Steven Wharry is the associate editor of CMA News
Canadian Medical Association Journal 1995; 153: 1150
[résumé]
As the CMA's provincial and territorial associations negotiate fee agreements with government, they must also begin as early as possible to inform members of any potential deal, physicians attending September's CMA-sponsored National Health Policy and Negotiations Conference in Ottawa were told.
Delegates heard that the galvanization of support from members by increasing the flow of information during negotiations can provide a big edge both at the bargaining table and after a deal has been reached.
At the Alberta Medical Association (AMA), for instance, a group now delivers messages from the negotiating committee to members as negotiations proceed. This "second table" of representatives, which advises the Board of Directors, keeps members informed about the issues being discussed.
"We realized we needed a second table because our last agreement was [reached], and then we went back to the members and tried to sell the deal," said Dr. Robert Burns, executive director of the AMA. "When the membership only voted 60% in favour of it, the board realized it had to do something differently."
The AMA decided its second table would comprise members from the negotiations, government affairs and communications committees, as well as other key representatives. The primary role was to advise the board during 1995 negotiations, but the second table was also expected to provide advice on communication with members.
Burns said the Alberta experience has been largely successful, but admits that more will have to be done to keep members informed about issues being negotiated and the process by which agreements are reached.
"The [second] table felt [it] had lived up to the task, but communication could have been better," said Burns. "There were concerns raised that we just made the `in-crowd' bigger, and many members still felt that they were not being informed."
Burns discussed the second-table concept during the fifth annual CMA National Health Policy and Negotiations Conference. Each year the conference brings together key players from each division who negotiate agreements with governments.
The conferences tackle different themes, but have an over-riding goal of improving negotiating skills; the CMA considers them a vital part of its role of serving as a clearinghouse for information that will help all divisions.
Dr. Jack Armstrong, the president, says the CMA is committed to developing new themes that focus on important health-policy issues that are likely to come up in the future. "This conference has come to represent one of the most important products of the CMA," said Armstrong.
Along with the second-table method of ensuring that members remain informed during the negotiating process, the 1995 conference examined possible opportunities for public-private financing of health care in Canada and the mutual-gains approach to negotiating.
Many divisional representatives say physicians' lack of trust that governments will implement agreements once they have been negotiated is one of the key hurdles in the negotiating process. The Medical Society of Nova Scotia recently endured this situation, when the province insisted it did not have the funds to meet the negotiated terms of an earlier contract.
Armstrong said that since external issues are likely to play even larger roles in future negotiations, the CMA will continue to seek ways to protect the interests of its members and divisions at the negotiating table.
"The negotiations process no longer considers questions of fees or prices in isolation," said Armstrong. "It has become intertwined within a medical/political framework, and this provides a host of challenges and opportunities, as well as threats."