Small Changes Big Impact

The art of negotiation and and family medicine in the time of COVID-19 with Dr. Nikolina Mizdrak

April 29, 2020 University of Toronto - Department of Family & Community Medicine Season 1 Episode 25
Small Changes Big Impact
The art of negotiation and and family medicine in the time of COVID-19 with Dr. Nikolina Mizdrak
Chapters
Small Changes Big Impact
The art of negotiation and and family medicine in the time of COVID-19 with Dr. Nikolina Mizdrak
Apr 29, 2020 Season 1 Episode 25
University of Toronto - Department of Family & Community Medicine

In studio today, we have Dr. Nikolina Mizdrak, a family physician at the Toronto Western Family Health Team, a physician member of the negotiating team for the OMA since 2017, and an associate professor in the Department of Family and Community Medicine at the University of Toronto. Today's episode focuses on the art of negotiation and important role the OMA plays in providing care to all patients. 

Show Notes Transcript

In studio today, we have Dr. Nikolina Mizdrak, a family physician at the Toronto Western Family Health Team, a physician member of the negotiating team for the OMA since 2017, and an associate professor in the Department of Family and Community Medicine at the University of Toronto. Today's episode focuses on the art of negotiation and important role the OMA plays in providing care to all patients. 

Dr. Rezmovitz:

Small Changes, Big Impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. In studio today, we have Dr. Nikolina Mizdrak, a family physician at the Toronto Western Family Health Team, a physician member of the negotiating team for the OMA since 2017, and an associate professor in the Department of Family and Community Medicine at the University of Toronto. Today's episode focuses on the important role the OMA plays in providing care to all patients. I hope you enjoy the show.

Dr. Mizdrak:

Oh, thank you for having me. I'm really excited to be here.

Dr. Rezmovitz:

So let's get right into things. How are you coping with COVID-19?

Dr. Mizdrak:

Well, I'm going a little bit stir-crazy. The house is in shambles and as I tell my husband, I can get through COVID anything, but homeschooling is killing me. How about you?

Dr. Rezmovitz:

Oh, listen - I will tell you straight up, I'm very, very lucky and privileged to have what I have. I have a healthy wife. I have four healthy kids. They are being homeschooled. I have a job. I'm very lucky and I'm very grateful to still be able to take part in people's lives. There are obviously challenges. There are many challenges that we face as family doctors, as humans, as parents, as a father. But I have to tell you that I really - I'm probably one of the lucky ones.

Dr. Mizdrak:

But were you fired by your children for trying to teach them long division by any chance?

Dr. Rezmovitz:

When you say fired [inaudible] - we've already had three out of the four kids cry this morning -

Dr. Mizdrak:

Exactly.

Dr. Rezmovitz:

And we've already been outside for some of our physical activity and we've already had an accident this morning.

Dr. Mizdrak:

Yeah. My children have pretty much said, "you know, mommy, I think we're going to ask daddy for help from now on."

Dr. Rezmovitz:

Listen, some of us have strengths, right? And the key is to try to use those strengths to achieve certain goals. And I don't think when you woke up that day - whatever it was, it probably wasn't this morning - but I don't think your goal was to do long division.

Dr. Mizdrak:

Yeah.

Dr. Rezmovitz:

And so you got to find a way to like reframe. Even these kids, they just need support. And maybe you're like me, maybe you're completely on the other end of the spectrum here, but I really don't care about school. I've got young kids and they'll learn it. Their teachers will have them bring it back up at some point. They will learn it. As much as they - your kid - if you look at a micro system, your kid in the system is not advancing very much and not learning very much, but nobody is. [inaudible] So they'll all have to learn it.

Dr. Mizdrak:

Yeah. I guess my circus performance school here at the house will have some benefits in the future, I'm sure but-

Dr. Rezmovitz:

Are you guys doing circus? 'Cause we are. [inaudible].

Dr. Mizdrak:

It just looks like a circus.

Dr. Rezmovitz:

Oh, okay. We've been doing a ton of physical feats. We kind of try to come up with a new trick every day. So I've got my one-year-old upside down. She's been on the back of every single one of my kids. We've been working on handstands and you know, trying different circus stuff. You should see them on the couch. It's like a safety net.

Dr. Mizdrak:

Well, I'll see what mine can do and maybe I'll share some of that later.

Dr. Rezmovitz:

Okay. So tell me how - let's go professional then.

Dr. Mizdrak:

Sure.

Dr. Rezmovitz:

How is work?

Dr. Mizdrak:

Work is good. I'm one of those people who is very privileged to be able to still work. Our unit has divided our physician in teams. We've converted to mostly virtual care. We're still giving after hours care, weekend care, daily care, but our teams are divided between supervising residents, being in clinic versus being remote at home. So we have a whole system to protect the team. And I'm also in negotiations right now with the Ministry, so that's taken a bunch of my time as well. And I also work at the COVID assessment unit at our hospital. So I think I would say I was busy, but I'm happily busy.

Dr. Rezmovitz:

So let's talk about some of the challenges that you're facing then in each of those three systems. I assume that the OMA has its own challenges. I assume that working in a COVID assessment center has its challenges, and teaching residents and being in the unit also has its challenges. Where would you like to start?

Dr. Mizdrak:

I think the challenges are broad and I think it cuts to all of these aspects actually. The question that I have is during this pandemic, when you have to teach residents for instance, when you have residents and family practice who are going to be graduating, I struggle and we all struggle to try to figure out how we're actually going to give them the curriculum that they should get. And I'm a firm believer that although they might be missing some basics of pandemic -sorry, missing some basics in family medicine training, I think this pandemic and the ability to work closely with staff remotely as well as in person is actually going to teach them a lifelong lesson. The truth is I'm not sure what that lifelong lesson is, except is to be tenacious and to be resilient in times of change, in times of a lot of fear. And I don't know if it's a bad thing for them to learn this for their longterm career. And I also think that that's the same with working in a COVID assessment unit or working in the OMA. These are really extraordinary times and I think the things that we're being asked to do and the things that we're learning are actually a privilege to learn.

Dr. Rezmovitz:

Yeah. You don't get these opportunities in medical school or in residency very often. Right.

Dr. Mizdrak:

You don't, these are extraordinary times. They really, really are.

Dr. Rezmovitz:

So do you have any stories from the front line in any of those areas that you've been? Either challenges or anything remarkable that you've seen?

Dr. Mizdrak:

I think that at times of conflict you see real human strengths and weaknesses, and I think that I am happy to say that what I've mostly seen is huge kindness and extraordinary care for patients. So I have seen teams get together - nurses, allied health professionals, physicians - get together to actually give the best care that patients would be able to get in this situation. Very caring patients sending us notes, thanking us for being there for them, even if it's remotely. And I've had messages from patients who are just so kind - "be careful, Dr. Mizdrak. Be safe" - just the kindest things that have been written that I won't get into but just really touching. But I also think there's challenges that we faced because of fear. And I mean, I work in a hospital and so I have the privilege of working in a hospital and I think that it's difficult in these times because the guidelines for how to treat COVID, the guidelines for how to test, keep changing and you have to be really on top of all this. But what I fundamentally believe after all of this is that grassroots physician - frontline physicians, nurses, staff, admin, allied health - those are the people who've actually moved the needle in the hospitals more than anybody else, in my opinion. When it comes to PPE, when it comes to appropriate contact tracing, when it comes to appropriate systems, overviews of how we deal with COVID in the hospital. In the end, if we don't have any physician or nurse or allied health deaths, it's actually because of the grassroots pushing the leadership to do the right thing. And that's something that I am proud of, but yet I'm also disappointed because I think leadership should take a bigger role in that - in protecting its staff.

Dr. Rezmovitz:

I don't think I could agree with you more. I'm part of a grassroots organization right now - conquercovid19.ca. We've been trying to bridge the gap between what leadership is bringing to frontline healthcare workers. And I have to tell you there was a huge gap in working at a hospital and working in the community.

Dr. Mizdrak:

I agree.

Dr. Rezmovitz:

I've been privileged to be on certain phone calls as some of my roles have changed over the last six weeks. And I have to tell you that the strategy for Ontario for providing PPE to acute care hospitals, to longterm care facilities, and to retirement residents leave community providers out in the cold. And I'm not talking about just family doctors, I'm talking about OMA members that practice in the community - so you've got pediatricians, specialists like rheumatologists, ophthalmologists, family doctors, you've got home care - you know, the unsung heroes of our healthcare system are the nurses and the PSWs that support our patients.

Dr. Mizdrak:

Yes they are. And they should get that credit 100%. Jeremy, do you know what? I think you need to be part of the OMA. I feel that you're a good advocate for us and I think you need to join the OMA and get on a district delegate role or something like that.

Dr. Rezmovitz:

I've heard that the initiation is pretty scary. So I've been afraid of going in.

Dr. Mizdrak:

No, no, no. Those are all stories and fairytales. It's fake news.

Dr. Rezmovitz:

We can talk about that later. My point is that when I ask the question, "how is the community going to be serviced to our leaders?" And their answer is, "well, we're going to put everybody, I'm in contact with you, Jeremy and conquercovid19." That is not a good strategy. That is not a government strategy - using a grassroots organization to bridge community workers to support them. Where is the leadership from our government to support the workers down the line in the community so that hospitals aren't overrun? So that longterm care facilities don't have these outbreaks? We need to figure out how to get the have-nots supplies. 'Cause that's what it feels like - a two tier system right now. And I recognize that acute care hospitals, their burn rates are way higher. I recognize there are outbreaks in the longterm care facilities. I recognize that there are - I work at a retirement residence and there was an outbreak where I work and I'll tell you the biggest problem at the retirement residence - and again this is probably true at all longterm care facilities - is that when you go on outbreak with even one patient, the whole place gets locked down. And so I had to have conversations with two residents who happened to be over the age of 90 who want to commit suicide. These are the things that I spend time on now, right? As a fallout from COVID-19 because they're isolated. It's a torture technique. And so my question to you is, you work in a hospital and you have PPE and you have a role right now, but the problem is you're probably still getting paid. Whereas the people in the community, what are we going to do as a physician member on the negotiating team, what do we do with situations where we are not getting paid as community doctors who work in fee for service models or blended models for for three months. We're not getting paid for three months. I've never heard of anything so ridiculous. If we were to tell the government, "Oh, by the way, we can't program your automatic payments for three months. It's okay. Keep working." Well, what would they say?

Dr. Mizdrak:

Well, so you bring up our negotiations for phase one, two and three of the pandemic, and it's actually a really tough question - what you ask - because that's the reality. And these are the conversations that we have had with government actually as the OMA negotiating team. And I think that there is no easy way out for fee for service physicians. There are some physicians like myself - to be fair, I am a full physician so I am protected in a sense - and I feel very, very upset for the fee for service positions, not just in family practice but all specialties who actually will be getting their money way later than they should. And the issue is, is that volumes are down. We've been asked to close our clinics. Actually, we've been asked to keep our clinics open, but we can't see as many patients and we don't have enough PPE and we're not going to get paid 'til June for the work that we've done. So it's honestly - it's not acceptable. And these are the points that we've made to the government very, very loudly as the OMA negotiating team.

Dr. Rezmovitz:

So can you discuss more phase one, phase two and phase three of the pandemic? What you alluded to earlier?

Dr. Mizdrak:

So phase one - as you all would probably know through your OMA updates - was the initiation of K-codes for virtual visits. So the idea was if patients couldn't come in and yet - unless they have - sorry, unless they had to come in. If you could do a lot of your visits virtually, you could bill those K-codes. So they would be K080, K081, K082 for family physicians, and K083 for specialists. What this meant is that they would be equivalent to your assessments - your basic assessments in office. You could bill these and get paid. Now the issue with that is that when we negotiated this, this was something that we believed on the other side would be programmable into their system very quickly. But unfortunately we found out through the media that those codes were not programmable until May. So that would leave physicians not being able to bill those on the OHIP system until May for work done in March. And as you may all know, usually you're about a month behind in terms of billings, in terms of the way the billing cycle works. So that's phase one. Phase two, we started negotiating very early on in the pandemic. And this is for surge payments to physician. And what I mean by that is not actually payments to physicians, but understanding that if there was a surge in COVID in the hospitals, we would have to mobilize and reallocate people's work and deploy them to other aspects of the hospital that they may not actually normally work in. And what we realized is the schedule of benefits could not actually pay for those services that would be needed because of many OHIP rules. So phase two was really, really focused on how do you pay acute care for patients in hospital. We've got a lot of feedback that that wasn't fair and left community physicians out, and I completely understood that feedback. The one point I'd like to say is that in phase two, there was also discussion about the ability to go onto phase three, which would deal with income stabilization for all physicians in Ontario. And the government was very clear that they were not ready to speak about income stabilization and phase two. They wanted some commitment. They wanted some codes with us as they're [inaudible] they wanted to make sure that we had codes to deal with the surge for acute care because that's what was coming. So phase three is where we are right now as we're doing this podcast. And I'm not really at liberty to tell you what's going on behind closed doors yet, but perhaps when this podcast comes out, you may know what happens.

Dr. Rezmovitz:

Yeah, I mean you can tell us if you want, we just won't put it in the podcast. We can edit it out. We can -

Dr. Mizdrak:

Sorry, I can't do that. I have an NDA and I am a vault.

Dr. Rezmovitz:

I know. I know you can't do that. It's unfair for me to even suggest those things.

Dr. Mizdrak:

I know you were joking and just remember it's the type of person I am. I have a lot of integrity in the work I do. I take this very seriously and this is why a lot of some of the comments I may have may reflect that something I've learned during this whole process is how much I love to do what I do, but how important it is not to take things personally that people say. So I feel that our negotiating task force has really put a lot of weight into this and there has been a lot of vitriol. There's been a lot of awful comments about us personally, about our integrity, about what we do in our lives in terms of how we can't represent all physicians. And I would like to just say that although I am an academic physician - I have worked in fee for service ,I've worked in a fig[?], I've worked in a salary model. I feel that regardless of that, my job is to represent all physicians. It's not my self interest. And I really take that seriously. So I just - for whoever's listening, I want them to know that I just want to do my job and I want to do well by all physicians in Ontario. It is not just about me as a family doctor, it is about all the colleagues that I represent. All my hospital colleagues, all my community colleagues, and I really take this job seriously and I don't take it lightly.

Dr. Rezmovitz:

Is there any way that you could expand on the structure or the process by which the negotiating team works? Like I would tell you, I don't know - when you say you're on the negotiating team - who's on a negotiating team? Who do you actually negotiate with and how does that process go? Because it's unfair for me to ask you questions like, "so who's badmouthing us?" I'm not gonna ask that question, obviously. I'm going to ask - I think it would do a huge service to all OMA members to understand the process of what you actually do so that we can get behind our negotiating team to help support this. Because I think a lot of the comments that I've heard, I don't think they're born in knowledge. I feel like sometimes there's a little bit of an ignorance or an uncertainty and so can you help me?

Dr. Mizdrak:

Maybe - you know what I could do. Maybe what would help this discussion is for me to go a little bit back in time. I think it would be good for you to know why I decided to get involved in the OMA and then I could kind of explain to you a little bit of the background and the history and how we do this and it might be more enlightening for listeners. What do you think about that?

Dr. Rezmovitz:

I say go for it.

Dr. Mizdrak:

Okay. So I - when I first started medicine, all I wanted to do was I wanted to teach. I wanted to teach and I wanted to survive having a family - basically three small kids with a wonderful husband. We were very social. We had tons of hobbies. I never thought of medical politics whatsoever. But one day in 2015. A woman by the name of Dr. Silvana Bolano in Ottawa, she's a GI specialist, started a Facebook group. It was a Facebook group saying pretty much what is going on here? The government is instituting clawbacks to our fees. And I remember thinking, "huh, what on earth is going on?" How are we getting clawed back money for work that we've done. So I've always been very financially comfortable in terms of billing and I've been our finance chair at our department for our family practice associates for over a decade. And I had a resident at the same time - an old resident - contact me and asked me to lunch. And at this lunch she said, "Nick, the OMA needs you. I think you'd be the perfect voice for physicians at this time." And I thought, "you know what? Why not? I love conflict. I think conflict is generative. I think that I can help. I don't think what's going on with the government and the OMA is right. Right now, I have a voice. I want to do something." So fast forward I got elected as a district 11 delegate and I started my role at the - or my career in the OMA - at that point. Something very small representing my district and zone downtown Toronto. So fast forward to kind of 2015, 2016 - end of 2015, 2016 - we have a failed TPSA - do you remember that Jeremy?

Dr. Rezmovitz:

Is that the contract?

Dr. Mizdrak:

Yes. The contract that no one liked. And there was an overthrowing of the board? If you recall?

Dr. Rezmovitz:

[inaudible] the Facebook group that you were invited to was Concerned Ontario Doctors.

Dr. Mizdrak:

At the time, that's what it was called. And the board had changed at that time for a variety of reasons. But basically there was a huge community and grassroots voice out there saying, "this is not okay, this is not the organization we want." And a lot of changes were made. So at that point, I obviously know, that I feel very comfortable speaking my mind. And after the failed TPSA, a new negotiations team was called for. So applications went out and I had absolutely no interest in doing that. I thought I was too young in my practice. I thought I didn't know enough about negotiations. I had taken a years long kind of leadership course at Rotman, but I thought, "you know, I don't know enough yet. I'm not sure if I'm the right person," but I got a phone call from a friend who's a very good negotiator. And after that phone call I thought to myself, "Hmm, maybe I should apply." So I think that what really got me to apply was actually my husband. When I told my husband about this phone call, I'll never forget it. He just said, "for sure. You have to do it. You were actually made for this type of work. There's no question." And so I applied. And I guess the rest is history. I've been on the negotiating committee as a physician member since 2017. What we've done since this time is we've negotiated a binding arbitration agreement and we've negotiated the PSA from 2017 to 2021 which ended with an arbitration - with the Kaplan board. And if you recall, there was an arbitration decision that the OMA has put out to all its members and from that came an appropriate working group as well as other things in the arbitration award. I won't get into all those details, but how we negotiate as a team is we have five physicians from the OMA, you typically have two family physicians, two specialists, and one other person who can be either group. You've got two labor lawyers, Mr. Howard Goldblatt and Mr. Steven Barrett, who are amazing, amazing labor lawyers who I can't say enough about. And we have remarkable OMA staff, including Catherine Dowdell and many, many other people who actually support us as a team. So when a team first meets, we get a lot of education, right Jeremy? Remember how I said I don't know how to negotiate. So we had some Rotman teaching. We have a lot of teaching on the history of negotiations and where the OMA has been, where it's going, et cetera, et cetera. And from there you also then get a mandate from your board in terms of what they want you to negotiate. From there, you also meet with all the sections of the OMA to see what their priorities are as well. So with that in mind, you meet with the government and what I mean by the government is you don't meet with Christine Elliot or Ford, you meet with their representatives. You meet with their lawyers, their physician representatives and all their staff across the table. And how this goes is you have proposals that you kind of go back and forth on. And the art of negotiation is understanding how you can get your interest to actually collide, right? And so it's a very interesting song and dance. And I would say that we are so fortunate at the OMA to have the lawyers that we have because they are Bulldogs. They really, really are. I can't say enough about them. I also think the Ministry, again, I know they're on the opposite side, but something I've learned through this process is they are good people. They're good people. They have a job to do. And sometimes we may not agree with what they say, but they also are very, very tenacious in keeping their mandate and their interests and the people that give them their marching orders may not be in the room. They're actually never in the room with us to understand some of the discussions we have. So those are some of the nuances of negotiating with the government.

Dr. Rezmovitz:

I'd really like to take that course in the hopes that one day I can negotiate with my children.

Dr. Mizdrak:

You know what, I found this negotiating help a lot, but I still can't do it with my children.

Dr. Rezmovitz:

Yeah.

Dr. Mizdrak:

Another little point -just to clarify too. Right now as I sit here with you and I talk to you about phase one, two and three, I also have had the wonderful opportunity of being chosen to be on the next negotiating team, which is called the negotiating task force. And so that is negotiations from 2021 to 25 in terms of the PSA. So because of the COVID-19 crisis right now, we were looped in to negotiate the phase one, two and three just so you understand the background on that as well.

Dr. Rezmovitz:

Yeah, so I think it's remarkable the work that you're doing, which honestly, I don't think a lot of the OMA members realize happens. I don't think they understand the process. I don't think they understand the governance structure and I don't think they understand that this is a continual battle and it's not a battle per se like we're up against the government. I think it's exactly what you said. We need to find a way to work within the government's mission to help support the patients that we have.

Dr. Mizdrak:

Absolutely. I mean, I think this all of this work that I've done and with the amazing people that I work with, it's really opened my eyes to a lot of the realities of the healthcare system and how decisions are made. I think we're very stretched thin in Ontario, but I just want to also make clear though - I am an absolute supporter of universal healthcare, but I do feel that there needs to be some upgrades to modernize it and to make some tweaks. And I think that there is a divide still within the Ministry, even within our own physician groups about workload, pay, relativity, and the value in the schedule of benefits or how we value each other versus a family doctor, a specialist, a radiologist, a rheumatologist. And I think that it's a really important sometimes to not believe that you think that you know what someone else does in their job. And that's something that's very interesting to me at the table when I hear the Ministry or the OMA talk about what physicians actually do.

Dr. Rezmovitz:

Yeah. It's really difficult. A lot of it has to do, I think with semantics. A lot of it has to do with culture and grandfathering in certain terms that haven't propelled the inclusivity. We work at the University of Toronto - there's an inclusivity mandate, but I have to tell you, I don't know if the OMA, and the culture that surrounds the OMA - like just regular life - really understands that inclusivity because I would argue that family physicians are specialists in generalism and yet we're still grouped into the - well family physicians and specialists, right? Like there's - and I don't know if that's because of the colleges - you've got a Royal College and you've got the College of Family Physicians of Canada. I don't know if it's a cultural issue of just grandfathering into GP. I don't know how many times I've been called "just a family doctor." You're a JAFD - you're just a family doctor versus, "Oh, you're a specialist." You know, it's got the term special in it. Maybe we should create a special designation for family doctors. You know, the SFP. I'm a special family doctor. You're a special family doctor, as we all are, just so that we can raise the bar on -

Dr. Mizdrak:

It's an interesting comment you make because I've had that comment as well, but I'll tell you something. For as many times as I've heard, "you're just a family doctor," my experience is opposite to yours. I would say that the vast majority of specialists that I've worked with don't just call me a family doctor. I have had numerous specialists tell me, "you know what, Nick, I don't know what to do with this patient. I have a specific specialty. I have a specific amount of knowledge. This is outside my scope. I need your help." And I've also been told by many specialists that they really value the work I do with the patients because of the holistic approach that we use as family physicians. So I would say that those semantics, and I think those sentiments that we are only family doctors, we're only referral-ogists to the specialist is actually waning because that's not my experience at the OMA. It's not my experience in the hospital. It's not my experience with the vast array of specialists that I deal with. I actually feel that some of them actually - it sounds crazy - put me on a pedestal for what I do because many of them have said, "Nick, I don't know if I could do what you do. I couldn't manage all that. Thank you so much." And so I would say I think the times are changing, Jeremy. I really do.

Dr. Rezmovitz:

I hope so. I was referring more from the public than within our own a physician group.

Dr. Mizdrak:

I see.

Dr. Rezmovitz:

As how we're being viewed. but from a standpoint of how we're being viewed within our own group, I would argue that there are I guess fees within the schedule of benefit that would probably need to come up to date to equalize the work that's being done all around for all patients in Ontario.

Dr. Mizdrak:

Well, let's be clear. The schedule of benefits is out of date. It is not representative of the work we do and the biggest example of this, Jeremy, is so clear now with COVID. If you see a patient in person, you can bill an A007. Before COVID and the K-code, you would not get paid for that visit. So that's just a simple example - I used family medicine codes, but it also applies to the specialists. That's ludicrous in this day and age of virtual care that the schedule of benefits doesn't have that. But I also know the background as to why it hasn't changed and why it takes so long. And it has to do with the fact that the OMA and the Ministry have not had great relationships for years. And I think for that schedule of benefits to change and for us to make a difference, we need to build those bridges with the Ministry. We need to have those good and really important discussions about what do we value in the schedule of benefits. And if - so if we value something, how do we pay for it?

Dr. Rezmovitz:

I agree. Completely agree. So my last question for you today is, what do you think is going to happen to these K-codes after COVID-19? Because if you speak - and I'm just going to speak on behalf of family doctors, because that's all I can speak to and the friends that I've been talking to - although I've got friends in pretty much every area of medicine - I'm going to speak about family doctors and tell you that a lot of family doctors are really enjoying the efficiency and the - that's coming out of phone calls and video calls. And it's not just an efficiency, I'm not talking about like we can get this done faster. It's that not every visit needs to come into the clinic. It's that you've got - taking into account accessibility. So patients have been able to access me way easier if they have mobility issues, if they have distance issues, if they have logistical issues. It's a phone call and it's a - or a virtual visit by video that allows us to care for our patients and value work that's being done. And so do you think - this is the prognosticator question - do you think it's going to continue after COVID-19?

Dr. Mizdrak:

So for now these codes are not permanent, but I think that I can't answer your question with any certainty. I can answer you with my own personal thoughts is that I think that this pandemic will have to change the way we deliver care on many fronts. And if it does, then we're going to have to negotiate for virtual codes at some point. So I think that you bring up an excellent point and I think things will change. I just don't know exactly the trajectory of how it's going to change.

Dr. Rezmovitz:

Well, I have to be upfront with you as I always am and let you know that I feel confident having you on our negotiating team. And my wish is that we could somehow keep these K-codes for telephone and video visits because my patients love it. They absolutely love it.

Dr. Mizdrak:

Yeah, I agree. I totally agree. Now Jeremy, may I take a little bit of leeway and just make a couple of other comments that I really want to mention? Would that be okay with you?

Dr. Rezmovitz:

Yeah, of course.

Dr. Mizdrak:

So I want to say something that's really important to me during this whole time - something is gratitude and I think that that's what keeps me grounded with the people around me and what I'm seeing in the hospitals and what I see in society with COVID. But I think that something that's really important for me to say is that I think a lot of the good work that I can do, and a lot of the good work that you do is honestly because we have a network. I feel like the only way I could do this work is if I had a cheerleading squad. It's a bottom - a cheerleading squad that's holding me up from the bottom. So that includes my family, my husband, my kids, my amazing colleagues at the Western, my amazing OMA colleagues, my chiefs. And I want to make sure that if someone's listening to this, that they don't get the impression that I'm this awful narcissist who thinks I'm so wonderful. I love what I do, but I could not do this without my home. The support at home or the support I have from my colleagues. There's no way that I could do it without them. And I think during these negotiations, I would say that my family and colleagues have stepped up to help me more than I can ever tell you. And so I want to thank them. I really wanna thank them. I wanna thank my husband in particular, my kids, my family and my amazing colleagues and friends and especially some of my colleagues at the Toronto Western. I know you know some of them - Dr. Diana Toubassi, Dr. Sarah Reid, Dr. Sarah Fleming and Dr. Azi Moaveni are just among the few - I couldn't do this work without them. They bring me up and I think that's really important, and whatever I do and whatever success I could have, it's all on the shoulders of these amazing people that helped me.

Dr. Rezmovitz:

That's amazing. Thank you so much for sharing today and I'm sure our listeners will be enlightened with what you've offered them today. And for the record, I don't think you're not awful narcissist, but a wonderful narcissist. Just kidding. Just kidding.

Dr. Mizdrak:

Well, actually wait a second, Jeremy. One thing I did notice is at the end of all this is I think you had put out a Facebook post that you wanted to have drinks with whoever answered your Facebook post first. So I thought it would be very good if Dr. Diana Toubassi the introvert, you, the ambivert and me, the extrovert meet for a drink at the end of all this to discuss.

Dr. Rezmovitz:

I don't think we need to wait. We can have a drink next week when it's released. Looking forward to it.

Dr. Mizdrak:

Awesome. Me too. I can't wait.

Dr. Rezmovitz:

Thank you very much.

Dr. Mizdrak:

Thank you for having me.

Dr. Rezmovitz:

You're welcome. Have a great day.

Dr. Mizdrak:

You too.

Dr. Rezmovitz:

This podcast was made possible through the support of the Department of Family and Community Medicine at the University of Toronto. Special thanks to Allison Mullin, Brian Da Silva and the whole podcast committee. Thanks for tuning in. See you next time.