HEN DOCTORS in small

northern places such as Van-

derhoof, Burns Lake and Fra-

ser Lake went on strike more

than two years ago, the issues

were eerily similar to what’s
going on today in Terrace and other more larger
centres,

Problems with finding and keeping doctors
' and avoiding burn out because of long hours were
paramount. ,

_ The day of the rural doctor willing to be con-
stantly on duty was over as modern physicians
prized family life and time off to recuperate from
the strains of their profession.

‘A growing shortage of trained physicians else-
where in B.C. and practically everywhere else
resulted in widespread job opportunities paying
“more money and with better working conditions
than offered in small town B.C.

Failing to make their point in presentations to
the. provincial government for more money,
northern rural physicians did in 1997 what Ter-
tace doctors did two weeks ago — they withdrew
ali but emergency services at their hospitals.

~ The government responded by appointing 1a-
bour consultant Lucy Dobbin, charged with look-
ing at the problem and recommending solutions.

‘In early 1998, this resulted in the Dobbin
Agreement — money to altract new recruits to
small towns, money for continuing education and
‘Money to provide on-call emergency care.

- This. new money was in addition to the North-
‘ern [solation Allowance, a program begun in
1978, which paid doctors a percentage premium
over and above their normal Medical Services
Plan billings. The premium varied according to
the location. In Terrace it is 14 per cent; in Kiti-
mat it is 19 per cent.

In signing the Dobbin Agreement, the pro-
vince created a precedent now at the heart of the
widespread physician strikes across B.C.

~ At the time the province and the B.C, Medical
Association, which acts as the doctors’ bargain-
ing agent when it comes to fees and other mat-
ters, agreed to work on a plan to address the pro-
blem of finding, keeping and paying doctors in
more remote and rural areas.

.. In Terrace, the principle of the Dobbin Agree-

ment surfaced later in 1998 when local doctors
presented their on-call plan to the Terrace and
. Area Health Council. Health council officials es-
timated the cost at more than $1.2 million a
year, $1.1 million for specialists and $122,000 a
year for general practitioners.

Meanwhile, in Prince George, a greater pro-
blem emerged. For any number of reasons, that
city, even though it is the largest in northern B.C.
and contains the majority of specialists and gen-
eral practitioners in the north, had trouble finding

and keeping people. Unlike Terrace and other. -

northern places, physicians there were not part of
the NIA program.

~. Through 1999 and into early 2000, doctors
.there crafted their own position paper on pay-
ment, recruitment and retention. Their proposals
“were presented to the provincial government in

The Terrace Standard, Wednesday, September 27, 2000 - AS

Joctors
dollars

A look at the history and the numbers
behind the rural doctors pay dispute

we

*

A special report by Rod Link

early May 2000, They were initially not met with
great enthusiasm, leading doctors there to follow
in the footsteps of their more rural colleagues
and withdraw services in June.

After a series of intense negotiations, the pra-
vince and Prince George doctors signed a $10
million deal which spoke to physician payments
and added $1 million to help find, recruit and
keep other medical professionals such as nurses.

The deal in Prince George gave doctors an in-
crease over their regular Medical Services Plan
based on a seniority scale. After one year, theyll
get a 7.5 per cent billings premium, rising to a
maximum of 17.5 per cent after five years.

More particularly, it directly addressed the
problem of specialist shortages in practically
every category, says Dr. Bert Kelly, a general

practitioner there and a key participant in the ne-.

getations with the government.

“We have four general surgeons, there should
be six. We have two orthopedic surgeons, there
should be six. We’re short one or two internists,”
says Kelly in starting lo reel off a tong list of va-
cancies, In all, Prince George is short 25 special-
ists and 10 general practitioners.

One way to attract specialists was by bringing
in an on-call payment schedule worth, in total,
$3.2 million, in addition to regular fee for service
billings, said Kelly.

“We had two aims here. Recruilment and re-
tention and bringing to our region the best people
we could,” he said of the on-call provisions.

Specialists in six care specialties - such as
general surgeons and orthopedic surgeons — re-

‘ceive $1,000 a day or just over $41 an hour when

on call. “We did that because these people when
they are called are pretty much up all night. We
also recognized that they might not be able to be
in their offices the next day,” said Kelly.

Other specialists who may not be called out

as often as the ones above, receive $500 a day or
$250 a day depending on their specialty.

While the issue of on-call pay for family prac-
titioners is contentious elsewherc, Kelly said it

wasn't in Prince George, where the deal gave no‘

on-call payments to family doctors.

“We have a certain mass (of physicians)
here,” said Kelly. “And we're so well organized
that none of us has to spend all night out of bed.”

There are also other medical aid avenues not
available in smaller towns at nights and on
weekends. For instance, there’s a walk-in clinic
thal’s open on nights and weekends and the
city’s hospital has in-house emergency physi-
cians, he said.

And there’s a specific program called “Doctor
of the Day” in which doctors who sign up, fe-
ceive $295 for being at the hospital for a 24-hour
period to provide care for people who do not
have a family physician. These doctors also re-
ceive full fee-for-service billings.

All of this combines to make a general practi-
tioner’s on-call duties in Prince George less one-
rous than in smaller places, said Kelly.

While the Prince George deal may have re-
presented an attempt to solve a problem in that
city, it simply created a huge one in cities such
as Terrace. That’s because the extra money for
doctors in Prince George, outweighed what was
available under the NIA program.

“Give us Prince George” became the rallying
cry for doctors across B.C. who threatened their
own withdrawal of services in the effort to force
more money and services out of the government.

To not at least match the deal for doctors in
Prince George, the province would simply invite
a catastrophe because there would be no incen-
tive to practice in more remote and rural areas,
say doctors elsewhere.

In fact, they say, any such deal must contain

what was done in Prince George plus mare.

The first community whose doctors organized
to negotiate with the provincial government after
the Prince George deal was signed was Williams
Lake. Unlike other northern communities, Wil-
liams Lake was never part of the NIA program,
meaning that city’s doctors were not only behind
Prince George, they were behind every other
place in the north. Doctors eventually settled for
a deal, not yet finalized, which the health mini-
stry says mirrors that of Prince George.

The Williams Lake deal has money for edu-
cation and for training and for the same annual
retention bonus scale as paid in Prince George.

There is also. money.for on-call for specialists
and for general practitioners. How that will be al-
located has tentatively been decided but won't
be released until the final agreement with the
province is signed, says Martin Oets, the chief

administrator of the Cariboo Chilcotin Commun-

ity Health Council.

He did say the medical community in Wil-
liams Lake, not the provincial government, will
decide how the $665,000 for on call payments to
the approximately 20 general practitioners and
seven specialists there will be allacated.

“In the end, the general practitioners took less
and gave il to the specialists,” said Octs.

A confusing several weeks followed as the
province attempted to first do deats city-by-city
and then retrenched to propose a province-wide
arrangement for remote and rural doctors.

That was accepted and a negotiating commit-
tee of doctors under the B.C. Medical Associa-
tion was struck to talk to the province.

Those talks broke down the end of August
with each side accusing the other of being the
first to walk away.

While the province said it was putting mil-
lions of new dollars on the table, the doctors said
it was merely a mixture of old money with some
new thrown in.

In Terrace, doctors joined others across the
province in organizing strike action. Specialists
withdrew all but emergency services at the hos-
pital Sept. 11 and general practitioners followed
on Sept. 15.

Premier Ujjal Dosanjh called the legislature
back on Sept. 17 passing a health expenditure
bill which laid out money for doctors, for hospi-
tals and for equipment.

Late last week the province released what il
said was its complete package for rural, remote
and northern doctors, saying it outlines what is
old and what is new money. As well, the pro-
vince wants to do away with the Northern Isola-
tion Allowance in favour of this new one.

The dollars, it said, are structured in such a
way that doctors in rural, remote and northern lo-
cations will slill be paid more than what their
counterparts in larger centres are or in smaller
centres down south. .

Doctors replied that they don’t trust what the
government is saying, Their job action continues.

Any planned escalation, says local physician
Dr. Bill Redpath, may not be closing offices or
withdrawing more services. It may just take ithe
form of doctors leaving town.

Here’s our best _

shot at the math

CONFUSION. CONTRADIC-
TION, Suspicion. Mistrust. Stub-
bornness. Anger.

Take all of these and add in pages
upon pages of mind-numbing statis-
tics, dollar amounts and insider lan-
(guage and you’ve about nailed the es-
sence of the dispute between doctors
and the provincial government.

In this issue we tried to outline the
exact dollar amounts of the provincial
government offer of last week, the
Prince George deal upon which doc-
tors are using as a base for their own

demands and what the local doctors
want, Our goal is to present as clear a
picture as possible so you, the reader,
can make a judgment yourself.

Information used was taken from
a variety of documents and a number
of interviews with those on all sides
of this dispute. Any errors of fact or
of interpretation are our own.

As a final note, the B.C. Medical
Association is preparing its own ana-
lysis of the government offer. We
hope to present that next week.

Rod Link, Editor

Doctors can choose flat
bonus pay or percentage

DOCTORS HERE are going to have to
spend time with a calculator in order
to decipher last week’s offer of annual
bonuses from the provincial govern-
ment. .

Based on available information
from the provincial government, here’s
how those calculations might go.

. An average general practitioner
billed the Medical Services Plan near-

- ly'$200,000 last year.

“Under the existing Northern Isola-
tion Allowance (NIA) here of 14 per
cent on top of those billings, a Terrace
general practitioner billing $200,000

‘who maintains full time office hours
‘would have received an extra $28,000

~ for:a total of $228,000.

. Under the new government offer,
that doctor can surrender the NIA pro-

‘pram, if he or she wishes, and choose
-a lump sum annual payment of
‘$45,000 instead, This would make for
a net annual increase of $17,000,

Under both the Prince George and

Williams Lake deals of earlier this
‘summer, doctors there billing $200,000
“= and assuming they have been in

Prince George for five years — will re-
‘ceive an annual bonus of $35,000.

‘In other words, a Terrace general
practitioner is ahead of a Prince
George counterpart by $10,000 based
on:the above set of calculations.

. On the other hand, the gain by a
Terrace general practitioner signing on
to. the lump sum $45,000 as opposed to
_». the $28,000 under the NIA program di-
-minishes the more he or she bills.

- “That's because NIA is a percentage of

billings.

In other words, the advantage to
switching stops at around $320,000 in
billings.

This is determined by taking 14 per
cent of $320,000 which is $44,800,
Add $320,000 and $44,800 and the re-
sult is $364,800. In turn, $320,000 plus
the lump sum of $45,000 works out ta
$365,000.

At the same time, a physician in
Prince George who bills $320,000 and
who has been there five years would
receive a premium top up of $56,000.

In other words, the Prince George
physician would earn more than the
one in Terrace for the same amount of
billings.

Similar calculations can be done
for the bonus of $56,250 being offered
to local specialists by the province.
The average specialist billing amount
last year was $297,000.

In its offer of last week, the pro-
vince did say that doctors have the op-
tion of staying with NIA’s 14 per cent
here or switching to the new lump sum
program.

The province also acknowledged
that some high-billing physicians
would earn less under the new program
if they switched.

If that happened, the government
added, it would top up the pay of these
physicians so they would not, in fact,
earn less than whal they do now for
the same level of service. =

Please note that these calculations
do not take into account any on-call
pay allotments.

nye

“Proposals for Terrace specialists

Parts of the package:

Existing... Gov't offer © . ‘Prince George deal Terrace docs demand

14 % NIA bonus plus 7.5% |
to 17.5% P.G. deal for total
retention bonus of 21.5%
‘to 31.5%. Worth $64,500
to $94,500 for sample

. Specialist.

Docs can choose 7.5% in first year of

existing 14 % NIA bonus program to

bonus or else 17.5% after five years.

“$56,250 new Worth $22,500 to

‘bonus plan. $52,500 for sample
Specialist.

14 % banus for
dacs in Terrace,
_Teferred to as the
Narthern Isolation
‘Allawance (NIA}.
Worth $42,000 a
year extra for
sample specialist. :

Retention premiums. This is
extra pay for working in a
remote area in addition to
regular billings. Sample
calculations based on a
specialist billing $300,000 a
year. (The provincial average
last year was $274,000.)

nal pay. Assim

F Hour,
127,600:
on call a th

A

doctors.

: : $10,000 for new $10,000 for new $10,000 for new

dactors. dactors.

Recruitment.

Education allowanc

Total bonuses fora $ 42,000 $ 81,250 $ 174,100 based on $ 94,500 at five-year

specialist who bills five-year maximum maximum plus to be |
$300,000 and works bonus level. determined on-call pay.
one-in-three call.

Total pay for that specialist, |$ 342,000: 5 981,250 8 ATA N00

Proposals for Terrace family doctors

Parts of the package Existing ' Gov't offer”... Prince George deal

rrace docs demand
Does can choose 7.5% in first year of 14% bonus (NIA) plus
existing 14% NIA bonus program rising to 7.5% to 17.5% (P.G. deal) |
bonus or else 17.5% after five years for total retention bonus of -
$45,000 new service. Werth $15,000 21.5% to 31.5%. Worth
bonus plan. _to $35,000 for sample $43,000 to $63,000 for
Adjusted for GP. sample GP.
part-time docs,

14 % bonus for
i docs in Terrace,
: referred to as

_ the Northern

‘Retention premiums. This is
‘extra pay for working in a
remote area in addition to
‘regular billings. Sample
‘calculations based on a ‘Isolation
general practitioner (GP) : Altowance (NIA).
‘billing $200,000 a year. (The | Worth $28,000
‘provincial average last year | a year extra for
‘was $197,000.) sample GP

N

2 Eats ea rare if RAT Ra
Recruitment None $10,000 for new $10,000 for new $10,000 for new doctors.
doctors. doctors.

p te ‘400

$63,000 (at flve year
level) plus to be
determined on-call pay.

‘Education allowane

$ 35,000 based on
five-year maximum
level.

$45,000 plus
‘on-call pay

Total bonus for a family

-$ 28,000
doctor who bills $200,000. .

5245,
all

ia

000 jphio‘on,$:296,000°

1. An agreement to pay general practitioners for being on-call In cities such as Terrace where thera are more than 10 gen-
eral practitioners was signed In June, This is a separate and distinct deal from the annual bonuses now being o
government. A number of aptions wera available and general practitioners here chose to be pald $10 an hour
their regular fee for service billings. This agreement has yet to be finalized and no money has been paid yet.

2, The $1,000 per day on-call pay is for core specialists such as general surgeons and orthopedic surgeons. The rate dips
to $500 and $250 a day for other specialists, depending upon their specialty, who are not considered as crucial to emer-
gency medical coverage as the core anes,

3, Although local general practitioners here have accepted an on-call pay agreement of $10 an hour in addition to regular
fas for service biltings,:there ara signs they now wish this to go to mediation as part of their overall dispute over money with
tha province. Specialists here appear to ba basing their on-call demands on the deal signed in Prince George but also ap-
pear to be willing to put thelr demands out to mediation. -