On-call agreement

I’m as perplexed as I’m sure most of you are with the level of misinformation, angst, and acrimony surrounding the disbursement of funds provided by the on-call agreement between the BCMA and the BC Ministry of Health (MOH). 

It turns out that the actual planning to include this item in formal negotiations began more than 21/2 years ago. A subcommittee of the Tariff Committee was formed with full representation from the various economic stakeholders and, strangely enough, a proposal consensus was reached with a minimum of fuss. In essence, it was agreed that on-call should be paid to doctors providing on-call for institutions or for those health regions that require doctors to be on call for some of these larger, sparsely populated rural areas. This money was not to be made available to doctors who were providing on-call service to their own patients or for doctors working regular shifts in hospitals, such as hospitalists and ER docs. Eventually, this proposal was placed on the table by our negotiators and as we all know it was eventually accepted by government with a basic $20, $30, $40 hourly rate formula (days, evenings, nights). This would have been fine, except the MOH decided that a further graded payment schedule that included a “time to respond” modifier was necessary. This little item threw a large administrative monkey wrench into the fiscal management of the funds available to satisfy the retroactivity component of the agreement. The MOH then made a purely economic decision to provide an across-the-board payment of retroactive on-call funds with no attempt to audit any of the submitted requests. There have been some windfall situations as a result of this decision, which in turn has made more than a few of our colleagues question the sanity of both the BCMA and the MOH—when in fact the BCMA has had nothing to do with this decision.

I have had a number of on-call horror stories related to me in the past month by doctors working in a variety of disciplines. As we all know, there are many stories on both sides of our made-in-BC professional dichotomy, but it makes little fraternal sense for me to “case study” this to death and exaggerate an artificial, illogical, philosophical division between colleagues. More importantly, we all have to get our heads around the concept that there are going to be some growing pains for a system that is in its infancy. This thing is still going through the logistics sieve, and what shakes out at the bottom will, I hope, be a program that provides effective, efficient use of physician resources. Those of you providing on-call for hospitals or regions will finally be compensated for a providing a vitally important service to your communities, and the communities in turn will feel the health care needs of their residents are optimized. 

For all this to work, however, hospitals and regions must work with their local doctors to create a physician resource plan for their hospital or region that is reasonable, fiscally prudent, and safe. In other word, hospitals and regions have to decide what they need then go out and pay for it.

Finally, the need for this kind of plan to be very flexible from both operational and budgetary perspectives in order to be successful is obvious to all of us who toil in the trenches, but I have doubts that many bureaucrats would agree with a doctor’s definition of administrative wisdom. 


James A. Wilson, MD. On-call agreement. BCMJ, Vol. 45, No. 1, January, February, 2003, Page(s) 6 - Editorials.

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