Ross Langley, MD, FRCPC, MACP; and Charles Weijer, MD, PhD, FRCPC
Following review of this case , the learner should be able to:
You have recently become the president of your local branch of the provincial medical association. The agenda for your first meeting of the provincial association arrives, and among the many items listed, one especially piques your interest: a report from the negotiation committee that talks for the next contract are not going well.
At the meeting, you learn that negotiations for a new contract have been ongoing for nearly two years. The association is asking for a 12 per cent increase in fees over the life of a three-year contract, higher standby fees for physicians on call for intensive care units outside cities and incentives to encourage physicians to relocate to areas such as yours. The association objects to the removal of certain insured services from the reimbursement schedule. The government wants the association to accept reduced fees for some services, and saved costs will be used to increase fees for undervalued services. You observe considerable polarization among the members with respect to physician job actions and whether it is ethical to undertake them.
You must now report back to your local branch, and you expect that the same concerns about the ethics of job actions will surface there. Two senior colleagues advise you to develop a framework outlining the ethical issues that you can use for discussion at the meeting.
Recognizing the right of our colleagues to disagree, we support the view on physician job action taken by the American College of Physicians. We conclude by quoting — and endorsing — their view:3
"Changes in the practice environment sometimes adversely affect the ability of physicians to provide patients with high-quality care and can challenge the physician's autonomy to exercise independent clinical judgment and even the ability to sustain a practice. However, physicians' efforts to advocate for system change should not include participation in joint actions that adversely affect access to healthcare or that result in anticompetitive behaviour. Physicians should not engage in strikes, work stoppages, slowdown, boycotts or other organized actions that are designed, implicitly or explicitly, to limit or deny services to patients that would otherwise be available. In general, physicians should individually and collectively find advocacy alternatives such as lobbying lawmakers and working to educate the public, patient groups and policymakers about their concerns. Protests and marches that constitute protected free speech and political activity can be legitimate means to seek redress, provided that they do not involve joint decisions to engage in actions that may harm patients."