Social contract not honored

Issue: BCMJ, vol. 43, No. 6, July August 2001, Page 317 Editorials

Hospitals are not honoring the social contract between them and BC’s surgeons. As long as anyone can remember, it was understood that surgeons worked at a hospital and provided coverage of the emergency department 24 hours a day, 365 days a year. In return for this they were able to work at the hospital and were able to have elective OR time and access to emergency OR time for urgent and emergent patients.

This is no longer the case. Health care administrators and governments have bought into the mantra of health care economists who suggest that there are too many hospitals, too many operating rooms, and a lot of surgery that did not need to be done. Not only that, hospitals are using so called RAD days, or reduced activity days, to “fine tune the budget.” These RAD days amount to closing the operating rooms for a day to save money, resulting in long delays for surgery for thousands of patients with cancer and cancer equivalents, not to mention years of delay for the apparently unimportant people who only have pain when they walk or incontinence when they laugh or cough.

Patients are becoming increasingly ill and increasingly elderly. Hospital emergency departments are being closed. The amount of phone work and triage for surgeons has skyrocketed.

The average surgeon in this province now has less than 1 day per week of operating time. Patients who come through the emergency department are constantly delayed before they can get needed surgery and surgeons are having to work at ungodly hours to try to get these cases done. This has led to the kind of waiting lists seen in the United Kingdom, measured not in months but in years.

I find it amusing that the hospital administrators and the Ministry of Health would go to the College to say that these surgeons are unethical in threatening to not provide call whereas, in fact, it is the hospitals and these same medical administrators who unethically deny adequate surgical access to the critically ill patients of British Columbia.

There is no question in my mind that the surgeons of British Columbia have kept their part of the social contract. It has been understood for decades that the quid pro quo for coverage of the emergency department 24 hours per day, 365 days per year is that the hospital provide adequate access for urgent, emergent, and elective surgery.

Surgeons, by and large, train until they are about 32 years of age before they can work. I personally have provided what I feel to be yeoman vascular surgery service to the province of British Columbia for over 20 years. I now get to work less than 8 hours per week to do what I was trained for. It is a travesty that the people of British Columbia have no access to the services of highly trained surgeons because the government and hospital officials have allowed the system to fall apart.

Perhaps this new government of Gordon Campbell will understand that the surgeons are not refusing to do call because they want to play golf. The surgeons are refusing to provide a service for nothing. It is time for the hospital administrators and government to realize that they have allowed the system to fall apart and it is time for them to review their decisions and keep their end of the bargain.


Anthony J. Salvian, MD. Social contract not honored. BCMJ, Vol. 43, No. 6, July, August, 2001, Page(s) 317 - Editorials.

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