A 3-person mediation panel, comprising 2 lawyers recommended by the British Columbia Medical Association and a government representative, is now gathering submissions. It was to report by mid-November. The parties then have until Nov. 30 to respond.

The mediators' findings are not binding, but Premier Ujjal Dosanjh has stated that if the panel finds the government's previous offer inadequate, it will be improved. BCMA President Marshall Dahl is optimistic. "Out of this should come a plan to keep enough doctors in these rural areas, that will treat people equitably but also [acknowledge] that some places are more remote and need better incentives."

Many doctors have fled rural BC, which has been plagued by chronic staff shortages. Patients are also on the move: Dahl says transfers to Alberta or Vancouver now "a fact of life."

Negotiations have been complicated by a unique political environment, said Dahl, referring to the NDP's 8 years in office. "It has been a fairly poisonous atmosphere, frankly, and it has taken a long time to bring things to resolution." In March the BCMA signed a 1-year agreement that provided more money for physicians. Doctors agreed to eliminate their reduced-activity days — the closure of offices 1 day a month — and the BCMA agreed not to condone any service withdrawals by MDs.

When doctors around the province began doing just that, the BCMA was left trying to mediate a solution. The withdrawal by some groups of doctors also thrust some physicians into the unfamiliar role of negotiator. "I was very worried that doctors in these communities would be taken advantage of," said Dahl. The association offered professional advice about negotiating skills, which most of the doctors accepted.

Late this summer, the government proposed that the BCMA become a union, which would give the government the power to use the courts to enforce agreements. (A referendum on unionization was rejected 4 years ago.)

"We have always gone for voluntary membership," said Dahl, who notes that more than 90% of the province's doctors belong to the BCMA. "We think organizations with mandatory membership get complacent and they don't do as good a job."