Pinch me

How did I become so jaded and untrusting? I was recently sitting in a meeting discussing the possibility of our local GPs forming a division of family practice when I found myself wondering what the government’s real agenda was. 

On the surface the plan appeared simple. Once a division is formed there is a collaborative services committee consisting of representatives from the division, the Ministry of Health, and the health region. 

Problems are brought forward by all parties to the committee to be addressed in a collaborative fashion, with no decision being binding. There is money available to ad­dress some of these problems like patient attachment, rising medication costs, or other issues identified. 

Novel approaches could be brought forward and funded on local issues such as medical care for the homeless or mentally ill, for example. This “division” concept came out of information meetings the government had with GPs, and is trying to address, with the support of the General Practice Services Committee (GPSC), the idea of having a local unified family practice “voice” that can be heard. So why do I distrust this process? 

There is a saying that history repeats itself, so perhaps it is time for some reflection. When I was in medical school the government decided to limit billing numbers. The prevailing opinion was that physicians create an income for themselves, so if you limit billing numbers you will control costs. Therefore, upon graduation, if I wanted a billing number without restrictions, I would have to practise in an underserviced community somewhere other than the Lower Mainland. This approach was challenged legally and deemed unconstitutional. 

Next, I remember a negotiated contract where the doctors of BC were partially responsible for the global physician budget. The government decided early on in the fiscal year that the doctors were going to exceed this budget, so without consultation they started to prorate us and keep a percentage of our billings. They then seem­ed surprised when we decided not to work for free and took reduced activity days, closed our offices, and did something else.

This was followed by signing a contract with the government in which if an agreement could not be negotiated and accepted by both parties then the dispute would go to binding arbitration. Former Chief Justice Allan McEachern was appointed as the arbitrator and then after his decision came out on our side the government ignor­ed his recommendations. I guess the contract was only unilaterally binding.

I still recollect members of government making comments during the fee negotiation process like “Doctors are morally reprehensible and should take a long hard look in the mirror.” I would open my newspaper most mornings curious to see what an evil person I was on that particular day of the week.

To be fair, over the last few years things have been changing. Through the GPSC and its initiatives I have come to feel valued as a family doctor. This is a strange feeling and it is difficult to trust. For years I had been told that I was greedy, overpaid, and selfish. Deep down I believed that I work­ed hard and was actually good value for the money and time that had been invested in me. As more and more evidence mounts that patients attached to a family doctor cost less than unattached patients, I feel somewhat vindicated. 

Opportunities for education are being made available, incentives for good all-round care of chronic diseases have been established, and I am being paid better—pinch me.

So forgive me if the old feelings of distrust begin to percolate to the surface—they have been well earned. Perhaps the dinosaurs like me will have to die off before a more trusting relationship can be formed between physicians, the government, and health regions. Speaking of which, my health region recently changed, again without consultation, bylaws guiding specialist coverage requiring the BCMA to form a special committee. 

Damn, there I go again. 

David R. Richardson, MD. Pinch me. BCMJ, Vol. 52, No. 6, July, August, 2010, Page(s) 284 - Editorials.

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