Tough Negotiations Avert B.C. Hospitalist Walkout
Two weeks of intense talks between hospitalists and government officials resulted in an 11th-hour compromise on June 29th in British Columbia, one day before hospitalists’ contracts were set to expire. Throughout the month of June, the B.C. hospitalists had threatened to move back to community practice if the Ministry of Health (MOH) did not offer a contract that recognized the value of their work. The hospitalists contended that low payment schedules and staffing levels were seriously undermining staff retention and recruiting—as well as patient safety. During the dispute, MOH officials had been equally adamant about their position. The province’s Minister of Health, George Abbott, said that the salaries were fair, and that the government would not be “held for ransom on this issue.”
Hospitalists believed that failure to reach agreement would have left many hospitals scrambling to provide coverage for hospitalized patients.
Wayne DeMott, MD, is a hospitalist at Royal Jubilee Hospital in Victoria, B.C., and chief negotiator for the British Columbia Medical Association’s Section of Hospitalist Medicine.
Hospitalists in B.C., he says, “are in a position to … severely compromise many functions of most major hospitals in this province. If an agreement had not been reached, we were quite prepared to stand up and take our leave.”
The June 29 compromise established a one-year period to re-examine workload issues and clarify funding models. If hospitalists are not satisfied at the six-month mark with the provisions to address ongoing funding, workload, recruitment and retention issues, they can give six months’ notice.
Roots of the Dispute
The majority of primary care in British Columbia has traditionally been provided by general practitioners. According to David Wilton, MD, one of the directors of the Vancouver Hospitalist Society, a nonprofit society that contracts with Vancouver General Hospital and the University of British Columbia Hospital (overseen by the Vancouver Coastal Health Authority), and a core negotiator for B.C. hospitalists at the talks, “the economic model for hospital care faltered through the late ’80s and early ’90s, and general practitioners started giving up their hospital privileges and focusing on their community-based practices.”
To fill the gap, many hospitals in the more populated urban areas started hospitalist programs, which evolved through the late ’90s and grew quickly after the year 2000. One of the largest health authorities in the province—the Fraser Health Authority—serves approximately 1.3 million people on the B.C. mainland, runs 12 hospitals, and now has 110 hospitalists working for that health authority alone. Most (85%-90%) Canadian hospitalists are trained in family practice medicine, as opposed to internal medicine.
In some ways, B.C. hospitalists have been victims of their own success. As programs grew and as house staff became aware of hospitalists’ skill sets and expertise, many shifted their work burdens to the hospitalist services, says Dr. Wilton. The workload climbed exponentially, but appreciation of hospitalists’ value-added services on the part of MOH officials did not keep pace with the workload. The result, explains Dr. Wilton, was a kind of disconnect between the intense nature of hospitalists’ services and their compensation and staffing structures.
“In British Columbia the local hospital administrators saw the efficiencies that we were bringing to the system,” explains Dr. Wilton. “They saw the improved quality of care and the fact that we were able to step in, be flexible, and help specialists in various areas and fill the gaps of care. But we hadn’t yet broken through to the higher levels of the provincial Ministry of Health. They didn’t fully recognize the value that we were bringing to the healthcare system and the fact that hospitalists are the cornerstone of the acute care system now.”
