Callback carnage

Canada’s past decade has seen important progress in physician pay for on-call availability. The journey in British Columbia has been fractious, with uneven gains between various groups. While the gains in the recently ratified BCMA Master Agreement are substantial for some members, unfortunately major inequities are entrenched for many isolated and rural practitioners.

At the root of the issue is the government’s MOCAP “callback” category that denies availability pay to physicians in call groups of less than three. Such physicians are put in the untenable position of either refusing to provide coverage (College bait), or providing the coverage without the tens of thousands in availability pay other BCMA members are receiving.

As we witnessed after the Prince George agreement, such extreme inequities can induce chaos into the delivery of care. Undoubtedly, many callback doctors will seek “deep cover” on principle; to deny the coverage that is not being funded. Other callback doctors will continue to put patient interests ahead of their own, but seethe with anger and resentment while doing so. All callback status physicians will face tremendous challenges with retention, recruitment, and locums.

I have spent the last 6 months imploring, even pleading, with the BCMA, the SSPS, and the BC College to be proactive and help avert the carnage. Each one acknowledges the proposed callback system is likely to prove inflammatory, however these organizations seem surprisingly content to watch from downtown Vancouver as the human toll unfolds across the province. Arguably, on-call pay gains have been largely won by the direct actions of the most isolated and rural physicians, and not the BCMA itself. How ironic that these isolated members, or their families, should now have to screen telephone calls, or blatantly lie to colleagues and friends to assert their hard-fought right for paid on-call availability.

So, if our leaders will not lead, once again it is up to the rank and file to act. Numerous actions are a certainty at individual and local levels. At the political level, the SSPS is particularly vulnerable on the callback issue because they must enroll 50% of eligible membership to exist. I urge those who support callback physicians to join me in returning the 2003 SSPS application unsigned (ditto the cheque), and a note offering to sign when they have delivered their constituents effective representation.

Recent history should have taught the Ministry and the BCMA that they ignore the plight of isolated physicians at their peril. MOCAP’s callback status must and will ultimately disappear. What actions will you take to expedite your profession achieving a stable and equitable paid on-call system?

—Kelly Silverthorn, MD

Kelly Silverthorn, MD. Callback carnage. BCMJ, Vol. 45, No. 1, January, February, 2003, Page(s) 10 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
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.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply