This letter is written in response to the process of trying to allocate monies between the specialist sections and those of general/family practice. I am a GP. I did a 2-year family practice residency in 1986–88 in Alberta. I currently practise in rural BC. I have been in the same practice for 19 years. I have active hospital privileges. At our hospital the specialists (except for surgeons doing elective surgery) are rarely designated the most responsible physicians. It is a GP-based hospital. There are respectful relations between the GPs and specialists—both groups providing excellent care.
I have a full-service family practice. I work in the ER one shift per week. I also have a contingent of patients in both the intermediate care and extended care institutions in our town. Up until 2 years ago I did maternity care. I am on call for my patients 24 hours a day. My work week averages about 55 hours. Family practice is in crisis. It is difficult to recruit medical graduates into family practice and to retain GPs in full-service work. I believe that the solution lies in the recognition and respect from the government and our profession for the complexity of our work. This recognition ultimately means increasing our remuneration and decreasing the disparity between the specialists and GPs.
I have personally observed that over the last 3 to 4 years my specialist colleagues have stopped complaining about their income. Certainly there are other topics of distress, but finances have ceased being one of them. They also seem to be driving nicer cars and going on better vacations. This coincides with the (almost) universal coverage of specialists by MOCAP. It seems only natural that the MOCAP program would have to be considered when trying to allocate new monies between specialists and general practice.
I read the arbitration agreement that allocated the fee increase to GPs and specialists. It seems to me that the judgment was an attempt to even out some of the increasing disparity between the specialists and general practice. One of the items that did not seem to be considered was the differential in office overhead. As a group of 10 GPs, our cumulative overhead is about 42%. We battle continually to try to lower that number. This overhead reflects the complexity of what we do. I suspect that specialists’ overhead is substantially less. As to the original arbitration agreement, I would have been happier to have more than 50% of the monies go to GPs, but I accepted the judge’s decision.
When I learned that the specialist section was contesting the award, I was distressed; it is both shameful and disrespectful. If one assumes that our profession really does wish to revitalize family practice then it is also a destructive and stupid action. It really does reflect upon the fact that as a group, specialists have really no idea or respect of the job that we do. At this time I feel that the BCMA can no longer represent both our separate financial interests and that we should cleave off into our own negotiating group. We could still cooperate on matters where our expertise and interests converge.
—Jeff Lynskey, MD
Thank you for the opportunity to respond to Dr Lynskey’s letter.
First, some facts and figures: approximately 1250 GPs and 3000 specialists receive MOCAP payments. There are currently about 4700 GPs and 3800 specialists working in BC. With respect to overhead, data from the recent overhead study show that the average GP’s overhead is 41.5%, while the average specialist’s is 36.4%. The range for specialists is from 20% to 51%.
I have heard from a number of members over the last months about allocation. I share their expressed concerns about the lengthy process and the involvement of the court system. This has been difficult and has had a negative impact on some of our relationships. The decision to make macro- and microallocation the responsibility of the two societies is one that was approved by BCMA members. The process is subject to law under the Commercial Arbitration Act, and if either society believed that errors in law had been made, I believe that its members would have expected it to at least consider appealing the arbitrator’s decision. The Society of General Practice and the Society of Specialist Physicians and Surgeons are both distinct from the BCMA, and both have a duty to their own members under the Society Act of BC.
There are a multitude of views about income disparity between different kinds of physicians. People have strongly held and widely different opinions about the definition of disparity and how we should address it. It has always been a challenge to meet the needs of our members with the finite resources we are able to negotiate from government.
The idea that specialists and GPs should negotiate completely separately is not a new one. When this round of negotiations is complete, including the macro- and microallocation, how we negotiate will be reviewed in detail. This will include consultation with our members. If the majority of our members make an informed decision to proceed in the direction of separate negotiations, then that is what will happen. We need to consider this carefully, as separate negotiations in provinces such as Quebec have resulted in one of the lowest fee schedules in Canada for both specialists and GPs.
I strongly believe that our own and our patients’ interests are best served by a strong and united professional organization. Our best chance of realizing fair economic reward for all physicians, as well as having the most effective impact on health policy, exists if all BC physicians are members of one professional organization.
It is critically important that the BCMA Board find a way forward, guided by our members, that gives us the best possible process for future negotiations. We are committed to doing that, with your participation.
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