In late June 2006, hospitalists in British Columbia (B.C.) were on the verge of walking out of their regions’ hospitals in protest over payment and workload. The strike was narrowly averted (see “Tough Negotiations Avert B.C. Hospitalist Walkout,” August 2006, p. 1), and chief negotiators for the B.C. hospitalists signed an interim agreement that left the door open for future pay hikes and an examination of workload among other issues.
Two years later, some progress in providing pay increases and adjusting workloads has happened, according to some B.C. hospitalists. David Wilton, MD, is one of the directors of the Vancouver Hospitalist Society, a nonprofit organization that contracts with Vancouver General Hospital and the University of British Columbia Hospital (both overseen by the Vancouver Coastal Health Authority). Although Dr. Wilton reports “things have been working at a snail’s pace,” he and his colleagues have made important inroads in developing more collegial relations with the British Columbia Medical Association (BCMA) and the Canadian College of Family Physicians (CCFP). By taking guidance from SHM, Canadian hospitalists are strengthening their own association by increasing awareness of the value of hospital medicine in Canada.
Where the Trouble Began
BC is divided into six regional health authorities—five of which have active hospitalist programs. Hospitals are administered by the health authorities, whose administrators have come to appreciate hospitalists’ value in increasing patient flow and thus reducing emergency room crowding. However, the health authority administrators do not determine hospitalists’ salaries. All B.C. physicians’ compensation is established through periodic negotiations between the BCMA and the province’s Ministry of Health (MOH).
A Letter of Agreement signed by the two sides in April 2006 revealed serious problems for the hospitalists. The association, dominated by establishment physicians, had (for purposes of the Letter of Agreement) placed hospitalists lower on the pay scale grid than community-based family physicians. Even though hospitalists in Canada predominantly are from a family practice background (the opposite of the United States, where the majority of hospitalists come from internal medicine backgrounds) the BCMA’s under-appreciation of hospitalists’ workloads led to a low base rate for calculating salary increases.
Subsequently, the B.C. hospitalists realized they needed to be proactive about their own interests and hired an attorney to attend meetings with the ministry. Although the ministry never agreed this second, public round of talks were negotiations, an agreement to re-examine contracts was reached.
—Wayne DeMott, MD, hospitalist at Royal Jubilee Hospital in Victoria, B.C.
The contract (signed in June 2006) stipulated timelines for a wind-down provision if there were no satisfactory outcomes with the alternate payments committee or the newly established tripartite Hospitalist Workload Model Working Group, comprised of MOH, local health authority, and hospitalist representatives. An interim contract was signed in September 2007 (retroactive to March 2007) and is again up for renewal since it is now past the April 1, 2008 deadline. The strategy for the near-term is to renew the compensation contract for shorter time periods and wait until the BCMA re-opens negotiations with the MOH in 2010 for an updated Letter of Agreement.
Repairing the Divide
In the meantime, B.C. hospitalists have delved into multiple initiatives they believe eventually will bear fruit. Chief among these is establishment of a hospitalist section within the BCMA. In 2006, the situation was “somewhat antagonistic” between hospitalists and the BCMA, says Geoff Appleton, MD, the current BCMA president.