After 18 years as a rural physician in Fraser Lake, B.C., 900 km north of Vancouver, Alan Gow considered moving last year to a less isolated practice in southern British Columbia. First, he advertised in medical publications to find a new doctor for Fraser Lake and the surrounding area, where he and a colleague serve about 5,000 people. The ads ran for three months without eliciting a single reply—no doubt, says Gow, because of the arduous schedules faced by rural doctors.
Besides putting in a full work week at Fraser Lake’s medical centre, he and his colleague are each on emergency call two nights a week, and from Friday evening to Monday morning on alternate weekends. Maintaining that rates of pay for on-call services are too low, Gow and 22 other physicians in British Columbia’s central interior have stopped carrying out normal hospital duties and refused most emergency calls since late January. About two-dozen rural physicians from other parts of the province subsequently joined the protest as they haggled with the province for a better deal. But last week, the talks collapsed amid recriminations on both sides. Gow suspects Premier Glen Clark’s NDP government of having a hidden agenda—“ultimately, they want to have physicians on salary, instead of the present system in which we’re rewarded for what we do.”
It was a week in which stresses and strains in Canada’s medicare system seemed to pop up everywhere as groups of doctors protested a continuing government squeeze on medical funding and on their incomes. While British Columbia’s rural doctors continued their partial withdrawal of services, thousands of physicians in other parts of the province staged their second one-day work stoppage in two weeks to back demands for increased medicare funding. In Alberta, doctors threatened “forceful action” if Premier Ralph Klein’s Conservative government does not pump new funds into health services, while in Montreal, 65 surgeons at
the city’s Sacré Coeur hospital mounted a two-day strike to back demands that the province reopen 140 recently shut down hospital beds.
There were more problems. In Edmonton, thousands of cleaners, laboratory technicians and other support workers walked off the job at seven hospitals in a shortlived strike called to back demands for higher pay and improved job security. The stoppage ended later the same day when negotiators for the two sides reached a tentative agreement. On top of everything else, a scarcity of anesthetists in some places—including Calgary, Toronto, Montreal and Halifax— forced hospitals to close operating rooms. Dr. John Cowan, Ottawa-based president of
the Canadian Anesthetists’ Society, blamed the shortage on several factors, including provincial funding cuts that reduced the number of training positions in hospitals. “Governments don’t seem to be concerned,” said Cowan, “because they see it as a way of saving money.”
The one-day protest by B.C. physicians, who withdrew all but essential services, forced hospitals to postpone hundreds of operations. With another withdrawal of services scheduled for March 31, the rhetoric increased as the government and the 7,000member B.C. Medical Association exchanged verbal barbs. The provincial funding squeeze and resulting delays for surgery have begun to kill people, claimed association president Dr. Granger Avery. He said he knew of three cases of patients who died while waiting for operations, but could not give details because of patient confidentiality.
The doctors say that even though Health Minister Penny Priddy announced an increase of $228 million to the overall health budget, a cumulative funding shortfall that has built up since 1996 is crippling health services. The system, declared Avery, “is in a shambles because of the organized rationing of health care.” In her response, Priddy accused the doctors of creating the problem, taking too much money out of the system by performing more costly procedures to inflate their incomes.
In Alberta, the province’s 5,200 „ member medical association « placed advertisements in 10 daily u newspapers threatening unspeI cified action if the Klein governi ment did not meet its demands, g which include eliminating a fiveg per-cent fee reduction imposed ° five years ago, and higher funding levels for health care. An association spokesman said doctors were considering various ways of pressuring the government, including rotating office closures and the possibility of direct billing some patients for doctors’ fees.
For Gow in Fraser Lake, the main worry is not the B.C. government’s threat to hire temporary replacements as he and his colleagues continue their campaign. What he fears is a government agenda to “gain greater control over physicians’ incomes, and over the whole health-care system.” It is a concern shared by many Canadian doctors as they fight governments over money and power—a quarrel in which patients stand to be the biggest losers.
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