Monday, January 16, 2017

A Bold (if Half-Baked) Idea for the National Medical Association

Half-baked? Sure. But it's something that hasn't been seriously discussed in the 20 years I've been in health care, if ever.

Last month, I wrote a post about the medical-political landscape in Prince Edward Island. Though the island and its health care system rarely garner much attention, they should. The government is on the cusp of passing a brazen piece of legislation giving the Minister of Health an effective veto over where and what a doctor may practice in the province. Rather than address what it perceives as doctors' bad behavior through existing mechanisms - audits, College complaints, billing clawbacks - the government opted for a power grab, that could easily inspire other jurisdictions to do the same.

Numbering barely 300 (if that), doctors in PEI lack the numbers or the money to mount a successful campaign pushing back against the government. It's not for a lack of fees. PEI doctors pay their medical society pretty much the same as Ontario doctors, but at a much lower payscale to offset the cost.

So what's my half-baked idea?

Have the national medical association pick up the baton and the cost of the fight.

I'm far from the first doctor-blogger to propose that medical associations need to be forceful and muscular when looking after doctors' interests. Still, those voices tend to focus on the provincial/territorial/state level, where - granted - the nitty-gritty of government relations, fee negotiations, etc. take place. In PEI, however, the doctors are facing a situation with few precedents: a direct attack on the practice scope and autonomy the profession is supposed to define for itself.

For all the talk about advocating for a strong medical profession, neither the Canadian nor American Medical Associations profess a dedication to preserving doctors' autonomy. Public relations campaigns are expensive, and legal challenges (that could potentially reach the Supreme Court) are very expensive.

There will never be agreement over what doctors should be paid, either between specialists and general practitioners, or between neighbor jurisdictions. We should all agree, however, that an encroachment on professional autonomy by government is not a regional problem, but a national one. And a national problem needs a national response. Let's add a new line to the Mission Statement of the national association: to protect the integrity and autonomy of the country's hard-working doctors.

Three hundred doctors can't bankroll a court challenge, but surely 85,000 - whose membership dollars are now used to debate marijuana laws and manage its beleaguered journal - can, and should do so with enthusiasm.

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