As you know, the Doctors of BC will have a new governance structure September 14, 2017. This new structure will consist of a smaller board and a large Representative Assembly (RA). The old board was truly representational, with all members able to vote in their districts . The new RA has around a dozen district representatives and 77 members appointed by their sections and societies. While this arrangement sounds good, there is a fundamental flaw – only 20 to 40 per cent of Doctors of BC members join their sections. As it stands the doctors on the RA will be representing a minority of members. I would like to propose a simple remedy: When you join or rejoin the Doctors of BC, you automatically get membership in your section or society. Every member would be able to have a say, and the new governance structure would be more representative. Please let me know what you think.
MSP has given notice that it wants to review any and all fees that in aggregate account for more than $1,000,000 a year in billings, and that appear to earn doctors more than $10 a minute. MSP has proposed that any such fees be halved or more, down to no more than $5 a minute.
Aside from the obvious problems of cutting any fee by such a large amount, I am unclear on how anyone can know how many minutes of work are in a fee code. When I see a patient for a neurology consult, the time I work is considerably greater than the 45 to 60 minutes I typically spend talking with and examining a patient. I put in hours triaging referrals, ordering and reviewing tests, answering phone calls, participating in hospital committees, teaching students and so on.
If I could bill $5 a minute for my patient-related activities (10 hours x 60 minutes x $5 a minute = $3,000 a day) I’d say, bring it on MSP! I imagine, however, MSP is thinking the minutes are from when you pick up a scalpel until you put it down. Can you imagine if we expected lawyers to only bill the 30 minutes you spoke with them, with no charge for the hours of preparing papers and submissions?
This transparent attempt at a relative value fee guide is misinformed. Even if our current fees aren’t as equitable as we might like, cherry picking particular items and reducing them by 50-90% without taking into account all we do for patients is not going to work.
Paul Straszak, Doctors of BC chief negotiator, will be starting consultations with all of us very soon. What do you want as a priority? General increases, targeted increases, new programs, something else? Mr Straszak can’t please everyone all the time but he has been very open to talking with us, and is a talented negotiator. He can’t try to get you what you need unless he knows what that is!
Patients often travel a long way to consult with us as specialists. If we need to see them in follow up, they have to travel again. I have been increasingly using telehealth, sometimes for first consults, and sometimes for follow up visits. In my health authority, Interior Health, we have a telehealth room in most facilities. I can use my own desk top computer or an iPad to have a face-to-face neurology visit with my patient. Most sections have good telehealth fee codes. In IH, one of our biggest users is Thoracic Surgery; one third of their billings is telehealth. Are those of you that aren’t using telehealth interested in a CME event to get you comfortable doing it? Let me know!