Why I am a candidate for President-Elect, Doctors of BC
May 2015 - Vancouver, BC
I have been asked by a number of individuals why a former President of the Canadian Medical Association would seek the Presidency of the Doctors of BC. My main reason is a strong belief in a more assertive role for doctors in the area of health policy reform, which under the constitution of Canada, is in the domain of provincial (rather than federal) jurisdiction. It is time for doctors in BC to take a leadership role in liberating both patients and doctors from policies and laws that ration access and funding. I have been involved in this mission for over 20 years and I believe that success is imminent.
Canada’s health system is performing badly. The Commonwealth Fund promotes improved access, quality, and efficiency for society's most vulnerable, including low-income people, minority groups, children, and the elderly. They recently ranked Canada’s health system as 10th of 11 developed countries. Within Canada, the Wait times Alliance has identified BC as the worst performing province. Polls show that over 95% of Canadians believe system needs a major overhaul or complete rebuild. Doctors of BC must be at the forefront of efforts to create a more efficient health system.
For those who are interested, a book chapter I wrote on leadership is posted here.
BC Fee Schedule
Part of government’s power over BC patients and their doctors is exercised through their control of resources. There is a need for more correlation with amount of work done, performance, expertise and value received by the patient. Rationing access to care is used to limit spending. Doctors’ incomes are fixed by government, while their expenses are subject to the free market. Rising costs, due to technological advances and demographics, are making sustainability a major source of concern.
Provincial medical commissions were the brainchild of Tommy Douglas. He believed the Chair should always be a physician. In BC the chair is always a government official. In a body that deals with patient access, patient funding, and defining medically required services, this must change.
The current fee schedule is problematic. A structural engineer’s site visit to a home construction site, or a service call from a home appliance technician should not command a fee that is over 3 times that of a physician’s house call. We need to generate data needed to create a valid and fair fee schedule. For example, should an orthopaedic hand surgeon’s consultant fee for assessment of a mangled hand be 33% more than a plastic surgery hand specialist? There are countless other examples of illogical fees in our schedule. The question of non-MSP work is another issue. The inclusion of so called private work in fee calculations could become irrelevant if the current constitutional challenge against restrictions on supplemental private insurance succeeds.
A move to a private public partnership in health care, including a hybrid system similar to that in every other country that offers universal care, will increase funding and capacity. There will be an absolute increase in funds. The efficiencies imposed on the public system by competition and a downsized bureaucracy will lead to a more effective system. I support a public system, but not when it is structured as a monopoly.
Patient Focused Funding and Medical Education
As CMA President I pushed hard for patient focused funding – where funds follow the patient - rather than the global funding of hospitals, which treats patients as cost items.
Sadly, government rationing of care has resulted in a situation where doctors graduating from residency programmes are restricted from commencing practice, especially where their specialty requires access to hospital resources. In my specialty alone, this has resulted in the farcical situation where there are over 150 highly trained young doctors who cannot get privileges. They are limited to doing locums. They did not go through well over 10 years of training just to do holiday relief work. The paradox is that some of the longest wait times in the country are in their field. As a former chair of resident education in my specialty, and a former chair of a Royal College exam committee, this makes me angry. We need to solve this problem, and empowering patients will do just that. If we move our funding system to one that ties a health authority’s revenue to patient care – funding attached to the patient – this will autocorrect, and jobs will be available for all newly trained specialists. And waiting times for access to care will plummet.
The BCMA made this a part of its policy on health funding. It empowers patients and realigns priorities in their favour. We need to reassert our commitment to this policy and push government to change.
Our association is in a difficult position when it comes to potentially adversarial interactions with government. In issues of health policy, we must put patients first and be able to engage in negotiations and pursue agenda that may conflict with the priorities of government. Yet they are also, effectively, our employer. It is understandably tough to take hard and contrary positions on policy while simultaneously going cap in hand to ask for increased funding. This explains, I believe, the lack of any pronouncements from Doctors of BC on a constitutional challenge that has, even by writers and lawyers in Eastern Canada, been called the biggest legal case in Canadian history.
As patient advocates we must also promote a commitment to patient empowerment. Last year the BC government, in an effort to promote a patient focused system, launched a health website (“ThinkhealthBC”) aimed at gathering patient feedback. Patients responded and spoke out about their many concerns. The website was closed down.
I believe I am qualified to promote necessary change. I am very well known to both government and opposition leaders. I was the Premier’s guest speaker at the BC Conversation on Health, attended by BC government leaders including municipal leaders, First Nations’ leaders, and Federal MP’s. I was an invited presenter the Canadian Senate Committee on Health, the Romanow Commission, the House of Commons Select Committee on Health and the British Select Parliamentary Committee on Health. As CMA President I addressed a luncheon gathering of MP’s in the Canadian Parliament.
The News and Press section on my website (brianday.ca) illustrates my experience with media relations. Media engagement will be necessary in dealing with government and informing the public.
One of the problems with our near single payer system of remuneration is that we are at risk of succumbing to a divide and rule approach when negotiating for resources. The “Iron Lady”, Margaret Thatcher, stood with little fear against the Red Army and the Soviet Union. She didn’t think twice about sending Britain’s entire army, navy and air force, including the Queen’s youngest son, to the South Atlantic to take on Argentina in the Falklands’ war. But, she drew the line in taking on the doctors of Britain when it came to health policy and funding. As a united profession, doctors in BC and Canada are very strong. The official BC government response to the current constitutional challenge is remarkable in that it blames doctors and patients for access and funding problems. We must strongly refute such accusations and re-affirm our mandate as patient advocates. We cannot adopt a “no comment” approach. The current legal challenge in BC is aimed at enacting existing CMA policy (supported by the former BCMA caucus) into law. The world literature is clear and confirms our health system is both very expensive and extremely inefficient when compared with other universal systems.
The Doctors of BC must advocate for BC patients to have the same rights and freedoms that the Supreme Court of Canada granted to Quebec residents in the Chaoulli case.
I have worked as a full time university faculty member and researcher, in full time public practice, and in private practice. I am an associate professor at UBC, and have been a visiting professor at many universities and learned societies throughout the world, including McGill, Manitoba, Ottawa, N. Carolina, Yale, Taipei, Manila, Cambridge (England), Madrid, Santiago, Mexico City, Acapulco, Chihuahua, Athens, Rome, Mumbai, Havana and Sydney. I have published over 200 articles and book chapters. I am the current recipient of the Don Rix Leadership Award of the Doctors of BC.
Doctors want a better health system for all. We must encourage debate, but avoid internal conflict. Now is not the time to consider revoking our conjoint membership in the CMA.
I am certain of victory in our constitutional challenge. The Doctors of BC must influence the new legislation that will result. Of the 3 candidates, I believe I am the most experienced and qualified to lead that effort. I am seeking a mandate from BC’s doctors to pursue an agenda aimed at solidifying and strengthening our profession as we implement the reforms necessary to elevate our health system from its lowly ranking. As we pursue such an agenda, doctors must be in the driver’s seat. We and our patients are under attack by governments and their agencies. This election is about supporting a mandate to repel such attacks and implement substantial reforms. If I am elected to the office of President-Elect of Doctors of BC, that will be my goal.
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