This is my first column for the BCMJ as your new president, and I’m very pleased to have this opportunity to discuss issues I feel will be important for physicians and our patients in the immediate future.
A key area is our ongoing relationship with the provincial government. During the current government’s first 4 years in office, this relationship could be described as “rocky” at best. Your past presidents, these last 4 years, have spent a good deal of time trying to work cooperatively with the government on a number of issues of concern to both patients and physicians. Cooperation on both sides is essential to ensure that physicians get the best agreements possible, and that the working environment of physicians is improved to make sure BC can successfully retain and recruit the doctors we so desperately need.
The result of May’s election will ensure that the next 4 years will be very interesting. With a greatly reduced majority, the government has been humbled. It won’t be so easy for them to unilaterally pass legislation without full debate, they will have to share more information than previously, and they will have to listen to and take into consideration other points of view. This will be good for BC, good for our patients, and good for physicians. And as your president, I will strive to secure the best possible relationship between this government and the doctors of BC.
A good working relationship will be necessary as we enter the two sets of negotiations mandated to commence this year. The first set of negotiations is for the final year of our present 3-year working agreement. Some of you will recall that in the last working agreement we agreed to no general fee compensation increase in the first 2 years of our agreement, and to defer a decision on the third year to later negotiations. Talks scheduled for this third year are set to begin no later than 1 October 2005 and will be subject to arbitration as early as 1 February 2006. We all remember what happened to our last “binding” arbitration, where the government declared, through Bill 9, the result null and void. How government responds to any award will be a measure of our future relations.
The second set of negotiations, also scheduled to begin in October of this year, is the renewal of our Master Agreement. This vital document is our charter of rights and defines every aspect of our relationship with government, including our ability to preserve our status as independent physicians who can truly advocate for our patients, as well as our freedom to choose such things as payment modalities and where and how we practise. It enshrines the principle that the BCMA negotiate directly with the province on behalf of all doctors, and it mandates one centrally administered available amount, safeguarding our health care system from devolved envelope funding to regional health authorities.
Unfortunately, the government has sent signals that it is looking to significantly weaken the Master Agreement, and in the process weaken the protection the agreement affords the doctors of British Columbia.
In my opinion, negotiations around the Master Agreement will be difficult. The BCMA, as a voluntary association of more than 8000 physicians, or about 95% of all physicians practising in British Columbia, is a formidable force. But, as the famous saying goes, “united we stand, divided we fall.”
If government’s agenda is to weaken our force, it will look at finding ways of diluting the BCMA’s right to represent physicians. It’s in all our best interests to ensure that our Master Agreement remains strong. Negative changes will adversely affect every doctor in the province, and ultimately adversely affect every one of our patients.
You will be hearing much more from both your BCMA Board representatives and me during the coming months as these negotiations commence. Negotiating the Master Agreement is probably the most important set of negotiations we have undertaken in some time. I urge you to please make yourselves familiar with what is at stake.
I look forward to meeting many of you in your communities during the coming year and I welcome your comments and concerns about issues, both local and provincial.
—Michael Golbey, MD
|Supreme Court decision
On Thursday, 9 June 2005, the Supreme Court of Canada issued its ruling on the controversial Chaoulli and Zeliotis v. Quebec case. The majority agreed with the complainants that prohibiting private insurance to pay for publicly funded health services in some instances can jeopardize the well-being of those who desperately need medical treatment. The ruling strikes down Quebec laws, which are very similar to British Columbia’s, that guarantee a virtual monopoly on medical services in the public health care system.
The Chaouilli decision is a complicated one and will require closer examination by all parties before its implications can be determined. As this Supreme Court case struck down Quebec law, not Canadian law, there will be no immediate changes to the way medicine is practised here in British Columbia.
The number-one health care priority for British Columbians is long waits, in often painful and stressful circumstances, for medical, surgical, and diagnostic procedures. It is now clear that the excessive wait for access to medical care will no longer be tolerated and that the provincial and federal governments will need to solve this problem quickly. The provincial government has targeted some funding toward reducing the wait list and we hope to continue to work with them on finding more ways in which to reduce wait times.
The Supreme Court justices state in the body of their decision, “Access to a waiting list is not access to health care.” The BCMA couldn’t agree more, and has been on record for nearly a decade advocating on behalf of patients the right to timely access to care. Two years ago the BCMA presented to the provincial government Patient Care Guarantees that laid out the framework to establish maximum wait times for medical, surgical, and diagnostic procedures. We hope that government will want to work with us on this issue.
The BCMA and the CMA are looking very closely at this court decision in an effort to better understand it, and what it will mean to physicians practising medicine in this country. This is a very complex decision and it will be discussed and analyzed by legal scholars, health care advocates, and government for quite some time.
A press release and information backgrounder can be found on our web site at www.bcma.org . We will keep you updated as new information becomes available.
—Michael Golbey, MD
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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.
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