There should be nothing complicated about drafting terms of reference for binding arbitration, the president of the Newfoundland and Labrador Medical Association (NLMA) said Thursday.
Dr. Yordan Karaivanov, president of the Newfoundland and Labrador Medical Association, speaks to reporters about binding arbitration for doctors Thursday.— Photo by Joe Gibbons/The Telegram
“We were hoping this was going to be settled a long time ago. This is not a complicated issue. There are enough examples in the legal world to point a way towards resolving that,” Dr. Yordan Karaivanov told reporters in St. John’s.
“And we don’t see that as a very time-consuming process. It is something that can be done very quickly and very easily.”
The NLMA has told the government it won’t begin negotiations for a new agreement until those terms of reference are set.
The right to binding arbitration was won when the doctors and the province struck a deal in 2010. That memorandum of agreement — deciding doctor pay and other contract issues — was for the period 2009-13.
Negotiations on a new deal have not yet begun. Arbitration would not kick in until talks have been going on for a year.
The NLMA told its 1,250 members this week that despite numerous attempts, it has been unable to engage the government in a discussion to finalize the terms.
A spokeswoman for Finance said Thursday arbitration is to be discussed at a meeting with the doctors May 16.
Binding arbitration can help the tone of negotiations, Karaivanov said.
“Both parties have to be reasonable if they know that in 12 months binding arbitration may be the dispute mechanism,” he said.
Karaivanov, a family doctor in Happy Valley-Goose Bay, spoke to reporters after his address to the St. John’s Rotary Club.
He spoke about primary care and changes needed to sustain the province’s health-care system.
One problem that affects accessibility is the high rate of chronic disease in the province — cancer, heart disease and diabetes, Karaivanov noted.
Another dilemma is the recruitment and retention of doctors.
Since the last contract, struck in 2010, there are about 100 more doctors in the province.
But he said the rate of those leaving has also gone up.
“Our membership data shows that every year for the last five years the number of practising doctors leaving the province has increased, from a low of 26 to a high of 50,” Karaivanov said.
Both parties have to be reasonable if they know that in 12 months binding arbitration may be the dispute mechanism. Dr. Yordan Karaivanov, president, Newfoundland and Labrador Medical Association
About four per cent of doctors leave every year, and that’s on top of the doctors who leave the system due to retirement.
To compensate, the province has recruited internationally. And Karaivanov said while many like him plant roots, most don’t — the average length of stay for international medical graduates — who account for 40 per cent of the province’s doctors — is two years.
And for those who graduate from Memorial University, only one in five family doctors who initially stay home are still practising here 10 years after graduation. While Karaivanov said MUN deserves accolades for the number of its graduates who decide to practice in rural areas, there is aggressive enticement from other provinces.
“One thing is certain. We need to turn around the retention rate of Memorial graduates quickly, to address our own access issues and also to get an appropriate return on investment for the millions of dollars being spent on the faculty and its recent expansion,” he said.
Karaivanov said primary health care needs a systematic change, a shift that includes more provision for doctors to work in integrated teams with other health professionals.
For instance, there is no special provision for doctors to bill for nursing care under MCP.
Practices that offer a scope of services, timely access to appointments, electronic records and continuity of care must be part of a new model of primary care, he said.
“We find the provincial government to be receptive to our advocacy around this issue,” Karaivanov said.
“We are in the early stages of putting ideas together that will, hopefully, turn into specific proposals for revamping primary health care.”