PMHx: the Northern B.C. docs dispute

In 1998, a small group of exhausted doctors in Northern British Columbia forced the province’s government to pay them for time spent on call. Within a few years, all B.C. doctors were compensated for time on call, and other provinces followed. At the time, the doctors in rural B.C. did it all: They were managing their own primary care clinics as well as practising emergency medicine, surgery and anesthesia at the local hospitals. Dr. Granger Avery, president of the British Columbia Medical Association (BCMA, now Doctors of BC) from 1997 to 1998, explained how rural B.C. physicians would work in their clinics during the day, staff the emergency room at night, and return to their clinic in the morning. “It was very difficult to recruit doctors because of the volume of work and the level of responsibility,” Dr. Avery explained. Read: PMHx: Telemedicine’s great leap forward in N.L. According to a B.C. ministry of health press release from the time, doctors were paid by fee-for-service and received a top-up for rural and remote practice. They received a fee each time they were called to treat a patient after hours, but were not paid for time spent on-call. There was a lot of unrest in the profession at the time, Dr. Avery explained. The ruling NDP government had a cap on funds available for healthcare. If costs got too high, the government reduced physicians’ fees to stay on budget; a process called prorationing. Every month, doctors would find out how much their payments were cut. It was in this context that 23 physicians formed the Northern Rural Doctors Group to fight for compensation for time on call, which would allow them to take time off after a night on call, or have another physician cover on-call duties. They sought advice from BCMA, but negotiated directly with the ministry of health. The ministry let the public know that the doctors in the group billed an average of $217,000 in the 1996/97 fiscal year. Read: PMHx: Painting a picture of the end The 23 doctors resigned their hospital privileges on Jan. 31, 1998. The hospitals had to close their emergency departments and inpatients were transferred to Prince George or other facilities, according to Dr. Brad Fritz, who summarized the group’s efforts in The BCMA, Then and Now: A selected History from 1965 to Doctors of BC. By March, doctors in other rural communities began to withdraw services to add pressure on the government. By the end of March, 80 doctors in 22 communities were not providing hospital services, Dr. Fritz reported. In April 1998, the government hired healthcare consultant Lucy Dobbin to study the issue. In a press release announcing her appointment, Minister of Health Penny Priddy said avenues of negotiation between the doctors and the ministry had been exhausted, hindered by the lack of a single voice to bargain on behalf of all the doctors in the northern and remote communities. Dobbin delivered her report in late May. It made 21 recommendations, including that rural physicians should be paid a stipend for time spent on call. The government agreed, and in June approved a budget of $6.5 million to cover 90 rural communities. The doctors returned to work the next day. Read: PMHx: A tale of three serpents The BCMA made on-call payments a major item in the 2001 negotiations with the province, and the resulting Medical On-Call Availability Program meant that all doctors providing on-call services were paid a stipend. Other provinces followed B.C.’s example to pay for time on call—all thanks to the actions of the Northern Rural Doctors Group.

PMHx: the Northern B.C. docs dispute

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