Do you know enough about the new BC health care agreement with doctors?

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Having read the agreement last night I have just completed the survey. My summary is as follows:
 

While GPs seem to have done better than others, the agreement is potentially divisive. I'm deeply concerned that the government is trying to supplant knowledgeable and skilled doctors with practitioners with less comprehensive training and experience. I also think it's silly to agree to limit our ability to take on the government by means of the threat of withdrawal of services. We didn't get enough back anyway in return for that concession. The PMA gives government (non-physicians) increasing control over how we practice; such regulation should only be in the hands of the COPS - College of Physicians and Surgeons.

I haven't made my mind up yet but will probably vote against the agreement. Meanwhile I'll watch discussions on the listserve.

Why would any of us withdraw services within the life of a contract to which we had agreed, if -- during the time that contract --its terms are being honoured? The surrender of which you speak is not in force once the government would be in breach of contract. The only caveat would be the need to at least have first attempted the dispute resolution procedures.

With consent of the author from the doclounge list serv. - Admin

From: Dr. Brian Day

My position on this was portrayed in an Op-Ed in the Medical Post that was published earlier this year (extract below). Physicians are effectively government employees who lack the protection and benefits that other government workers enjoy.

The British Columbia auditor general recently issued a report that questioned the “cost-effectiveness” of physicians in the health system. His simplistic, impractical recommendations are reminiscent of other government bureaucrats, who look upon doctors as conscripted civil servants rather than professionals. As Canadian Medical Association president in 2007, I wrote to all auditors general in Canada asking them why our health system (responsible for more than 40% of most provincial budgets) is rated last in value for money when compared with 29 European countries. The responders replied they did not have the resources to study the issue.

Physician surveys reveal that about 75% favour a payment scheme that is not pure fee for service.

Many would embrace a 35- to 40-hour week with benefits, overtime and holiday pay, sick and educational leave, sabbaticals and pensions similar to those that civil servants with similar educational levels receive. The reality is that governments prefer the sweatshop (a term from the English Industrial Revolution) approach, relying on piecework to deliver low-cost products or services to consumers, while placing heavy demands on workers who provide cheap, efficient labour to the employer.

In the non-medical world, markets influence value and worth. Lawyers will pay doctors far more for describing surgery than government pays for performing it. A Vancouver realtor sold three houses last week, earning $450,000. The fee for a weekend visit by a plumber to inspect a copper pipe is double that of a urologist to inspect a urethral pipe. A British professional soccer player just negotiated a salary of $500,000 a week. I previously operated on his teammate, who recognized (as did his agent and team) the value of a successful outcome.

Rewarding excellence

It is true that one cannot easily put a price on saving a life, or restoring the ability to walk or read, but governments have gone too far, and are harming patients, by eliminating virtually all rewards for excellence, expertise, efficiency and productivity.

We have allowed paternalistic control by government. Our office expenses depend on the free market, but in generating revenue we are conscripted workers. In accepting educational grants, malpractice premium supplements and retirement funding, we succumb to that state and give up flexibility in managing our own resources.

In 1944, when the average British Columbia worker made 91 cents per hour, an orthopedic surgeon’s fee for treating osteomyelitis was $300. Based on inflation, the equivalent fee today would be $6,150 (current fee is $183). The cost of a Vancouver detached house then was about $4,000; today it varies from $900,000 to $2 million. In 1981, the arthroscopic meniscectomy fee in B.C. was $294. Based on inflation it would now be $771 (current fee is $280).

My examples are from orthopedics, but similarities exist in other specialties and explain why young doctors lag behind their predecessors in their ability to pay off debts or purchase a home. Canadian Institute for Health Information figures reveal that doctors’ gross revenues (before overhead and staff) represent 15% of total health expenditures in Canada. In 1987 the figure was 15.7%. It is mathematically and historically wrong to blame doctors’ remuneration for rising costs.

Governments know that our current system is unsustainable. We must consider an alternative to the “cap in hand” approach to negotiating with governments that blame us for their ineptitude in managing the health system. The introduction of competition and market forces will force governments to engage in long-term, rather than three- to four-year planning.

 

Thanks again Brian.

A few hours ago I cast my ballot to reject the recommendation. I don't expect it to make the slightest difference to the outcome, which will be a large majority in favour. However I felt that it was important to let the Board know that not everyone is deliriously happy with this PMA. From a purely pecuniary perspective I will likely benefit in the short term: but is it good for the profession as a whole? Is it good for our patients? I believe not.

The practice - the art and the science - of medicine has deteriorated over the past 30 to 50 years. It has become formulaic. The management of people and their medical problems has been reduced to following algorithms, with no room for adaptation to the differences, subtle or otherwise, between individuals, cultures and even races. We have allowed it to become mechanical and thus dehumanized and dehumanizing.

We have abandoned the injunction of Harvey Cushing:
 

“A physician is obligated to consider more than a diseased organ, more even than the whole man – he must view the man in his world.”  

This PMA will limit our ability to do this.