The outdated Ontario Schedule of Benefits (SOB) was last published in 1992.  Regardless of new surgical  procedures being performed at the time, there was no sign of an updated SOB by the mid 1990s to reflect new codes.

Faced with a severe economic recession and a ballooning provincial deficit, the Ontario NDP government (Rae Days) enacted aggressive austerity measures that targeted health care spending. The impacts on Ontario physicians were historic, resulting in reduced income autonomy, structural workforce shifts, and long-term changes to how doctors were represented. In 1993, the government unilaterally imposed a global cap on the pool of funds allocated for physician fee-for-service billings. If total provincial billings exceeded this predetermined budget, individual physician fees were clawed back or reduced. In 1993, the government passed the Social Contract Act, which overrode existing collective agreements across the public sector to force $2 billion in spending cuts, wage freezes, capped enrollment, doctor shortage.

The 1995 Ontario government omnibus bill refers to Bill 26, officially known as the Savings and Restructuring Act, 1996, introduced by Premier Mike Harris's Progressive Conservative government as a core piece of their "Common Sense Revolution" platform. Critics compared the sweeping, aggressive health care reforms to the federal War Measures Act to sound the alarm on the unprecedented, dictatorial powers the provincial bill granted to the Cabinet. Hospital closures, amalgamations and LHINs ensued.

OMA, Section/District reps and tariff reps were under non disclosure agreements when negotiating with the OMA and Ministry. So, Ontario Section Chair on General Surgery Dr. Ciaran Kealy together with a few close colleagues discuss the idea of an independant organized interest group.

Ontario Section Chair on General Surgery Dr. Ciaran Kealy chairs the usualy Annual Meeting for members of the OMA Section on General Surgery.  It's unanimous, a motion is carried to form a new organization.  It is intended to be called the Ontario Association of General Surgeons with the mission to be the voice of general surgeons in Ontario, with the freedom to lobby their interests without the restrictions of belonging to the OMA.

With the help of a few key general surgeons and their wives, the first informal meeting has been called to organize the Ontario Association of General Surgeons on Nov.5, 1995 at the Toronto Prince Hotel.  The first dues are collected from members, which will help fund the registration as a formal non-profit organization.

The first issue of The Cutting Edge newsletter is published by the new OAGS President Dr. Ciaran Kealy and his daughter, Maureen, out of his home.  This publication will soon become the cornerstone of communications with its membership for decades to come.

The OAGS hires an executive assistant and shares office space on Richmond St. W, Toronto. A phone, computer and fax machine are purchased. The first of many mailouts and faxed communications begin with a survey to 435 Ontario General Surgeons.

Fourteen board members have been appointed to represent general surgeons in each Ontario district: Drs. Ciaran Kealy (President), Chester Pitter (Vice President), Joseph Margolian (Secretary), Garry Fisher (Treasurer), Philip Barron, Leo Chaikof, Suru Chande, James Forrest, Jack Long, Dennis Pitt, Gary Rosenthal, John Rowsom, Stephen Silverberg, Barry Stanley.

The first quarterly board meeting takes place at the OMA headquarters in Toronto.  The OMA Section executive and OAGS Directors coordinate efforts and work together to prepare strategy for the spring marathon meetings with the OMA Central Tariff Committee.  Results from the survey are in with a successful high rate of return.

Letters Patent - As of April 26, 1996, the application for incorporation as a registered non-profit organization has been approved by the Ontario Ministry of Consumer and Commerical Relations.

The Ministry threatened the introduction of specialty-specific caps, the lowest of which would be placed upon General Surgery and Neurosurgery in the cutting specialties.  In response, three specialties were considering sanctions on any new referrals.  OAGS also discussed Job Action and opting out of OHIP.  Ultimately, OAGS members passed 2 motions for job action: 1) No new referrals to be seen in the office as of September 1, 2026, 2) Members to change their CMPA coverage from operative to non-operative status, which could've brought general surgery to a halt.  Instead, OAGS joined forces with the Specialist Coalition and began job action on November 8, 2026 and lasted 5 weeks!  This proved successful, as Premier Harris soon stepped in and pushed to expedite negotiations for  an amicable resolution. 

An interim agreement was passed January 11, 2027, but the OMA and MOH finally ratified a 3-yr agreement on May 14, 1997. Highlights:

• General Surgery votes 91.44% in favour (total vote is 87.73% in favour)
• total increase of 4.5% to the base FFS pool over 3 yrs in compounding amts of 1.5%
• OMA now has right to represent physicians in negotiations with gov't
• clawbacks will be abolished after 1998
• RBRVS - full resource-based relative value schedule commission to be set up and schedule produced by 1998
• thresholds - certain specialties still singled out for exemptions, at the disadvantage of other specialties like General Surgery

The Toronto Star published a series of articles quoting miscoded bile duct injuries. They referred to slashed common bile ducts and picked out 21 hospital with unacceptable rates of injury.  OAGS in collaboration with OMA undertook a campaign to contact all 21 institutions and reviewed their medical record data.  They found that there was no code for an injured common bile duct.  Incidents such as perforation of the gall bladder being removed through a lap port or damaged by a grasper were given the weighting as injured common bile ducts.  OAGS President Dr. Ciaran Kealy accused the paper of attacking hospitals and defaming general surgeon reputations.  OAGS lobbied for accountability and retribution.  Subsequently, the paper offered to audit the data, which disproved their allegations and relented with a retraction and an apology in 1998.  Victory!

With new OAGS President Dr. Philip Barron at the helm, we entered the era of relativity.  General Surgery played an important role in the initiation of the Resource Based Relative Value Schedule (RBRVS).  The methodology debate was contentious.  The Commission opted for the objective method with the rider that all specialties can add, with some limitations, what they have referred to as a global adjustment to the final RVU figure.  The pilot project included 4 specialties: general surgery, pediatrics, internal medicine and radiology.  A lot of time and effort was spent by the OAGS board at this time. The RBRVS report and process appeared to be fair and balanced and off to a good start.

Hospital restructuring and closures were also the priority of the Harris gov't at this time as well.

OAGS appoints its first ever Resident Representative to report to the OAGS board of directors.  

Almost a new millennium and Ontario doctors were still under the burden of unpaid call.  After a massive undertaking strategy of surveying its members and following up with one-to-one cold calls to members across the province, OAGS began to campaign for remuneration.  Members want a retainer plus fee-for-service.  OAGS subsequently passed a motion for an On-Call Position Statement to "endorse a maximum on-call of 1-in-5 weekdays and 1 weekend per month", with the hope that it will provide guidance and protection for general surgeons negotiating hospital on-call services throughout the province. Further to this, job action was discussed again but has its detractors.

OAGS works with other organizations and surgical bodies.  One such example is the government's new Cancer Care Ontario Oncology Network.  CMPA premium crisis also looms.

Paid call becomes a major negotiating pressure tactic for the next OMA/MOH agreement.  The new agreement finally recognizes that physicians can no longer be expected to provide on-call services without remuneration.  Since the newly agreed upon remuneration is decidedly inadequate, docs have been assured that MDs can still negotiate with their hospital admins for additional funding.   To derive an improved compensation formula, a new Hospital On-call Coverage Committee (HOCC) is created.  Since our Tariff Chair Dr. Jim Forrest had already spearheaded this endeavor, he is appointed to the committee to represent OAGS/Section on General Surgery.  On-call remuneration finally begins September 1st, 2000.  Bravo!

OAGS defends its community surgeons against an ICES article published in the CMAJ.  In it, the gov't, UofT and Sunnybrook allege that there are 53% better survival rate for women with early stage breast cancer who are treated at teaching centres than community hospitals, based on antiquated data.  

In the same year, OAGS advocates in favour of Alternate Payment Plans (APP) for its remote members such as $500 per diem weekdays and $1000 per diem wkd days.

OAGS and General Surgery together with all other sections outright rejects of the RBRVS draft report.  Although the relativity process seemed altruistic with the hope that general surgery might benefit, instead it offered a 2% decrease across the board.  OAGS pledges to lobby the OMA through the Central Tariff Committee and the Physician Services Committee for fair surgical fees and adequate on-call compensation. 

Dr. Angus Maciver succeeds Dr. Phil Barron as the new OAGS President. 

After months of networking, APPs finally become a reality in September 2003.  The contract requires the physician to bill OHIP and 90% will be remitted to the MD, while 10% will go to a hospital organization.  Remuneration negotiations continue.

OAGS performs a workforce survey 10 years in.  Average age of general surgeons was 51.  Youngest was 33yrs, eldest was 78yrs.  Consult waiting list increased for 64% in the last 2yrs.  Difficulty to arrange emergency surgery was difficult to extremely difficult for 39%.....

Longer wait times ensue in Ontario - academic and community.  Although cancer surgery is a priority, it should not interfere with other urgent and planned surgeries.  OAGS makes a position statement:  "that a general surgeon requires, at minimum, access to the OR two full days per week, which may include endoscopy time (7.5 hrs/day)."  

Dr. Jeff Kolbasnik succeeds Dr. Angus Maciver as OAGS President.  OAGS continues to lobby for improved relativity methodology.  It also endeavours to inform members of the importance of getting tested and disclosing any knowledge of blood borne pathogen (BBP) infection, yet it also defends its against penalizing general surgeons while overlooking other hospital OR staff.  Although there was increased gov't funding to hospitals through LHINs for additional general surgery procedures, it was learned most of this money was not spent or mismanaged;  OAGS lobbied these general surgery concerns to the Ministry. And the year ends with renowned Canadian NASA astronaut and surgeon Dr. Dave Williams as our Annual Meeting keynote speaker.

With a new President at the wheel, Dr. Chris Vinden and the OAGS unveil a modern new logo that better represents new era surgeons.  The image of the province of Ontario in the shape of a surgeon's hand holding a scalpel, in a blue colour historically associated with medicine.

Although the Ministry was exploring outpatient services in out of hospital facilities, it ended up revamping hospital funding and proceeded to move high volume procedures out of the hospitals, arguing it will help alleviate wait lists.   OAGS advocated issues relating to governance, accountability, access and quality.   

After serving 5 years on the board, Dr. Alice Wei becomes the first female President, succeeding Dr. Chris Vinden.

After almost 20 years, Dr. Harshad Telang of Thunder Bay is the first OAGS President representing Northern Ontario since the inaugural president.

OAGS board members discuss the organization's role going forward and decide upon a clarified and slightly revised mission statement, which the new website will be built upon for its membership: Advocacy. Education. Quality.

Being only the 2nd President representing Toronto in 25 years, Dr. Timothy Jackson leads the board into a new decade.  During his term, the OAGS helped to advocate important work by Ontario Surgical Quality Improvement Network (ON-SQIN) and NSQIP. 

Joining a partnership with MD Financial Management (later known as BNS Group with Scotiabank and CMA) garnered many benefits, one of which was the inaugural and popular OAGS Resident Research Grant Competition in 2020!

Covid descended in Ontario in March, 2020.  OAGS had to figure out how to pivot quickly with digital communications and virtual technology.  Instead of meeting at the OMA headquarters in Toronto 3 times a year, the board members came together on Zoom calls.  There was also a rush on to communicate the latest Ministry of Health protocols and policies to our members by the usual method of email but also moreso on social media.  As for the AGM, new OAGS President Dr. Tim Jackson and Education Program Committee Chair Dr. Jennifer Macmillan took a leap of faith and converted the OAGS Annual Meeting to a virtual event app platform.  Although out of our element, it was a highly attended success with the support of our members!  Unfortunately, sponsorship and membership were impacted.

Dr. Jackson was also an advisor to the Ontario gov't Pandemic Response Planning team re. approach to scaling elective surgeries at the time.

After 20 years since being our OAGS Resident Representative, Dr. Kevin Lefebvre takes the helm as OAGS President.

OAGS dons a new look with not only a new primary website but also a second event website.  We also have a wider presence online with several social media channels.

Hailing from North Bay, Dr. Ravinder Singh is only the 3rd President representing Northern Ontario.