The governance and representation dilemma

The governance and representation dilemma

The conflict between good governance and effective member representation is an issue that the BCMA has looked at for 20 years and has been subjected to four previous reviews. The current Board model of 39 voting and 11 nonvoting members allows Board members to be both representatives of their constituencies and strategic decision-makers whose policies can affect the membership at large. The BCMA has been assessing whether that model continues to best serve the membership in today’s rapidly changing environment.

The Ad Hoc Committee for Governance and Structure has conducted a lengthy review of the current Board structure and developed a proposal for a revitalized Board structure that separates the two key elements of governance and representation. The Board of Directors is now seeking member opinion and input on the proposed changes.

The proposals from the Ad Hoc Committee include: 

• A smaller board of directors, whose members would be elected by the membership, would meet frequently throughout the year, would hold the fiduciary responsibility, and would act on behalf of members and the organization as a whole. 

• A representative assembly comprising up to 80 members elected by constituencies would provide oversight of the Board’s performance, be responsible for appointing chairs and members of key committees, and participate in such things as health care policy development. The assembly, like the Board, would report to the membership. 

Please visit the BCMA web site at to view the entire proposal or, if you prefer, just the summary of key proposals. Your input and opinion on this topic are important. On the web site you will also find a link to Survey Monkey, a secure online survey vehicle that asks 15 key questions on members’ desire for change and a chat room where members can post their thoughts and interact with others. Other methods of gaining member input are also being implemented.

The BCMA has many issues that bring us together, but some issues—economic or compensation issues—tend to divide us. No one is happy when they feel that their interests are not being served. This proposed governance model makes an effort to reconcile these differences and to ensure that the Board of Directors works as efficiently as possible. 

—Arun Garg, MD
Ad Hoc Committee for Governance and Structure

Breast milk substitutes resource

With the dramatic increase in the number of infant formulas on the market in the last 5 years, deciding which formula to use for infants who cannot be breastfed has become much more challenging. The Community Nutritionists Council of BC has recently revised and updated its Compendium of Breastmilk Substitutes. The 46-page document is intended as a reference for health professionals providing information to parents who are feeding their infants commercial formula. The information in the compendium is evidence-based and there is an extensive bibliography. Reviewers include medical health officers, breastfeeding advocates, public health nurses, and dietitians.

There was no sponsorship or external funding for the development of this document. The compendium was developed by members of the Community Nutritionists Council of British Columbia.

To download a PDF copy of the document, go to

Pharmacare and insurance plans

The BCMA frequently receives inquiries about how Pharmacare and the Extended Health Benefit under the Standard Plan of the Health Benefits Trust Fund interact. Here are the answers to some of the most common questions.

What is Pharmacare?

Pharmacare is a government-sponsored plan that protects families from unusually high prescription/designated medical costs.

Am I covered?

You are automatically covered when registered under the Medical Services Plan (MSP) of BC. 

What level of coverage is provided by Pharmacare?

Pharmacare will pay 70% of your eligible medication expenses (75% of eligible medication expenses if you were born in 1939 or earlier) after you have satisfied your annual Pharmacare deductible.

What is an annual Pharmacare deductible?

A deductible refers to the amount of money you must spend in one year before Pharmacare will start paying a portion of your medication. Pharmacare determines your annual deductible based on your previous year’s taxable income. A consent form must be sent to Pharmacare to give them permission to access this information. If you do not file an income tax return or don’t provide a consent form to Pharmacare, Pharmacare cannot determine a proper annual deductible for you and will therefore assign an annual deductible amount of $10 000.

What level of coverage will my extended health benefit under the Standard Plan provide?

The extended health benefit under the Standard Plan of the Health Benefits Trust Fund pays 80% of eligible health expenses. Like Pharmacare, this benefit also has an annual deductible that must be paid before expenses can be reimbursed to you. The annual deductible for a single person is $50 and the annual deductible for a person with dependants is $100.

What happens when I need to fill a prescription?

When you purchase a prescription, your pharmacist will enter your personal health number on the PharmaNet system. The system will then automatically determine whether or not you have met your annual Pharmacare deductible.

If you have not met your deductible, the pharmacist will charge you the full cost of the medication plus a dispensing fee. After paying the charge, you can then submit the cost of your charge to Sun Life under the Standard Plan’s extended health benefits.

If you have met your deductible, Pharmacare will pay 70% of your eligible medication expenses (75% of eligible medication expenses if you were born in 1939 or earlier) and the pharmacist will then charge you the difference. You may then submit your charge to Sun Life under the Standard Plan’s extended health benefits.

Example 1

• Prescription drug expenses of $146.

• Single person.

• Annual Pharmacare deductible not met.

• Annual Standard Plan health deductible not met.

Prescription drug cost 

Subtract amount paid by Pharmacare at 70% 

“Out of pocket” expense 

Subtract Standard Plan health annual deductible of $50 (up to $50) 

Amount payable under Standard Plan health benefit at 80% 

Total “out of pocket” expense








Example 2

• Prescription drug expenses of $146.

• Single person.

• Annual Pharmacare deductible met.

• Annual Standard Plan health deductible met.

Prescription drug cost 

Subtract amount paid by Pharmacare at 70% 

“Out of pocket” expense 

Subtract Standard Plan health annual deductible (up to $50) 

Amount payable under Standard Plan health benefit at 80% 

Total “out of pocket” expense




(already met)



What happens if I don’t register with Pharmacare?

As noted above, Pharmacare will assign you an annual deductible of $10 000. In addition, the extended health benefit under the Standard Plan will limit the amount of drug costs for which you will be reimbursed to $600 per year (the limit is $100 per year if you are over age 65).

—Sandie Braid, CEBS
BCMA Benefits

Scholarships for your children’s education

The BCMA is offering three $500 scholarships for the children of BCMA members in good standing to help defray the cost of their post-secondary education at a university, college, or technical school. Eligibility requirements and application forms are available online at or through Ms Tara Lyon at 604 638-2842 or The deadline for applications is 1 May 2007.

Love wins MacDermot prize

In January the BC Medical Journal Editorial Board was pleased to award the 2006 J.H. MacDermot Prize for Excellence in Medical Journalism to Ms Mia Love for her article “Tools for addiction care: A community learning perspective.” The article was accepted for publication in late 2006 and printed in the January/February issue (BCMJ 2007;49:26-32). Ms Love is a third-year medical undergraduate student at UBC.

The MacDermot Prize comes with a cash award of $1000 for the best article on any medicine-related topic submitted to the BCMJ by a medical student in British Columbia. The prize, which is awarded by the BCMJ on behalf of the BCMA, honors Dr John Henry MacDermot (1883–1969), who became the editor of the Vancouver Medical Bulletin at its formation in 1924, remaining at the helm until 1959, when it became the BC Medical Journal. He was editor of the BCMJ until he retired in 1967. Dr MacDermot was also past-president of both the VMA and the BCMA.

Congratulations, Ms Love!

Agreement news update

The BCMA members’ web site is your place for information about the 2006 Agreement that members ratified last May. There are updates on how the Agreement is being implemented, including topics such as information technology in physicians’ offices (PITO), general practice items (GPSC), general compensation changes, rural programs, MOCAP, emergency medicine, specialist services, and alternative payments. Go to the members’ home page at, click on the Agreement News Update button, and follow the links to news about PITO, GPSC, and more.


The request for proposals (RFP) for developing electronic medical records has been released. Please check the member web site for details about what’s included in the RFP: costing, vendor selection, implementation plans, and so on.

The national search for the PITO program director is continuing. An executive search firm has been retained, with the goal of having the program director selected by spring 2007.

A Privacy Working Group was formed in November 2006 with a mandate to work on privacy requirements, the privacy impact assessment, and to provide input and advice to the PITO Steering Committee on key privacy issue topics related to PITO. 

The Working Group includes representation from the BCMA, College of Physicians and Surgeons, Provincial eHealth Privacy, Security and Legislation Office, PITO Clinical Advisory Group physicians, and EMR project team members. For more information, please check the member web site.


A number of information sessions will be held throughout the province, running from 1 May to 14 June. These sessions are designed to assist family physicians and their practice staff to maximize new fee billings by addressing topics such as practice management, increased patient access, improvement of chronic disease management, and more. For more information, please check the member web site.

The Maternity Care Network payment will be increased to $1500 per quarter, effective 31 December 2006. All who have billed for the Network payment for this date at the old value of $1250 will be automatically paid at the higher amount, but the higher amount of $1500 must be entered for the network payment on future billings.

The new fee code, 14008, is a 50% bonus to the postnatal care after an elective C-section and must be billed in conjunction with fee item 14108. The new fee has been established at $48.32 and is payable to the family physician who is responsible or shares the responsibility for providing the patient’s general practice medical care. Claims for 14008 may be submitted after the 22 January 2007 MSP billing close off. Payments will be made to a maximum of one bonus per patient delivered and to a maximum of 25 bonuses per calendar year under fee items 14004, 14008, 14009, or any combination of these items.

—Fiona Youatt
BCMA Communications

New insurance certificates arriving soon

Members who are insured for one or more benefits under BCMA Insurance Plans (life insurance, accidental death and dismemberment, long-term disability, physicians’ disability insurance, office overhead, and critical illness) will soon be receiving a package of certificates, one certificate for each insurance benefit. Our mailing target is the end of February. The certificates will be filed in a specially designed folder so that you can keep them all together in a safe place. If your spouse is covered for life or critical illness insurance (or both), he or she will receive a separate certificate but in the same package.

Please ensure that when you receive this important package, you review the certificates. If you have any questions, do not hesitate to contact one of the insurance administrators:

Ms Karen Paul, 604 638-2836 or 800 665-2262, ext. 2836

Ms Lorie Arlitt, 604 638-2882 or 800 665-2262, ext. 2882

—Sandie Braid, CEBS
BCMA Benefits

Call for nominations 

Dr David M. Bachop Gold Medal for Distinguished Medical Service

Awarded to a BC doctor who has made an extraordinary contribution in the field of organized medicine and/or community service. Achievement should be so outstanding as to serve as an inspiration and a challenge to the medical profession in BC. Only one award will be made in any one year; there is no obligation to make the award annually. Deadline: Friday, 6 April 2007. A letter of nomination including a current CV should be sent to Ms Lorie Janzen, BCMA, 115–1665 West Broadway, Vancouver, BC V6J 5A4.

Arun K. Garg, PhD, MD, Sandie Braid, CEBS, Fiona Youatt,. The governance and representation dilemma. BCMJ, Vol. 49, No. 2, March, 2007, Page(s) 85-88 - News.

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

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