medical profession
in a very visible and repeated fashion. This may have had an important psychological
effect both on the profession and on the government in holding firm on
the legislation. We repeatedly pointed out fallacious arguments the OMA
was using: that extra billing was an effective way to control costs; that
patients didn't suffer as a result of extra billing; that extra billing was
a mechanism to reward superior physicians; that physician autonomy in practice
would be compromised by the legislation. Credible challenges to these points
could only have come from within the profession, and our responses compromised
the OMA's ability to spread misinformation. Our effectiveness was such that
quite early in the battle the OMA refused to participate in any debates with
the MRG, or any panels or news programs if a member of the MRG were to be
present. We also gained a great deal of credibility with the government,
and also with the Conservative opposition. For example, an intervention by
Mike Rachlis played an important role in avoiding further delay in passing
the Health Care Accessibility Act.
One testimony to our impact was an editorial that appeared in Ontario
Medicine, the OMA's official journal, after the strike was over. It castigated
the media for its coverage of the MRG. One section of the editorial provides
a good description of the MRG's effectiveness: "Perhaps the most disturbing
breach of journalism ethics evident in some of the news media, particularly
the Toronto Star, the Globe and Mail and the CBC, is their insistence on
including, with virtually every comment by the O.M.A., a contrary statement
by the Medical Reform Group...It isn't so much their statements that rankles
(sic), but the fact that such an insignificant rump group is given "equal
time" with the recognized representatives of Ontario's 18,000 physicians."
Four years after the event a CMA representative, in a statement published
in the CMAJ, still referred to the MRG during this period as being, "darlings
of the media".
It is clear that in the extra billing crisis the MRG fulfilled, in an
outstanding fashion, the role of political lobbying that the majority of
the membership see as its primary mission.
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