Letter from Dr. V. Bennett, MD FRCPC Room 184, Ellis Hall
103 Hospital Drive Tel: (306) 966-8230
Royal University Hospital Fax: (306) 966-8177
SASKATOON, Sk S7N 0W8
27 November 2000
Dr. Brian Scharfstein,
Executive Director,
Saskatchewan Medical Association
402-321 21st Street East
Saskatoon, SK
S7K 0C1
Dear Brian,
Following the meeting of the RA last weekend, I reflected further on the state of negotiations, the events
being reported in the media affecting specific specialty resources, and circumstances that are relevant to
psychiatric care in the Province of Saskatchewan. I would like to offer, what I hope are, constructive suggestions for the Board and negotiating committee to consider as the next weeks of negotiations unfold.
In a climate of severe health care spending rationalization and questionable decisions by health care
administrators, various interest groups become more desperate and begin to act autonomously. This has been evident in the College of Medicine for some time. The recent and separate negotiating activities of specific specialty groups is an unsettling pattern that serves to undermine the SMA negotiating process affecting all other physician groups. There is the risk of a snowball effect, where each section, defining its 'unique' problems becomes its own bargaining unit.
People leaving Saskatchewan have made a decision and are by default no longer interested in being part of an in house solution. I stated during the meeting of the RA that I am not packing and leaving, nor I am I interested or supportive of such threats as a lever in any negotiating process. To be clear, I believe, consistent with the SMA's mission statement, that the SMA is necessary, relevant and the most effective voice for all physicians. To be effective in that capacity, the SMA must provide balanced, broad and unified representation. Intersectional conflict, independent 'deals' and finding loopholes in resolutions undermines the spirit of the mission statement. The SMA must begin to address these issues.
More specifically, we should be able to address psychiatric manpower issues without unilateral action and at the same time uphold the interests of physicians across the province.
Child psychiatry resources are in a desperate state. The current career training child psychiatry residents at the U of S have expressed interest in practicing in Saskatchewan in academic and clinical settings. All will be ready for practice within one year. With the critical shortage of child psychiatrists throughout North America, they may easily be lured away by more attractive offers. Further, none of the other psychiatry residents in Saskatoon are pursuing child psychiatry. The minister of health has a stated interest in the health and well being of children. There is potential to improve child psychiatry resources,
but we must seize the opportunity now.
The contract psychiatry dispute is one you are very familiar with. With the majority of psychiatric services outside of Saskatoon being provided by contract psychiatrists, we must bring the full bargaining potential of the SMA to bear on resolving the crisis. Many of our colleagues are demoralized and some certainly will be leaving. Achieving a fair and flexible contract will improve hopes of recruitment, ease the stress on family physicians trying to arrange psychiatric consultation and ultimately better serve
the people of Saskatchewan.
With respect to negotiations, modifications and alternatives could still be considered that is within the mandate of the negotiating committee and is perceived by government in good faith. During my tenure with PAIRS and in turn the CAIR Board of Directors; I was involved in negotiations for several years. I had the fortunate opportunity to attend two negotiation workshops including one conducted by the
former chief negotiator of a major airline pilot's association. Defining mandates, understanding the
ramifications of bargaining in good faith and how to apply leverage were among the more important negotiating tools we were familiarized with. With this in mind, I have several suggestions that I hope are worth considering by the SMA during negotiations. I was mindful of developing suggestions that will affect all members of the SMA while improving the environment in which we strive to improve and
stabilize psychiatric resources.
1. Disparity Fund: Within the mandate of negotiating for insured services, and acknowledging the lack of success in correcting disparity, explore the possibility of creating a Disparity Fund for the current contract period. Broadly speaking, this fund would be share among the lowest income sections and allow each said section to determine which fee codes to adjust. This process would increase the baseline of disadvantaged sections over the term of the contract and make future adjustments to the
fee schedule more relevant. Using such an approach partly shifts the disparity issue to the negotiating table thereby reducing conflict between sections.
2. Time based fee codes: Although not generally considered, there is room within the negotiating mandate to adjust specific fee codes (for example, 760A is a selective code and there is a proposal to expand its definition). Establish a fund to specifically adjust time based feed codes for sections in the low end of the disparity index and whose earnings are primarily determined by the use of time fee codes. Adjusting time based fee codes is an issue that has been before the SMA for some time. Earnings based
on procedural codes and 'visit' codes are limited only by the 'number' of procedures that occur. After controlling for overhead costs and hours of work, time places rigid limits on earnings.
3. Contract Psychiatrists: The negotiations for contract psychiatrists fall outside the mandate of
negotiations for insured services. The leverage achieved however, by 1100 members of the SMA is much greater than that brought to bear by 30 contract psychiatrists. Tying ratification of a new SMA contract to resolving the contract psychiatrist dispute would send two clear messages. The first is directed to government and health districts indicating that all sections within the SMA are
unified in support of contract ratification. The second, and equally as important, is a voice of solidarity within the SMA that helps reduce the perception by some individuals and sections of being an isolated voice.
The section of Psychiatry is working on many fronts to address Psychiatry resources. We have had very limited success in addressing this issue and much of the effort is not well coordinated. I believe the SPA needs to better coordinate its activities and together with the SMA work towards enhancing and stabilizing Psychiatric resources. Major progress in reducing the disparity index is an important step in the process. To that end, the recommendations outlined above begin to effectively address disparity (as per the longstanding directive of the RA) and create leverage in resolving the contract psychiatrist's
dilemma.
These recommendations are provided while trying to be cognizant of those sections that have yet to benefit from the disparity process. In considering these proposals, the membership will need to understand the global benefits that can be achieved.
Thank-you for your time and interest. I look forward to talking with you further about these matters. Please feel free to contact me at any time.
Respectfully submitted,
V. Bennett, MD FRCPC
Department of Psychiatry.
C: Dr. R Milev, Mr. E Hobday, Dr. R Bowen,
Dr. S Shrikhande, Dr. D Keegan, Dr. E Cherland,
Dr. S Khuka-Mohamad,
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