Medical staff bylaws have been a bit of a sticky problem for BC’s hospitals for many years. There has never been a province-wide design requirement that all hospital medical staff bylaws were supposed to follow, despite a government requirement that all medical staff bylaws be reviewed and validated by a monitoring committee in Victoria. As a result, bylaws were, in many instances, very cumbersome documents and, once in place and acceptable to Victoria, were extremely difficult to change. In an effort to bring some common sense to this polyglot of often nonsensical, outdated, poorly worded documents, it was decided that a common set of medical staff bylaws should be created that would fit the basic requirements of any hospital in the province.

At first glance this seems to be an admirable project and one would assume that its completion, ratification, and implementation should bring order and common sense to the governance of physician activities in all our hospitals. However—this will come as a big surprise to all of you—health care bureaucrats quickly realized that by controlling the content and wording of a legislated common set of medical staff bylaws, they owned a mechanism that would eventually provide them with control over every physician’s professional activities in every hospital in the province. At the same instant, I suspect, they realized that this document also provided them with a mechanism to control the functioning and autonomy of area medical advisory committees (AMACs). Theoretically at least, it would also allow regions to curtail physician input into decision-making processes and would allow regions to mandate department head appointments (or decide to appoint only regional department heads). Finally, and perhaps the most worrisome bit, was the proposed inclusion of legislated appointment terms for medical staff representatives. Personally, I found this little item the most bothersome and pervasive evidence of ideologically driven government interference. Government is, it seems, determined to interfere in our own democratic process by limiting the term of our elected and physician-funded representatives as a thinly veiled mechanism to ensure that any effective, articulate physician representative will be around for as short a time as possible. It is no one’s business how long we want our elected and physician-funded representatives to serve. Neither the region nor the hospital should have any say in this process and I find it repugnant that health bureaucrats have persisted in insisting that this item be included in the final document. It is a poorly disguised attempt to disrupt, diminish, and denigrate the impact of physician participation in all the important administrative and operational decision-making processes of a system that requires an enormous personal and professional commitment by all of us in order for it to function. As a 747 captain said to me a few years ago, “If I don’t get in the cockpit it doesn’t fly.”

While this whole sorry story has been unfolding, some of our elected local representatives have naturally been very vocal in their disagreement with the situation. However, their valid, well-articulated criticisms have been met with denial, character assassination, and attempts to remove them from their elected positions and strip them of their mandated capacity to report committee activities. These individuals are our elected representatives and are our voice in the dirty world of BC medical politics. When the bureaucrats go after our elected representatives they are going after you and me, and I am as angry about this as I can remember being in a very long time. I hope you share my outrage and take a closer look at what this might mean to your professional and personal life. Finally, if government, through its local health bureaucrats, is successful in stifling our voice in the hospitals in this province, our patients will have lost their only advocate in this huge, patient-unfriendly bureaucracy.

—JAW