Mike Morris, MD, president of the Section of Hospital Medicine, agrees with this characterization. A hospitalist at Nanaimo Regional General Hospital (part of the Vancouver Island Health Authority), Dr. Morris believes that most of the health authorities, which administer the region’s hospitals, appreciate hospitalists’ value. “They know how much we help the patient flow and problems in the emergency room,” he says. Emergency department crowding has been a huge problem in British Columbia, due to lack of hospital beds and a dearth of long-term-care beds. “Hospitalists are able to come in and safely discharge people on a timely basis, and help the flow through the emergency department. That’s one of our biggest values to the hospital. We think that the family physicians coming into the hospital are platinum doctors because they’re keeping up with the rapid changes in hospital medicine. And we feel that they are being highly undervalued.”
On average, hospitalists were making $111 an hour (Canadian dollars, equating to about $98 U.S. dollars at the July 12 exchange rate). According to Dr. Wilton, the hospitalists contended that their earning potential was at least equivalent to that of a lower-intensity Monday-Friday community-based general practice. At the negotiations, they valued their services at $135/hour. If the government was unwilling to value hospitalists’ compensation appropriately, they warned they could easily return to a community-based practice model.
Payment Not the Only Issue
The province of British Columbia is divided into six health authorities, five of which have active hospitalist programs. Overarching compensation frameworks for all physicians are established through negotiations between the British Columbia Medical Association (BCMA) and the MOH. Individual health authorities then negotiate specific terms of compensation and workload expectations with physicians. There is considerable variation between health authorities (and indeed throughout each of the Canadian provinces) regarding hospitalists’ workload models, such as the number of expected patient encounters per shift and compensation packages.
The BCMA had recently completed contract renewal negotiations involving the entire physician body in British Columbia and the government on April 1, resulting in a new six-year Letter of Agreement that hospitalists maintained did not address their needs.
“The way we saw [the Letter of Agreement] being interpreted,” says Dr. Wilton, “was that the base rate for calculating our advances going forward was going to be between 10% and 25% less than what we were currently earning. Part of our goal was to get a wage that is consistent with the complexity and intensity of our work. I think that, in the eyes of the government, they were seeing our work and our value more in the range of the less-intense community-based general practice work. We wanted to shift that focus more towards the intensity of the acute care setting, where we think we’re more comparable to emergency medicine and internal medicine specialists.”
Dr. DeMott adds, “The workload model is a very important aspect of what we do. It isn’t only what you are paid, it is what you are being asked to do for what you’re being paid. Workload expectations have tremendous implications for the health of this career path in the future, the ability to recruit into this career path, and the ability to retain people, so that they do not become burnt out or personally destroyed.”
Views of the Dispute
B.C. hospitalists decided to hire their own attorney (the Vancouver firm of Tevlin Gleadle) and a press relations person to take their dispute public. Margaret MacDiarmid, MD, is president of the BCMA and has her own family practice in the Kootenays region eight hours east/southeast of Vancouver on the British Columbian mainland. “We [the BCMA] were very keen to assist, if we could, in the resolution of the conflict, and we were calling them about that,” she explains. “But we felt we had to operate within the Letter of Agreement that we had just signed, which I think is reasonable. So we did not play any active role in the final resolution.”