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The Physician Master Agreement (PMA) is the document that governs compensation and benefits for Fee-for-Service and Alternatively Paid Physicians in BC. In our bi-annual Member Survey, it is continually identified as the most important program and/or service in which Doctors of BC supports members. Members, however, frequently wonder how the negotiations process works, what actually takes place and when, and how their wishes are incorporated into the final agreement.
The following overview explains the key steps and milestones in developing the negotiations mandate, the bargaining process, and how an agreement is approved by members. It also highlights the importance of the physician voice in the development of the negotiating mandate and in bargaining.
Well in advance of us sitting down with government to start discussions, much prep work has already taken place. PMA negotiations are driven by members’ priorities on key issues such as funding for programs, fees, and benefits that we gather through extensive member consultation via a number of different avenues: our comprehensive negotiations survey; virtual webinars and Q&A sessions with members; and meetings with all sections and both societies, physician members of the GPSC, SSC, SCC, JSC, and the Joint Benefits Committee, and the Representative Assembly.
Once all the feedback is collected, it is then carefully analyzed to identify recurring themes and priority areas. Important issues raised by members for the 2022 PMA include funding to address growing business costs and ongoing support for virtual services to patients.
2. Understanding the environment
While member consultation is underway, Doctors of BC staff undertake an environmental review taking into consideration factors that can impact negotiations such as: economic indicators, other provincial settlements, government and Ministry priorities, and the Doctors of BC Strategic plan.
3. Developing the draft plan with physician input
Once all member input is gathered and sorted into themes and the negotiations environment is assessed, Doctors of BC’s Negotiations team develops a draft negotiating plan which is then reviewed by two physician committees. Each of these committees offers a different perspective that provides expertise and input into the following elements of the draft negotiating plan: the strategic approach we will take with government, the core objectives that need to be achieved within the agreement, and the opening proposals.
Negotiations Coordinating Group (NCG): comprised of the nine physicians who will play an active role in the upcoming PMA negotiations, this committee is the first to receive and review the draft negotiating plan. The NCG considers the plan through the lens of those physicians with the most negotiating experience, and they focus on how we can achieve our member priorities in the context of the negotiating environment. The NCG has completed this work, and made its recommendations to the Negotiations Forum.
Negotiations Forum (NF): comprised of 16 physician members who represent the broad cross section of physician practices in BC, the NF ensures that the amended PMA negotiations plan appropriately balances the collective interests of the entire membership, and is representative of them. The NF is responsible for making a recommendation on the draft negotiating plan to the Board.
4. Final approval by the Board of Directors
Once the draft negotiating plan is endorsed by the Negotiations Forum, it is presented to the Doctors of BC Board of Directors for final approval. Approval by the Board constitutes direction to the Statutory Negotiating Committee to formally begin negotiations with the BC government.
5. Face-to-face negotiations
When negotiations between Doctors of BC and the BC government formally begins, it is carried out by the Statutory Negotiating Committee (SNC). Comprised of experienced physicians from the NCG and supported by staff from the Doctors of BC’s Economics, Advocacy and Negotiations Department, the SNC’s primary responsibility is to conduct PMA negotiations in accordance with the negotiating plan approved by the Board of Directors. Doctors of BC’s Chief Negotiator is the chief advisor to the SNC and is the committee’s official spokesperson in the negotiations.
Both government and Doctors of BC typically agree to a communications/media blackout during the period of face-to-face negotiations so that each party can explore the broadest range of options to find a deal that represents both parties’ best interests. This is a common practice in negotiations of this nature.
6. Agreement and ratification
Once a tentative agreement has been reached by both parties, the following steps are taken:
Board of Directors: Reviews and must approve the tentative agreement. Board approval constitutes direction that the tentative agreement be distributed to the general membership for ratification.
Membership referendum: A summary of the tentative agreement and the detailed changes to the PMA are distributed to the general membership for consideration in the ratification vote.
Ratification vote: Members are given 3-5 weeks to review the material and to vote on whether to accept or reject the changes.
If a majority of the voting membership supports of the deal, it is ratified and the agreement is signed by all parties.
If a majority of the voting membership rejects the deal, we return to the bargaining table with government.
If we are unable to come to an agreement with government, the PMA states that a Conciliation Panel – a dispute resolution body – shall be appointed to help resolve outstanding compensation issues. The Chair of the Conciliation Panel will initially attempt to mediate an agreement between the parties. However, if that is not achieved then the Conciliation Panel will release a report with its recommended settlement terms for the outstanding issues. There are two types of recommendations:
Central Recommendations contain the recommended settlement terms for physician compensation (Fees, Service, Salary and Sessional Contract rates), On-Call Issues, and Benefits issues. These are binding on the parties unless government rejects them within 10 days.
Other Recommendations contain the recommended settlement terms for all other issues and are not binding on either party.
2022 PMA negotiations timeline
The timeline below outlines key elements during the 2022 PMA negotiations process.
Step 1: Gathering information
Between October 2020 and January 2021, member input and feedback was gathered through the following avenues:
Negotiations survey of all members to identify overall member priorities.
Briefings with each Section and Society, as well as meetings with Doctors of BC members on each Joint Collaborative Committee and the Alternative Issues Payment Committee, to outline the PMA negotiations context and discuss priorities (each group then provides a written submission).
Two virtual member consultation webinars and Q&A sessions to provide negotiations context as a background for written submissions identifying individual member priorities.
Representative Assembly briefing and workshop to determine overarching negotiations principles.
Meeting with Board members to identify priorities.
Step 2: Developing the negotiating plan and mandate
Between March and June of 2021, Doctors of BC’s Negotiations team developed the draft negotiating plan which was reviewed by the Negotiations Coordinating Group and the Negotiations Forum, and ultimately approved by Doctors of BC’s Board.
Step 3:Negotiating the agreement
Bargaining between Doctors of BC and the BC government began in January 2022, with the agreement being ratified in December 2022.
Realities of physician compensation
How doctors are paid
There are a number of different ways that doctors get paid, but by far the most common is fee-for-service (FFS) – a fee is paid for each service doctors provide to their patients. The Medical Services Plan pays these fees, which are funded by public dollars. Other models include service, sessional, and salaried contracts for doctors who provide services to a publicly funded agency, such as a Health Authority, or at a hospital or community setting. Over the last few years, there has been a growing desire from many established and new-to-practice doctors to move away from a straight FFS payment method to some other or alternative payment models.
Doctors of BC supports the development and testing of new payment models in an environment where physician choice is protected and where parties have the opportunity to evaluate their effectiveness before broader use. In 2020 the BC Ministry of Health consulted with Doctors of BC and introduced a number of new contract options for BC doctors that provide more choice for those who want to move away from FFS and practice in a different way. More information can be found on our New Contract Options page, our Payment Models – Information for Physicians page, as well as in our summary paper, Physician Compensation Models: A Backgrounderwhich provides an overview of different payment models based on a review of BC and other jurisdictions.
How overhead fits in
Many physicians are responsible for paying overhead costs associated with running their practice. These costs come directly from any income they take in and have a huge range: from about 5% for some specialties, up to 35% for family practice, and even higher for other specialties. Overhead costs are typically comprised of IT infrastructure such as computers and electronic medical records software; medical equipment such as stethoscopes, blood pressure cuffs, weight scales, etc.; staff support, office rent, insurance, and utility payments, to name a few. The doctors’ income as reported in government’s annual ‘blue book’ is gross income that needs to cover payment of these overhead costs – that total would need to have overhead costs subtracted from it to identify the net amount of doctors’ income.
How the Joint Collaborative Committees fit into negotiations
For the past 15 years, Joint Collaborative Committees (JCCs) have been working to improve BC’s health care system. A partnership between Doctors of BC and the BC government, the four committees – Family Practice Services Committee, the Specialist Services Committee, the Shared Care Committee, and the Joint Standing Committee on Rural Issues – connect doctors, government, health authorities, patients and families, health professions, and other stakeholders who work together to improve access to care by focusing on patients and families/caregivers, building physician capacity, and coordinating health system services.
Funding for the work undertaken by the JCCs is provided through the Physician Master Agreement (PMA).
The 2022 Physician Master Agreement
The 2022 Physician Master Agreement (PMA) was ratified by members in December 2022. For information on the current PMA, including an overview summary as well as the PMA document in its entirety, please visit our 2022 Physician Master Agreement webpage (login required).