PHYSICIAN RELATIONS IN CANADA - SHOOTING INWARD AS THE CIRCLE CLOSES

As economic disputes between physicians become more frequent, discussi ons between physicians are becoming increasingly important. Those seek ing insight into how physician organizations might mediate these dispu tes may be able to learn from others who have had negotiating responsi bilities for over a quarter of a century-the provincial medical associ ations in Canada. in this article we examine the structure, process, a nd outcomes of negotiations between physicians, with a focus on respon ses to new physician expenditure caps in Ontario, Alberta, and British Columbia. Early negotiations between physicians over changes in relat ive fees favored general practitioners because they were the dominant voting block within the associations. Despite fewer gains in the fee a rena, specialists were willing to remain in the associations because a ll physicians generally enjoyed similar income growth. Under new physi cian expenditure caps, however, physicians have been unable to resolve conflicts over how to allocate income limits across specialties. Nego tiations between physicians face expanding economic issues and di verg ing interests as expenditure caps force physicians to concentrate on t otal costs.