I must admit I was fooled. I actually thought this government understood how important it was going to be to make peace with BC’s doctors. The realization that Canada’s doctors were leaving, retiring, and dying in record numbers (David Baxter’s demographics doomsday lectures have been describing this scenario for the past decade) seems to be shared by just about every Canadian province, other than BC. Most of this country’s health ministers seem to have finally figured out that if you want doctors to stay and/or keep working, you have to reward them with an income that allows for a reasonable lifestyle. We all know the BC government is presently hooped economically, and is trying to hang on and wait for the world economy to start percolating again. It is also crystal-clear that they are trying to be fiscally prudent and use good business principles in their decision-making, but this is one dispute that has the potential to be far uglier than they imagine. There is an enormous undercurrent of anger, mistrust, acrimony, and revolt in BC’s medical professionals after many years of battling with various governments, and if Victoria thinks the doctors will roll over on this one, they had better get some new advisers.
Because I basically operate from a position of political paranoia (as virtually all doctors do) I began to wonder why this government would go out of its way to antagonize a group that had started out so firmly on their side. They have really done nothing to address either BC’s short-term or long-term physician shortages. There has been the promise of an increase in the supply of physicians, but this has taken the form of an announcement that there will be a few more positions in the medical school, numbers that will not have any substantive impact on the crunch expected in about 8 to 10 years. The promised money for increased nursing training seems lost somewhere between Victoria and the phrase “pie-in-the-sky,” and hospitals have been forced to reduce services even further—including laying off nurses because no funding has been provided to hospitals to pay for their nurses’ salary increases. Interestingly, a doctor quoted recently in one of Vancouver’s papers said that unless there was a renewed effort on the part of the provincial government to live up to the spirit of Justice McEachern’s arbitration award, he expected large numbers of specialists and anesthetists to leave in the next year, which would almost certainly force the closure of his moderately large general hospital in BC’s interior. I know this current group of politicians are not stupid, they haven’t been in power long enough to become arrogant, and they seem to have a pretty good grasp of how important health care is to the people who will vote in the next election. So there has to be something else going on here that has political import and that requires a decision that is currently too politically hot to handle. My guess is, the people in power want someone else (BC’s doctors) to be the bad guys and force them to make some politically unappealing decisions. In other words, if we kick up enough of a fuss, withdraw services, threaten to leave or retire and generally create a sense of medical anarchy, Victoria will be forced to establish a system of partially privatized medical/surgical services (almost certainly already designed and ready to implement). I fully expect we will comply and do what they expect us to do fairly quickly. As a result of the government being forced to act to save medicare, I also suspect that as a result of the introduction of this new “plan” for the provision and funding of medical services, significant efficiencies will be found in their new system, providing more funding for the training of health professionals in the next decade.
The next 6 months will be interesting to see how everything plays out here in BC, but it will be even more interesting to see what our publicly funded medicare system will look like countrywide in the next few years as the “big four” (BC, Alberta, Ontario, and Quebec) head down the road of partial privatization.
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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