Binding arbitration the only reasonable option
On March 19 the Newfoundland and Labrador Medical Association (NLMA) called on Premier Danny Williams to refer negotiations for a new agreement between the province’s doctors and government to binding arbitration.
The premier promptly dismissed this possibility, stating: “under no circumstances are we prepared to send this matter to binding arbitration.”
Despite Mr. Williams’ edict, the NLMA is not abandoning our position. We believe arbitration is entirely justified and in the best interest of not only the province’s doctors, but the public as well.
The NLMA and government are not the only stakeholders in this seemingly endless negotiation. Every single resident in this province has a major interest in the outcome because at some point, with very few exceptions, each of us will come to depend on the medical care system for help. We must be sure the services we require will be there for us in a satisfactory and secure way today and in the future. We believe that it is critical for every resident to draw their own conclusions about what is best for them. This should occur based on the real medical care challenges we face and not government’s conjecture, doctor bashing or conspiracy theories.
The current deadlock gives rise to a number of questions that deserve answers. Why is the NLMA calling for binding arbitration? How would binding arbitration work? Why is arbitration in the public’s best interest? Does the government have the legal or moral authority to refuse the NLMA if arbitration is in the public’s best interest?
In order for negotiations between any two parties to be successful there needs to be mutual trust, respect and confidence. Unfortunately, the NLMA experience over the last 15 months has eroded our faith in reaching a fair and meaningful outcome. A brief review of some of the recent developments explains why the NLMA has lost confidence in the process.
On March 17, the premier described the NLMA’s written proposal of March 3 with the following statement: “ Through the roof, not affordable, can’t be dealt with, can’t be satisfied, can’t be answered.” With those mere 15 words the premier snuffed out 15 months of what the NLMA was led to believe were genuine negotiations. He has already made up his mind and declared publicly, in no uncertain terms, that the NLMA proposals were worthless. He happens to also have the final word on the government’s level of support for medical services in our province. To make matters worse, the NLMA was informed of the government position through the media rather than directly, violating the very conditions of confidentiality that the NLMA was asked by government to observe. This was not the only such violation by government - the same betrayal had occurred previously in the spring of 2008.
When the premier decided to scold the doctors in the St. John’s lab he referenced the fact that they earned a $350,000 salary and in the same breath unleashed his judgment of the so-called “over the moon” NLMA proposal. This left the impression that all salaried physicians earn the same money, have unreasonable expectations and are undeserving. In fact, the vast majority of salaried physicians actually earn about half that amount (between $ 150,000 and $ 180,000). Moreover, the arrangements for those currently receiving the $350,000 were made directly by then Minister of Health Ross Wiseman to individual physicians. These arrangements were not negotiated with the NLMA. This can be substantiated by a review of the most recent agreement, which makes no reference at all to the $350,000 the premier speaks of.
The NLMA has been clear from the very beginning that our focus is on the functionality of the medical care system in contrast to government’s focus on patterned bargaining. Doctors want a medical workforce that is adequate and a working environment that is stable to enable safe and timely medical care. That requires fair and competitive compensation. It also requires a government that actually listens to what doctors have to say. More than six weeks have now passed since our proposal was transmitted to the government and still there is no substantive reply, only the pre- mier’s wanton assailing of the province’s doctors. Our proposals are now out there for everyone to examine for themselves. They are focused on identifying and solving problems, they are presented in a conciliatory tone open to compromise and calling for an on-going collaborative approach - certainly undeserving of the repudiation we received.
Government seems to be treating these negotiations as a contest that they have to win at all costs. Beating the doctors into submission will give the government nothing but a hollow victory and will jeopardize our medical services for years to come. After all is said and done, do we want the physicians in this province feeling undervalued, bruised, demoralized and unfairly treated? Because that is exactly how they feel today. Is this the kind of environment that will keep doctors here and attract new ones to our province? Is this the way to build and maintain a stable and effective medical care system? If the past 15 months have resulted in paralysis and acrimony, isn’t it time to try something different? The doctors feel that binding arbitration is the best alternative.
The NLMA’s position on arbitration flows from Section 12 of the Canada Health Act. In order for provinces to receive federal funding for insured medical services, they “must provide for reasonable compensation for all insured health services rendered by medical practitioners” [ 12.( 1)(c)]. The requirement for reasonable compensation is deemed to have been complied with, if the provincial government enters into an agreement with an organization representing the medical practitioners. The agreement must provide arrangements for negotiating compensation and for settling disputes. More specifically, Section 12(2)( b) states: “ for the settlement of disputes relating to compensation through, at the option of the appropriate provincial organizations.... conciliation or binding arbitration by a panel that is equally representative of the provincial organizations and the province and has an independent chairman.” The provincial government still retains the option of over-ruling the panel by Act of the legislature.
The arbitration process described above is not unprecedented in our province. In 2002, this process successfully resolved the impasse between doctors and the former government. It is an objective and neutral process by which awards are determined on the merits of the cases put forward by the parties. Surely any fair-minded person who wants to see a timely end to this otherwise stagnant negotiation and put the future of medical services on the right track will understand why arbitration is the only reasonable way to go. And the government should accept binding arbitration, not because they are compelled to but because it is the right thing to do.
Robert Ritter Executive Director