Doctor Strikes in Canada: A Brief History

Taylor LougheedOctober 24, 2015 by | 2 comments

With the recent unilateral government decisions in Ontario, there has been a growing buzz about potential physician job action. I felt it would be worthwhile to do a bit of digging and present a brief history of previous physician job actions and strikes in Canada to help inform some of the discussion.

July 11, 1962 Rally in support of physicians (Saskatchewan Archives Board)

July 11, 1962 Rally in support of physicians (Saskatchewan Archives Board)

Saskatchewan 19621 2

On July 1, 1962, the Lloyd Government of Saskatchewan (successor to the Tommy Douglas government) passed the Medicare Bill. Physicians, opposed to the growing government interference in healthcare and with significant community and media support, went on strike.

By mid-July, however, support for the strike had waned considerably and a mediator from the UK was brought in to broker a compromise deal. The eventual agreement saw the government paying 85% of the college fee schedule on a fee-for-service basis, and with subsequent amendments in early August, which allowed physicians to practice outside of the provincial insurance plan.

Despite initial strong support, the strike was considered to be very unpopular with patients. During the strike action, the government worked to attract physicians from the UK, US, and other provinces to provide at least some medical service, with some communities going so far as to setup and fund emergency clinics themselves. Of note, is that a follow-up survey in 1965 found that the majority of the province’s physicians supported continuing the medicare plan.

Quebec 19703

In October 1970, the majority of specialist physicians in Quebec left the province in protest of the looming implementation of a provincial medicare bill. The main points of contention centered on the ability to opt-out of the program, and the prohibition on “extra-billing” above what the provincial insurance plan would cover.

On October 15th, the specialists were legislated back to work by the provincial government, and on November 1, the Quebec Medicare plan went into effect.

It is unclear what compromise deal, if any, was struck.

Ontario 19864 5 6 7

In 1986, the Ontario government proposed legislation that would prevent doctors from ‘extra-billings’. At that time, the Ontario Health Insurance Plan (OHIP) covered 80% of the negotiated fees provided by doctors, while the remaining 20% could be charged to the patient at the doctor’s discretion. While reportedly only a small number of physicians performed this extra-billing, the majority of physicians were against the legislation that would eliminate this process. The result of this bill was a strike sanctioned by the Ontario Medical Association (OMA) that lasted in various forms for approximately three weeks. Ultimately, the bill passed and multiple reports from that time suggested that the strike was very unpopular, with nursing organizations and the public largely coming out in opposition.

British Columbia 19988

In 1998-1999, the British Columbia Medical Association identified 20 Rationed Access Days (RADs) as a job action for their members to participate in as a form of protest against the government’s fixed cap funding of physician payment and proration. Essentially, if physician fees were anticipated to reach the proposed hard cap on funding, certain fees would be reduced. Physicians felt this form of pro-rating undervalued the services they were providing, and eventually they identified job action as the means by which to put pressure on the government. The RADs ended after the pro-rating process was abandoned.

British Columbia 20029 10

On May 21, 2002, the British Columbia Medical Association (BCMA) advocated to members that they withdraw services. This followed a prolonged and bitter negotiation period with the government that saw an arbitration award of $392 million (and possible further increases) and a protected binding arbitration process. The government, concerned that their budget would not allow for any additional award, capped the arbitration award at $392 million, and scrapped the future binding arbitration process.

On May 31, 2002, the doctors were advised to return to work following an agreement negotiated between the government and the BCMA. The agreement exceeded the previously set cap on the $392 arbitration award and allowed for job action if the government rejected the binding arbitration process in the future.

Of note, over the course of the strike, several thousands of surgeries had been cancelled.

Newfoundland & Labrador 200211 12 13

On September 30, 2002, the Newfoundland and Labrador Medical Association endorsed a strike that saw its 930 doctors cancel non-essential visits and clinic appointments. At the heart of the discussion was physician compensation. At that time, doctors in Newfoundland & Labrador were reportedly the lowest paid doctors in Canada.

The strike lasted 17 days, saw wait times in the ED of up to 20 hours, and caused a backlog of an estimated 30,000 missed appointments. The deal to end the strike included a minimum of an additional $50 million in funding for physician compensation and a binding arbitration process (that ultimately awarded a total of $54,194,373 for physician compensation in various forms).

Quebec 200214 15 16

On November 12, 2002; December 2, 2002; and January 16, 2003, Quebec medical specialists, under the direction of the Fédération des médicines specialists du Québec (FMSQ), undertook “study days” as a form of protest after contract talks broke down with the provincial government. These three study days resulted in hundreds of elective surgeries and thousands of appointments being cancelled. While the dispute was ultimately resolved, it was wildly unpopular with various advocacy groups.

On June 27, 2006, the Superior Court of Quebec authorized a class action by the Conseil pour la protection des malades (CPM)/Council for the Protection of Patients against the FMSQ. Legally, the study days were deemed to be strike days in disguise, and in December 2010 the FMSQ was ordered to pay $2.5 million in compensatory damages ($250 each for 10,000 impacted patients), and $2 million in punitive damages. With interest, the total judgement was approximately $7 million.

In the subsequent appeal, the appeal judge reduced the number of impacted CPM patients to 3351 – the number of surgeries that were cancelled over the course of the days of action. The compensatory damages were therefore reduced from $2.5 million to $837,750. The punitive damages were also struck, as the appeal court felt that while the actions were intentional, there were adequate steps taken to provide emergency coverage.

The FMSQ in its membership reports listed a total penalty of $1,470,700 being paid, though the breakdown is unclear.

In 2016…?

Unilateral action by provincial governments has seemingly been a threat for many decades, with even arbitration being susceptible to attacks by way of legislation. The previous strikes ultimately paint a mixed picture of how withdrawing or restricting services may force a government’s hand, but also damage trust with patients as well as a physicians central role in our system.

Will a strike force a government to better fund doctors, or to better fund alternatives where possible? Would potential job action be effective? Damaging? Both?

Ideally we will not have to find out.

 

Taylor Lougheed

About the Author

Taylor Lougheed is a physician in Family and Emergency Medicine, and passionate about sustainable public healthcare, quality improvement and patient safety, medical education, and global health.

  1. Gregory P. Marchildon. Doctor’s Strike. The Encyclopedia of Saskatchewan. Retrieved from: http://esask.uregina.ca/entry/doctors_strike.html
  2. Saskatchewan Doctor’s Strike. Historica Canada. Retrieved from: http://www.thecanadianencyclopedia.ca/en/article/saskatchewan-doctors-strike/
  3. Taylor, M. G., & Maslove, A. (2009). Health insurance and Canadian public policy: The seven decisions that created the health insurance system and their outcomes (Vol. 213). McGill-Queen’s Press-MQUP
  4. Duffin, J. (2011). The Impact of Health Care Single-Payer. American journal of public health, 101(7). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110239/
  5. Shamess, B. A. (1986). The Ontario doctors’ strike. CMAJ: Canadian Medical Association Journal, 135(8), 841. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1491495/
  6. The Ontario Doctor’s Strike. Canadian Museum of History. Retrieved from: http://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-7h11e.shtml
  7. Meslin, E. M. (1987). The moral costs of the Ontario physicians’ strike. Hastings Center Report, 17(4), 11-14.
  8. Reid, R. J., Schneider, D., Barer, M., Hanvelt, R., McGrail, K., Pagliccia, N., & Evans, R. G. (2001). The doctor is out: physician participation in the Rationed Access Day work stoppage in British Columbia, 1998/99. Hospital quarterly, 6(2), suppl-3. Retrieved from: http://www.longwoods.com/content/17244
  9. CBC News. BC Faces Doctor’s Strike. (May 21, 2002). Retrieved from: http://www.cbc.ca/news/canada/b-c-faces-doctors-strike-1.343788
  10. CBC News. Doctors, BC Government Settle Dispute (May 31, 2002). Retrieved from: http://www.cbc.ca/news/canada/doctors-b-c-government-settle-dispute-1.330127
  11. CBC News. Doctors On Strike in Newfoundland. (October 2, 2002). Retrieved from: http://www.cbc.ca/news/canada/doctors-on-strike-in-newfoundland-1.354912
  12. CBC News. Backlog, confusion follow Nfld Doctor’s Strike. (October 18, 2002). Retrieved from: http://www.cbc.ca/news/canada/backlog-confusion-follow-end-to-nfld-doctors-strike-1.308969
  13. Arbitration Award (PDF). Retrieved from: http://www.gov.nf.ca/publicat/2003/NLMAArbitration.pdf
  14. Fédération des médecins spécialistes du Québec c. Conseil pour la protection des malades, 2014 QCCA 459 (CanLII). Retrieved from: http://www.canlii.org/fr/qc/qcca/doc/2014/2014qcca459/2014qcca459.html
  15. Conseil Pour la Protection des Malades. Areas of Interventions: Class Actions. Retrieved from: http://cpm.qc.ca/en/areas-of-intervention/class-actions/
  16. Fédération des médicines spécialists du Québec. Le Specialiste.(PDF) Retrieved from: https://www.fmsq.org/documents/10275/8382126/leSpecialisteJuin2015_ANG.pdf

2 Comments

  1. Laura

    Thank you for this informative article, Taylor! I had no idea there were so many job actions, or that our current universal healthcare system was contested by doctors at first. Fascinating!

    • Taylor Lougheed
      Taylor Lougheed

      Thanks for taking the time to read & comment, Laura. Glad you found it interesting!

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