As B.C. health-care system 'teetering,' health minister angers doctors again

The rocky relationship between the provincial government and B.C.’s physicians appears further damaged in the wake of a surprise offer to new doctors graduating medical school. 

What most attendees understood to be an information and feedback session on the future of family medicine last week instead saw Health Minister Adrian Dix make a surprise presentation offering a controversial contract and debt-forgiveness pitch in exchange for practising medicine in B.C.

Doctors who graduated last year or will graduate medical school this year are being offered a $295,000 fixed salary, $24,000 signing bonus and up to $150,000 in student loan debt forgiveness if they work in the province for five years.

Roughly 40 per cent of a family doctor’s annual salary goes to cover the overhead of running their practice, which often requires hours of unpaid work, so the offer is not as good as it may sound to those outside of the field.

Many were left out of the consultation process and the offer, which does little to deal with the issues doctors are already struggling with, excludes some potential candidates.

In a stern letter sent to the ministry and associations representing doctors and resident doctors, University of British Columbia Family Medicine lead residents Dr. Ana Boskovic and Dr. Romina Moradi wrote not only was the intent of the session “misrepresented” to them, but the exclusion of International Medical Graduates from the offer was “disrespectful, inequitable, feeding into the systemic racism many of our colleagues regularly face.”

The president of the Resident Doctors of B.C. took a diplomatic tone in an interview with CTV News, insisting that the Ministry of Health has been responsive to their feedback in past discussions but acknowledged the offer has gone over like a lead balloon.

“There's been a significant amount of anger and frustration among the community of residents and I think part of that has to do with the consultation process,” said Dr. Devon Mitchell. “One of the big messages we want to carry forward working with government is that there needs to be a more robust system of consulting with residents – particularly those intimately affected.” 

TALKS BETWEEN GOVERNMENT AND DOCTORS ON HOLD

Last month, the health minister angered family doctors after he said nurse practitioners provide better primary care, and the premier tried to smooth things over with a “reset” as John Horgan got involved with discussions about what he admitted was a “teetering” health-care system.

Dix was defensive about the offer, bristling at suggestions it’s a public relations move meant to make it look like the government is taking action on the primary care crisis, without offering a solution for the thousands of family physicians already struggling with a gruelling workload and outdated payment model.

“This is a temporary step, in a sense, because we want a broader deal that makes it better for everybody and throughout the system,” he told reporters on Tuesday. “In the interim as we work together on those things, I think people want us to take action -- this is action. It’s not a step to solve every problem, but it’s a step to encourage young doctors to become part of full family-practice medicine.”

He did not deny suggestions he blindsided doctors. Over the weekend, the Family Doctors of B.C. sent an internal memo to member organizations where leaders claimed not to know about the proposal, insisting they’d taken doctors concerns to the ministry, and that they had told the deputy health minister they “will not attend future meetings with the Ministry unless (they) have direct input into the agenda.”

Surgeons, anaesthesiologists and radiologists are among those who’ve criticized the minister’s “top-down” approach to planning and decision-making without consulting front-line staff. 

CONTRACTS AND CONTROL: THE CONTROVERSY EXPLAINED

There’s been much discussion about the fee-for-service payment model, universally described by doctors as outdated and failing to consider skyrocketing overhead costs and the time physicians spend with patients. 

But the province’s offer for new-to-practice doctors to have a set salary is probably just as unpopular.

Veteran physicians are taking to social media, warning their new peers that they’d be signing away independence in how they run their practice for a set amount each year, with overhead costs unpredictable and contracted doctors unable to work more or modify their workload, and potentially even their hours, in response to changing conditions.

“The average overhead costs for a family physician is between $115- and $125,000 -- right off the bat you take that off,” explained resident doctor Alexander Kilpatrick.

Long-time family doctor Jennifer Lush called the offer in the midst of skyrocketing inflation and a family doctor crisis, “a bit like offering a glass of water to somebody when the house is on fire.”