Here are the questions whose answers below persuaded me to vote in favour:
1. Given the existing PMA goes through 2016, why eclipse it by pre-committing – now, in 2014 – to a 5 year agreement when we could have waited in the hope of a clearer and maybe better economic picture in 2016?
It turns out that if we had instead limited ourselves to the originally provided-for two year “reopener” for 2014-2016, we would have been constrained to negotiate ONLY fees. This would have been in the current circumstance wherein there was no money and there was a real risk of clawback of what we currently have. For those who cannot recall or otherwise had no experience with clawbacks, these have historically (including in Ontario) proved highly demoralizing for the profession and yet risked to be sufficiently limited so as to not galvanize our members into any significant solidarity. Particularly in the current climate wherein we recognize a troubled economy.
2. How then is this alternative, i.e. what we have been presented with, any better?
For one thing, it achieves, financially, an agreement, by government, not to clawback and, rather, to do the reverse, i.e. to provide some “positive” (albeit very limited in the first two years) new amounts, as part of an agreement wherein both sides enable the government to balance its books in the next 2 years, at the same time as committing to some rear-loading in years 3, 4, 5 when the economy is projected to better-enable such increases. Including funding to cover the majority of CMPA fee increases.
3. What else does it achieve?
For another, it creates the possibility to pursue, without having to pre-commit to, reforms:
- Both sides recognize that Canada is not scoring very well on value for money and that we need to reshape how things are done. We only lack (or do not yet know whether we would reach) agreement on what that ought to be. The agreement permits, without forcing, the reshaping, and
- One of the big messages from Sections, and particularly Sections whose members are captive to health authority decision-making, is to extract some requirement for health authorities to open-up their decision-making to more and ostensibly helpful input from physicians. For this to have been secured within this agreement represents a tremendous breakthrough as part of a package we are starting to hear is the envy of the rest of Canada.
10 replies on “2014 Physician Master Agreement”
Jim, I appreciate your efforts to keep the membership informed. I have lost faith in the BCMA. I see us getting further and further under the control of the MOH and the corporation that the BCMA has become. I am glad I have only another 5+ years to go.I voted against this PMA.
What do I want? Fees that reflect the services I provide. I don’t want hand outs to cover RRSPs, CMPA, CME etc. I don’t want a secretive society negotiating behind closed doors on my behalf.
If I had the energy,I’d opt out again.
Willie
Willie, I can understand why you voted as you did. Each of our choices is largely governed by how we construe the information available to us. That said, (1) the extent to which the Ministry has in any way augmented its “control” and to which the BCMA has in any way become too “corporate” are owed largely or entirely to the vast majority of our membership’s failure to be part of any conversation that it has, through its own inaction, failed to generate and (2) recognizing that failure, I trust the agreement before us to be the best achievable in our current circumstances.
Appreciate your work.
I voted not to accept the PMA because:
1. Much of the “new money” is what was leftover from the previous PMA.
2. I am sick and tired of the government cutting the salaries of those that have – probably – the greatest impact on society (teachers, doctors, nurses, etc). Cuts to one group (e.g. public employees) is then used to justify cuts to others (teachers) and the downward spiral continues with us. Cuts to the public system also take us one step closer to dissolving the public system (as docs are lured away by the relative increasing financial benefits). I consider 0.5% increase a 1.86% pay cut.
3. I don’t trust anything negotiated by Mr. Straszak.
Hi Peter,
re your #1 and #2, I am not sure whether you had already voted before I posted to this page, nor whether what I wrote would have made any difference. I am not sure that the money being carried over from the old agreement into new (itself a good thing) is being represented as “new” and the challenge in voting down any proposal is to take stock of whatever would be your alternative. re #3, I can understand why people could be hesitant to trust personnel who have moved from government-paid positions into a quasi-competing private sector. But it’s important to be open to the possibility that people who are both capable and persons of integrity, where such is the case, can prove both adaptable and also loyal to the new employer (in this case the BCMA / Doctors of BC) in pursuing its best interests. If it is any help for me to say so, nothing in my encounters with any of the staff who have come over from government, Mr Straszak included, has given me any cause to be mistrustful. My experience has been the opposite. As an aside, I disagreed with some judgements published in the press in relation to the teachers’ litigation which judgements could have coloured people’s views. Coming back to the Agreement, once I obtained the answers above, I had no qualms voting to accept it. But that’s just me.
I have no problem with people going from one employer to another. The reason I don’t trust Mr. Straszak is exactly because he is NOT a person of “integrity”. He admitted, under oath, to negotiating in bad faith with teachers. By definition, a person of integrity does not put values on hold on request. I’m shocked that anyone would refer to him as such.
Regarding the PMA… governments have been arguing that “tough times” require that people accept poor deals. They do this as they simultaneously brag about our robust economy, and how well they’re doing. Each time a group accepts a paycut, it gives the government more leverage to shortchange the next group. It will not get better in the future, unless we are firm in the present.
In the past, they’ve told nurses they can’t pay, and weeks later MLAs approved 20% wage increases for themselves. They “nickel and dime” during negotiations, but when the Olympics go over budget, they pay with little argument. We have a CEO telling us to clear our surgical backlogs, then cuts OR time in Delta hospital and shunts slates to other hospitals. During a wage freeze Lynda Cranston approved raises for 18 administrators, with no consequences.
The hipocrisy is shocking. There’s money in the system, it’s just going to the wrong places.
Any time anyone passes judgment on circumstances at which they were not present, they risk to do so with only partial information. If Mr Straszak had been employed by the Teachers Federation, you would have cause for your criticism. But he was employed by, and owed his duty of advising (and of obedience) to his employer, i.e. government, who was in an adversarial relationship with teachers. What we saw unfold could certainly be called “hardball”. But unethical or lacking in integrity at the level of the negotiator? I’m not so sure. Questions of ethics would better be levied at the employer who determines the actions of its employees except any who were in a position to walk away, i.e. quit.
If it is “shocking” that I limited my evaluation of the person to my own encounters with him, so be it.
As far as the PMA, it seems you are suggesting there’s enough money. So beyond the now-fixed Olympic costs, which provincial budget line items would you propose to cut so as to redirect more into health services and to pay more to our nurses and teachers? And what steps would you want taken to reconcile those physician groups who believe they are underpaid with the assessment that the Canadian medical system, for what it spends, achieves poor value?
I think we’re using different definitions of the word, “integrity”. I consider integrity a compliment that is earned exactly during times of “adversarial relationships”, and/or when refusing to carry out unethical directives from superiors (i.e. “quit”). Pushing a group to strike is not without significant social, psychological and economic consequence. I’m not saying he’s not a good negotiator, loyal employee or “nice” person.
Where would I “find the money”?
That’s not my job. I don’t have time required to focus on it. That’s what government is paid to do, but rarely held accountable for. However, I have a few thoughts to stimulate discussion…
1. From a “big picture” perspective, I would start by losing 5-6 of the 7 health authorities. I’m convinced they are a barrier to efficiency. Alberta has 1 health authority. I’m not sure about other provinces.
2. CIHI reveals that BC is the second lowest per capita funded health system in Canada. Why is that?
3. From CIHI… Alberta spends about 20% more per capita than does BC. Employees (docs, nurses, RTs, cleaners, etc) earn about 40% more. I interpret this as “room for improvement” in our system’s efficiency.
4. Stop treating healthcare “like a business”. Patient outcomes are longterm, budgets are quarterly. I don’t think it’s a sensible approach.
5. Eliminate/minimize “budget silos”. I see this in the hospital all the time. One department makes decisions that benefits their own budget, but costs the “system as a whole” much more money. One of many examples: no funding for nurses to run a second OR, so emergency list patients spend another day in hospital. This approach saves the OR budge, but costs the system an extra 600-800 dollars (?) per day in hospital stay / physician rounds, etc.
6. Costs are constantly rising, services constantly cut. If everyone (teachers, BCGEU, nurses, docs, etc) is accepting pay cuts over the last few years (raises below the inflation rate of 2.35%), as they have, how do we explain these increases in cost?
About “value for money”…
The attorney general never said physicians are providing “poor value for money”. What is actually in the report is that there is no way of “measuring” value for money. Very different.
Hi again Peter. As the visual display for these comments is getting “tighter” I’ll keep it short. I think your comments are great stimuli for discussion. I think the BCMA needs to foster our bashing ideas around, so we can better see where to take them. The question of HAs (how many, doing what) is a good one. On the question of value for money, there is a lot more that doctors and government ought to be doing beyond anything written about by the auditor general who, by the way, is not the only source of data on how we’re doing.
Are the instruments of change now instruments of the status quo?
Telling doctors to vote because “you sufficiently trust the people who have put it together to be able to endorse what is on offer, even if you do not fully understand it” and providing your view on 3 items out of 239 pages is disturbing. This controlled messaging is similar to the behaviour of the BCMA (DoctorsOfBC).
I don’t think this is good advice. Controlled messaging is a very real problem. Doctors need to be able to understand matters.
I am not even sure that I understand your opening sentence. Are you seriously contending me to be an agent of the status quo?
Your second sentence “Telling doctors…” appears to be a misrepresentation of what I wrote in an email which I sent out yesterday, in which “you sufficiently trust…” was a bullet point listed among what the casting of ballots could mean, and not what it ought to mean.
Why should I post more than 3 items out of 239 pages when those items (which were the very same questions as you had asked me three days before) were my only basis to hesitate to cast my ballot? And to which I obtained answers directly from Mr Straszak.
Last but not least, if my objective was to control messaging, why would I approve comments that did anything but agree with me?