BCMA 2012-2013 Annual Report

+education+health+advocacy+support+policy+engagement+resources+technology+insurance+quality+benefits+negotiation+support+resources+engagement+education+health support+advocacy+policy+technology+insurance+quality+benefits+negotiation+support+resources+engagement+education+health support+resources policy+technology+insurance+quality+benefits+negotiation+support+advocacy+teciw+ +education+health support+advocacy+technology+BCMA+YOU+insuranceion+health support+advocacy+policy+technology+quality+insurance+support+adv pport+resources+engagement+education+health support+advocacy+policy+technology+insurance+quality+benefits+negotiation+support+resources+engagement+education+health support+advocacy+policy+technology+insurance+quality+benefits+negotiation+support+resources+engagement+education+health support+advocacy+policy+technology+insurance+quality+benefits+negotiation+support+resources+engagement+education+health support+advocacy+policy+technology+insurance+quality+benefits+negotiation+support+resources+engagement+education+health support+advocacy+policy+technology+insurance+quality+benefits+negotiation+support+resources+engagement+education+health support+advocacy+tech licy+insurance+benefits+support+resources+engagement+education+health supp ort+engagement+resources+technology+quality+benefits+insurance+support+ne advocacy+support+resources+engagement+education+health support+technolog

2012 | 2013 ANNUAL REPORT

BRITISH COLUMBIA MEDICAL ASSOCIATION

| CONTENTS

BCMA members are entitled to an exceptional range of valuable benefits, services, and opportunities tailored to their professional and personal needs.

MESSAGE FROM THE CEO 4 / REPORT OF THE CHAIR OF THE BOARD 6 / REPORT OF THE PRESIDENT 7 HIGHLIGHTS OF 2012 8 / BCMA + YOU 12 / AUDITORS’ REPORT 24 / FINANCIALS 25 DRAFT MINUTES OF THE ANNUAL BUSINESS SESSION AND GENERAL ASSEMBLY 36

2 | BRITISH COLUMBIA MEDICAL ASSOCIATION

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+engagement +education

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+policy+technology+insurance

+quality +benefits

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BCMA + youMESSAGE FROM THE CEO

The BCMA is about you, the physicians of British Columbia. You may notice that the annual report has a different look and feel this year. We asked a range of physicians from Salt Spring Island to Dawson Creek how the BCMA has made a positive difference in both their professional and personal lives. I hope you will take the time to read their stories. They highlight our commitment to providing value to our members, which we do in many different ways.

These stories are important because they focus on how the BCMA can provide value to you. The Association exists to improve the professional satisfaction of the physicians of BC by seeking the highest standard of health care for the benefit of both patients and the professionals who work in the system, and also by pursuing fair economic reward for all physicians.

In my first full year as the CEO of the BCMA I have worked closely with Board members, committee members, and staff to help the organization face a future of service to the profession.

Negotiations with the provincial government are, of course, a big part of how we serve you. While physicians in other provinces faced (and continue to face) significant challenges, we were pleased to have reached an agreement. But all agreements are temporary and we have only to read the news headlines to know that funding pressures in the BC health care system continue to escalate, and many groups and sectors are competing for limited resources. In preparation for upcoming “re-opener” talks, our new Chief Negotiator and Executive Director of Negotiations, Mr Paul Straszak, spent the latter part of the year meeting with physicians, primarily through the societies and sections, to hear first-hand your priorities for our next negotiations.

Mr Straszak’s engagement on negotiations responds to one of the most important things we hear from you: that the BCMA needs to be more engaged and connected with its members. That’s why our President, Dr Shelley Ross, travelled widely to personally meet with members in big and small communities around the province. In addition, Dr Sam Bugis and Mr Rob Hulyk, of our Physician and External Affairs team, travelled around the province meeting with specialist sections and health authority staff. As CEO, I met personally with every Board member in sometimes

“The BCMA has an important role to play in advocating for doctors while you advocate for

your patients.”


2012 2013 ANNUAL REPORT

long interviews to ensure that I understood their perspectives on what is needed by our members. Together, these efforts constituted an engagement effort not seen in recent years. We are listening to you, and as an organization we will be working hard to respond to the things you tell us are important to you.

This year the Board started meeting more often than in the past. At each meeting the Board has reserved time to consider future-oriented strategic priorities, all of which should result in a new strategic plan later in 2013. This plan will focus on ensuring that everything we do adds value for members. The BCMA has an important role to play in advocating for doctors while you advocate for your patients. You will be hearing more about this work in the coming year.

There were some key milestones this year. I have already mentioned the arrival of Mr Straszak, who has a long history in negotiations for institutions in both the private and public sectors. He replaced Mr Geoff Holter, who had a long and distinguished career as the Chief Negotiator for the BCMA.

We extend our best wishes to Mr Holter in his retirement.

In April, the Physician Health Program rejoined the BCMA. Executive Director Dr Andrew Clarke is a welcome addition to the senior staff team, helping us better understand some of the pressures of practice from an individual member’s perspective, though never at the expense of the privacy of individuals. We also welcomed Ms Marisa Adair to the BCMA as Executive Director of Communications and Public Affairs. Ms Adair’s blend of communications knowledge, strategic sense, and journalism makes her a strong addition to our team.

In December, Dr Dan MacCarthy retired from his position as Executive Director of Practice Support and Quality after 14 years with the Association. Dr MacCarthy led in the creation and development of programs under the General Practice Services Committee. These programs have made a big difference in the ability of family physicians to provide the best care for their patients. We owe much to Dr MacCarthy for his vision and are happy that he

continues part time as the MD Consultant to the department. I was pleased to announce the appointment of Dr Jonathan Agnew as the new Executive Director of Practice Support and Quality. Dr Agnew has been with the BCMA for 8 years and was most recently our Director of Policy.

I also want to express my thanks to long-standing members of the senior staff of the BCMA, Ms Christiane Ahpin, Chief Operating Officer, and Mr Jim Aikman, Executive Director of Economics and Policy Analysis. With the arrival of new staff it would be easy, but wrong, to ignore the ongoing and invaluable assistance they provide to the Board, members, and the entire organization. That is mirrored by great staff throughout the organization. It is our goal to make the BCMA a great place to work, and with the quality of our staff we are a long way down the path to that goal.

There were many positive developments in the last year, but there are always new challenges ahead. I look forward to working with you to learn about and meet those challenges.

“We are listening to you, and as an organization we will be working hard to respond to the things you tell us are important to you.”

ALLAN P. SECKEL, QC BCMA CHIEF EXECUTIVE OFFICER

5BRITISH COLUMBIA MEDICAL ASSOCIATION |

change + growth REPORT OF THE CHAIR OF THE BOARD OF DIRECTORS

It is with respect that I write my first Chair’s report. This year has been one of change, and I have been impressed throughout this time with the dedication to service to the profession that the Board and officers have demonstrated.

The Board saw a number of new directors elected, as in previous years, which guarantees ongoing input of new ideas, new perspectives, and a fulsome debate on all issues.

This year has seen a number of changes involving policy, bylaw, and committee and meeting assessments and reviews. These changes reflect the Board’s ongoing vision of providing excellent service to members and adhering to best practices in moving forward the business of the day. The process of change has been interesting, thought-provoking, and valuable in educating the Board and officers on their roles and obligations.

This past year, Board meetings decreased in length and increased in frequency. These changes have allowed the Board a greater degree of continuity between meetings and enabled us to have educational and policy development days on a regular basis, as we work with the CEO toward becoming an efficient, nimble, goal- oriented organization.

The CEO and the Governance and Nominations Committee are working on a number of projects, including a review of all committees and the nomination process for various committees. This is a Herculean task that should be acknowledged. We will keep the membership appraised of changes as this work progresses.

The CMA’s General Council meeting held this past year in Yellowknife once again saw the BCMA delegation as leaders in presenting their resolutions, many of which were accepted. The BCMA is viewed as a significant contributor to health care policy developed in Canada, and I congratulate the delegation and staff for their exemplary dedication.

This past year has also seen some BCMA staff changes. In his CEO’s report, Mr Seckel acknowledges the retirements of Mr Geoff Holter and Dr Dan MacCarthy; the Board is grateful to them for their many years of dedication and service to our profession. We are also happy to welcome Mr Paul Straszak, Ms Marisa Adair, and Dr Jonathan Agnew into their new positions.

I could not do my job without the backing of a number of people. I would like to acknowledge the support and wisdom of Board Vice-Chair Dr Nigel Walton, Resolutions Committee members Dr Trina Larsen-Soles and Dr Kevin McLeod, and BCMA staff support Ms Susan Martin and Ms Wendy Hunt – all of whom contribute to making my job as Chair of the Board an especially rewarding one.

The BCMA is truly an organization of excellence, with staff whose expertise and dedication is second-to-none. Your Board could not do what it does on behalf of the profession without these most capable individuals, and I thank them for all their hard work.

CAROLE WILLIAMS, MD CHAIR OF THE BOARD OF DIRECTORS



united + strong REPORT OF THE PRESIDENT

It has been a tremendous pleasure to serve as your president. At the start of my term I set out a number of goals and was prepared to work hard to accomplish them. These were goals that would benefit the profession in a number of different ways. Specifically, I felt it was important to work toward uniting the profession, to find common ground, because we are stronger united than when we are fragmented. The future of the physician work force remains a significant concern. We need to find out what the BCMA can do to maximize professional satisfaction, anticipate future needs, and prepare now, not tomorrow.

These goals aren’t going to be achieved by sitting in a board room and tossing ideas around. We need to hear from physicians directly about what matters to you, getting to the bottom of the actual problems and listening to your ideas regarding solutions. I felt that the most effective way to accomplish this was to meet face-to-face with as many physicians as possible. After one year and thousands of kilometres, after visiting numerous rural and remote areas, as well as more urban communities, and meeting with so many passionate physicians who have spoken frankly about their issues, we are much closer to achieving these goals.

While travelling to meet physicians I also met with many MLAs from both political parties. Speaking with them individually was one more way to reach out to one of our most important stakeholders, to enhance and build positive relationships. We discussed physician shortages, the difficulty of working with limited resources, the importance of the BCMA and government working together,

what patients in their communities require, and the value the collaborative BCMA/Ministry of Health programs bring to those communities. I am pleased to have met several times with Dr Margaret MacDiarmid during her time as Minister of Health, and with opposition health critic Mr Mike Farnworth.

As well, I met with media across the province. It’s important for us to build good will with the public and make clear the patient benefits of programs developed to increase the number of physicians in certain areas, improve access to services provided by physicians, and decrease wait times.

This past year, I met with various stakeholder groups, listening to their concerns and providing input, as needed. Meetings and events I attended include an anti-bullying seminar held by the provincial government (ERASE), a number of meetings and events with the Office of the Superintendent of Motor Vehicle and ICBC, medical student and resident events, and a tour of a senior’s centre that is part of the Chilliwack Division of Family Practice.

Thank you to the BCMA Board for all your support and guidance this past year. And thank you also to the BCMA staff for your hard work on behalf of the doctors in this province and for ensuring that I was exactly where I was supposed to be as I travelled this great province.

SHELLEY ROSS, MD PRESIDENT

“ We need to find out what the BCMA can do to maximize professional satisfaction, anticipate future needs, and prepare now, not tomorrow.”


Ratification of the Physician Master Agreement

In July 2012, BCMA members showed their strong support for the renewed Physician Master Agreement (PMA), voting 92% in favour of accepting the four-year agreement.

Under the terms of the PMA the compensation provisions for the first two years of the agreement were set, with compensation for the latter two years subject to new negotiation starting in June 2013.

The initial agreement set aside $20 million for specialist sections facing recruitment and retention difficulties. Allocation of those funds is being arbitrated by Eric

Harris, QC based on submissions from the specialist sections. Once the allocation decisions have been made, the relevant fee changes will be implemented retroactive to April 1, 2012.

Mr Harris has also worked with the Alternative Payments Committee toward addressing a number of outstanding issues affecting alternatively paid physicians. The PMA provided $14 million to address service contract and salary agreement issues.

The agreement also set the stage for the General Practice Services Committee to move forward with A GP for Me, its patient attachment initiative, which was announced in February 2013.

As agreed by the BCMA and the Ministry of Health, the PMA will be reopened for negotiation this summer concerning compensation, benefits, on-call issues, alternative payment physician issues, IT funding, and matters of general application. Preparation for those negotiations began in the fall of 2012.

Release of BCMA policy paper: Closing the Gap – Youth Transitioning to Adult Care in BC

Improved treatments and other medical advances have led to an increasing number of youth with life-limiting disorders now surviving well into adulthood. Every year about 1,700 young

The last year has seen progress in all facets of the Association, with a special focus on youth health care, specialist engagement, and a new Physician Master Agreement.

improvement + progress HIGHLIGHTS OF 2012


2012 2013 ANNUAL REPORT HIGHLIGHTS OF 2012

people with chronic, complex health care needs are discharged from BC Children’s Hospital when they turn 18. For many of these youth the abrupt transition to the adult care system is traumatic as they are forced to find health professionals with the specialized skills they require for their ongoing treatment.

In December 2012, the BCMA released a policy paper on this issue, entitled Closing the Gap – Youth Transitioning to Adult Care in BC. The paper identifies the population at risk and the issues associated with a poor transition to adult care. It then explores a number of transition models and reviews the successes and challenges of the province’s

current system for transitioning youth with complex health needs to adult care.

Building on the successful elements of the current system, the paper offers ten recommen-dations for government and ten commitments from the BCMA toward building a framework for the improved transitioning of young patients to adult care.

Significant among these recommendations are the following:

• All pediatric patients with complex and chronic illness should have, in addition to pediatric care providers, a family physician from birth.

• Patients graduating from pediatric care should have individualized transition plans.

• A method should be developed for the identification and ongoing tracking of youth patients with complex and chronic illness to evaluate successful transition and long-term health outcomes.

The paper emphasizes the importance of the General Practice Services Committee, the Specialist Services Committee, and the Shared Care Committee as collaborative structures that have proven effective at improving care for specific patient populations.


Rollout of the Child and Youth Mental Health module for family physicians

An estimated 15% of children and youth in BC live with some form of mental illness. It is further estimated that one in five young people with a mental illness has not been diagnosed.

To address the issue, in the spring of 2012 the joint BCMA/Ministry of Health Practice Support Program launched its Child and Youth Mental Health learning module for family physicians. The module is designed to provide physicians with the skills and resources they need to identify and treat children and youth with mild to moderate anxiety, attention deficit

hyperactivity disorder, and depression. The module also offers training for physicians to identify youth at risk for suicide.

The value of improved mental health training for family physicians is supported by evidence that shows about 70% of mental health disorders first occur prior to age 25, and that most mental health disorders in young people can be effectively treated in primary care, if identified early.

More than 135 physicians have already received training through the Child and Youth Mental Health module, and a total of 500 are expected to complete the module within the next two years.


2012 2013 ANNUAL REPORT HIGHLIGHTS OF 2012

Expanding engagement with specialist and facility-based physicians

In recent years throughout British Columbia’s health system there has been a strong focus on addressing the needs of GPs and supporting primary care.

In an effort to ensure that specialist members receive a corresponding level of attention to their needs, over the past year the BCMA’s Department of Physician and External Affairs has made a priority of connecting with the specialty sections to ensure specialists are aware of the services and support available to them through the BCMA.

As a first step, the department interviewed people from virtually every one of the BCMA’s 39 specialist sections to identify their

needs and discuss ways in which the Association can provide help.

One priority for specialists involves changes proposed by the government to privileging and credentialing. The BCMA is now involved in discussions on the scope of initiatives regarding privileging, credentialing, and performance review. The Association is reviewing the proposed changes to assess the extent of their impact on specialists, and advocating on behalf of members that any changes made be fair and reasonable.

The BCMA is also examining ways to better support hospital- and facility-based physicians to improve consultation and engagement with BC’s health authorities.

In 2012/13, the Association developed an array of administrative services available to all specialist sections, but of particular value to the smaller sections, typically comprising fewer than 60 specialists. These smaller sections are often led by physicians with very limited administrative support, who now have access to the support and resources required to properly serve their interests.

And the BCMA continues to work through the joint BCMA/Ministry of Health Specialist Services Committee (SSC) to support and engage specialists. Twenty-one SSC projects to support improvement of the specialist care system in BC were approved for development in 2012/13.


support + advocacy

In this year’s annual report we focus on a handful of physicians from around the province who have benefited from the BCMA’s valuable services and programs. Their stories represent just some of the many ways the BCMA supports its members and helps improve life for BC physicians.

Dr Jacques Brussow (a Dawson Creek ER physician) tells us about the support his community received from the Rural Emergency Enhancement Fund, improving both the quality of life for local physicians and access to emergency care in his community.

Dr Lianne Lacroix (a Kelowna family physician) tells us how the PITO program helped her implement an electronic medical record system, allowing her to transform her practice for both her and her patients.

Dr Steven Shaver (a Courtenay ophthalmologist) tells us about the protection and peace of mind his BCMA insurance brings him.

Dr Shane Barclay (a family physician on Salt Spring Island) tells us about the support he received from the Shared Care Committee for a teledermatology pilot project, boosting access for patients and improving local physicians’ peace of mind, knowing they’re providing better care to their patients.

Dr Scott Comeau (a geriatrician in West Vancouver) tells us how the BCMA’s Parental Leave Program – now extended to male physicians –allowed him to focus on family, taking several months off after the birth of his second child.

There are many more BCMA stories like these to tell–dozens of other programs and services are helping physicians help their patients. In fact, we’ve put an extra story on the BCMA website. It’s about Dr Stephen Ashwell (a general practitioner in Dawson Creek), who took advantage of the Rural Education Action Plan in order to receive advanced oncology training. Dr Ashwell is happy that he can provide first-rate cancer care to his patients, and his patients appreciate receiving their care locally.

www.bcma.org


BCMA + YOU2012 2013 ANNUAL REPORT

Our members + their stories

DR JACQUES BRUSSOW Emergency room physician Dawson Creek, BC

DR LIANNE LACROIXFamily physician Kelowna, BC

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DR SHANE BARCLAYFamily physicianSalt Spring Island, BC

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DR SCOTT COMEAUGeriatrician West Vancouver, BC

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DR STEVEN SHAVER Ophthalmologist Courtenay, BC

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Like many physicians, Courtenay ophthalmologist Dr Steve Shaver has a busy life. But Shaver’s life is perhaps a little more hectic than most. In addition to his medical practice, he shares responsibility for a large blended family of nine kids, ranging in age from four to 22. What’s more, until last year he didn’t have life insurance – adding considerably to his stress load.

“I was very busy and I had no time to organize my life,” says Shaver. “I knew I was under insured, I just didn’t know what to do about it.”

The solution arrived in the form of an email about BCMA’s insurance services. Almost on a whim, Shaver responded to the email and was immediately contacted by BCMA insurance advisor Julie Kwan, who arranged a visit with Shaver in his Courtenay office.

“We went through everything – all the details of my insurance needs, all the things I had avoided and was stressed out by. It was kind of like going to a doctor of insurance.”

The end result for Shaver was a comprehensive insurance package with multiple policies. He says he appreciated Kwan’s objective approach to his insurance needs, which let him consider policies from companies outside the BCMA.

Overall, says Shaver, “I’m so glad I replied to that initial email. I went from feeling a huge amount of stress about this stuff to ‘Hey – I’m good!’”

Kwan estimates 40% of BCMA members are under insured, especially younger members with growing families and changing financial circumstances.

“I’m so glad I replied to that initial email. I went from feeling a huge amount of stress about this stuff to, ‘Hey – I’m good!’”

protection + peace of mindBCMA INSURANCE OFFERS STRESS RELIEF

THE BCMA:

Has provided insurance to members since 1950.

Manages over 19,000 policies.

Has three full-time non-commissioned insurance advisors.

Refunded over $4.28M of life insurance premiums to members in the last 5 years.


2012 2013 ANNUAL REPORT BCMA + YOU

Dr Steven Shaver Ophthalmologist Courtenay, BC

Dr Lianne Lacroix Family physician

Kelowna, BC

“My EMR lets me give patients what they want and helps me to better manage the complex needs

of my chronic patients.”


information + technologyNEVER TOO LATE FOR EMR

A CLOSER LOOK AT PITO:

4,000+ BC physicians, or 80% of the approximately 5000 targeted* full-service family practice and specialist physicians in BC, now use EMR.

An estimated 82% of full-service GPs, 77% of medical/consultant specialists, and 73% of surgeons are now on EMR.

Percentage of physicians on EMR, by region: North 90% Interior 82% Island 76% Vancouver 75% Fraser 72%

BC communities served almost 100% by physicians using EMR include Cowichan Valley, White Rock, Sunshine Coast, Kamloops, Salmon Arm, Kootenay-Boundary region, Mission, Campbell River, Prince George, and most of the communities in the North.

Family physician Dr Lianne Lacroix has been practising medicine for 40 years, with the last 30 spent in Kelowna. At 69, you might think she would be ready to hang up her stethoscope. But since 2008 when she computerized her practice with the help of the Physician Information Technology Office (PITO), Lacroix has found renewed passion for her work.

“The computer is helping me so much that I hate the idea of retiring,” says Lacroix. “I keep telling my patients I’ll be here for a few more years, and I just carry on one year at a time.”

Lacroix is a solo practitioner with about 1,200 patients, about 90% of whom are women. “A lot of my patients are getting old and are on

lots of medications,” she says. “Before the computer, it was a lot of work keeping track of their meds and writing out all those prescriptions.”

She also appreciates the virtual elimination of paper-based patient file folders, which had grown so large she could hardly lift them. And since acquiring voice recognition software, she no longer has to type her notes. “Now I dictate all my patient notes and histories into my computer. I even dictate all my letters to specialists,” says Lacroix.

Although getting started with her EMR system was a challenge – Lacroix describes herself and her MOA as “not very technically advanced” – she found the

BCMA/Ministry of Health’s PITO program provided all the help and encouragement she needed. “To advance medicine we must overcome our fears and press forward,” says Lacroix, referring to her initial concerns about adopting an EMR.

Now when she consults a patient about lab results, instead of pulling pages from a weighty file folder, she shows the results on a colourful screen display and creates a print-out for the patient. “It’s a different way of practising,” says Lacroix, “Patients want to be more involved in their care and want more information. My EMR lets me give patients what they want and helps me to better manage the complex needs of my chronic patients.”

(* Excludes hospital-/health authority-based, retired, locum, and walk-in clinic-based physicians and solo practice physicians within a year of standard retirement age.)


THE SHARED CARE COMMITTEE:

Was formed in 2006.

Represents family and specialist physicians.

Works to improve the flow of patients between primary and specialist care.

Has 9 initiatives.

When a patient is troubled by a painful rash, any delay in treatment can be very frustrating. So when Salt Spring Island family physician Dr Shane Barclay found some of his patients waiting many months for a dermatology appointment in Victoria, he decided to try a different approach.

Barclay was familiar with a teledermatology program in Alberta called Consult Derm. The program lets family physicians send photos of unusual patient skin conditions to a dermatologist for diagnosis and treatment recommendations. The program has a diagnosis accuracy rate of up to 90%.

“In Alberta, the current turnaround time for a teledermatology consult is under three days,” says Barclay.

“And the average wait time for a dermatology appointment is 104 days.”

Barclay approached the founder of Consult Derm, Edmonton dermatologist Dr Jaggi Rao, toward developing a BC-based version of the program. The result was BC Consult Derm, launched as a pilot project in 2011 with the support of Vancouver dermatologist Dr Neil Kitson and funding from the joint BCMA/Ministry of Health Shared Care Committee.

The pilot initially involved five Salt Spring family physicians, but with its success the program has expanded. BC Consult Derm now has three dermatologists offering consultations for about 80 general practitioners in the South Vancouver Island region.

The average turnaround time for a teledermatology consultation is currently about 24 hours.

“So far everything’s going fine, but we need more dermatologists involved if we want to expand the service throughout the province,” says Barclay. Based on demand for the teledermatology service in Alberta, Barclay estimates the BC program will eventually need the support of about six dermatologists.

Barclay says a cost analysis based on 78 Salt Spring Island patients who received teledermatology care found that, in comparison to the costs involved in patients going to Victoria for dermatology appointments, the program saved about $20,000.

family + specialist physiciansFINDING SHARED CARE SOLUTIONS



Dr Shane Barclay Family physician Salt Spring Island, BC

Dr Jacques BrussowER physician

Dawson Creek, BC

“REEF is making a difference... Quality of life is improved for physicians, and emergency services are improved for

the communities.”


engaged + connectedSUPPORTING EMERGENCY SERVICES IN RURAL HOSPITALS

RURAL SUPPORT:

Joint BCMA/Ministry of Health support for rural physicians: 11 main programs, multiple initiatives.

166+ rural communities are supported by these programs.

Approximately 50 communities are eligible for REEF.

To address the issue, in 2010 the BCMA and Ministery of Health launched the Rural Emergency Enhancement Fund (REEF). The fund offers financial support to rural physicians who commit to helping ensure local emergency services are always available.

Dawson Creek family physician Dr Jacques Brussow says the incentives provided through REEF are much appreciated by the nine physicians who share emergency duties at Dawson Creek and District Hospital. To provide 24/7 emergency coverage for the hospital, each physician works one 12-hour shift a week in emergency, alternating weekly between days and nights. They also each work two week-end shifts every three weeks.

Although the physicians in Dawson Creek are doing fairly well at sharing emergency duties, Brussow says some communities have more doctors closer to retirement, who don’t want to do night shifts anymore. “That puts a lot of pressure on the younger guys to do extra nights,” says Brussow. But with the added incentive from REEF to compensate for the extra shifts, “things seems to work out quite well.”

However, in the smaller, more remote northern community of Fort Nelson, the issue of maintaining 24/7 emergency coverage is even more challenging.

“Fort Nelson only has three physicians, so if one goes on

holiday, the other two are on call 24 hours, every second day for emergency. That routine gets to you,” says Dr Brussow. Encouraged by the incentives provided through REEF, Dr Brussow’s colleagues in Fort St. John, 380 kilometres south of Fort Nelson, are stepping up and often provide weekend emergency relief for Fort Nelson’s over-taxed physicians.

“REEF is making a difference in communities like Dawson Creek, but even more so in small places like Fort Nelson,” says Dr Brussow. “Quality of life is improved for physicians, and emergency services are improved for the communities.”

Ensuring emergency services are available 24/7 in community hospitals around British Columbia can be a challenge. It’s one that’s especially difficult for smaller communities with just a few local physicians to share the load.


flexibility + forward thinkingPARENTAL LEAVE A POPULAR OPTION FOR MALE DOCS

BCMA BENEFITS: The BCMA administers five negotiated benefits:

Canadian Medical Protective Association Rebate (CMPA).

Continuing Medical Education Fund (CME). Contributory Professional Retirement Savings

Plan (CPRSP). Parental Leave Program (PLP). Physicians’ Disability Insurance (PDI).

9,500+ physicians access these benefits.

CMPA and CME are the most utilized.

Taking advantage of a recent change to the BCMA’s Parental Leave Program that allows male physicians to qualify for support, Comeau decided he would take the full 17 weeks of paid leave offered by the program.

“I was already planning on taking time off,” says Comeau, “but getting some income was great and let me take more time than I otherwise would have.”

In 2002 when the BCMA started offering parental leave, the program was only available to female physicians. That changed in April 2010 when the program was expanded to include male

physicians, as well as physicians expecting a child through a surrogate birth mother or by adoption.

Program administrator Lorie Lynch says the number of physicians taking advantage of the Parental Leave Program has grown every year. This year she expects the number will surpass 300 – with male doctors accounting for about a third of the total.

Under the program, qualified physicians can take up to 17 weeks of paid parental leave during the first year following a child’s birth. The time does not

have to be taken off through consecutive weeks. Compensation is scaled to a physician’s eligible income earned in BC, to a maximum of $1,000 per week.

Although he appreciated the income provided for his parental leave, for Comeau, the real pay-off came from the experience of being with his wife during a significant time for their young family.

“I really enjoyed being there for those first few months,” says Comeau. “I took part in everything that was happening with them. It was great.”

When his wife became pregnant with their second child, West Vancouver geriatrician Dr Scott Comeau decided he would do things differently the second time around.



Dr Scott Comeau Geriatrician West Vancouver, BC

“I really enjoyed being there for those first few months. I took part in everything that was happening with them. It was great.”

INDEPENDENT AUDITORS’ REPORT

To the Members of British Columbia Medical Association

REPORT ON THE FINANCIAL STATEMENTS

We have audited the accompanying financial statements of the British Columbia Medical Association, which comprise the statements of financial position as at December 31, 2012, December 31, 2011 and January 1, 2011, the statements of operations, changes in net assets and cash flows for the years ended December 31, 2012 and December 31, 2011, and notes, comprising a summary of significant accounting policies and other explanatory information.

Management’s Responsibility for the Financial Statements

Management is responsible for the preparation and fair presentation of these financial statements in accordance with Canadian accounting standards for not-for-profit organizations, and for such internal control as management determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

Auditors’ Responsibility

Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with Canadian generally accepted auditing standards. Those standards require that we comply with ethical requirements and plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on our judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, we consider internal control relevant to the entity’s preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by management, as well as evaluating the overall presentation of the financial statements.

We believe that the audit evidence we have obtained in our audits is sufficient and appropriate to provide a basis for our audit opinion.

Opinion

In our opinion, the financial statements present fairly, in all material respects, the financial position of the British Columbia Medical Association as at December 31, 2012, December 31, 2011 and January 1, 2011, and its results of operations and its cash flows for the years ended December 31, 2012 and December 31, 2011 in accordance with Canadian accounting standards for not-for-profit organizations.

Report on Other Legal and Regulatory Requirements

As required by the Society Act (British Columbia), we report that, in our opinion, these principles have been applied on a basis consistent with that of the preceding year.

Chartered Accountants, April 6, 2013 Vancouver, Canada



STATEMENTS OF FINANCIAL POSITION

DECEMBER 31, 2012, DECEMBER 31, 2011 AND JANUARY 1, 2011

December 31, December 31, January 1, 2012 2011 2011

ASSETSCurrent assets: Cash $ 11,209,551 $ 3,827,127 $ 413,005 Accounts receivable (note 3) 1,620,480 1,580,562 1,603,755 Due from BCMA Collaboratives 138,611 – – Prepaid expenses 273,633 139,861 235,209 Short-term investments (note 4) 3,332,987 9,275,665 7,842,026 16,575,262 14,823,215 10,093,995

Investments (note 4) 20,688,325 18,512,959 19,116,548 Investment in BCMA Agencies Limited (note 5) 51 51 1 Capital assets (note 6) 2,804,222 2,919,652 3,059,617 Cash held for designated holding accounts (note 7) 297,730 12,140,229 2,882,753 $ 40,365,590 $ 48,396,106 $ 35,152,914

LIABILITIES AND NET ASSETSCurrent liabilities: Accounts payable and accrued liabilities $ 2,023,020 $ 2,014,934 $ 1,694,135 Due to BCMA Collaboratives – 848,713 574,774 Prepaid membership dues 993,887 1,537,077 1,021,547 Group life premiums accounts 1,512,817 1,421,890 75,210 Group insurance accounts 1,247,119 779,507 1,549,263 Employee future benefits (note 8) – – 1,497,007 5,776,843 6,602,121 6,411,936

Deferred contributions (note 9) 4,974,112 3,258,351 1,127,559 Designated holding accounts (note 7) 297,730 12,140,229 2,882,753 11,048,685 22,000,701 10,422,248

NET ASSETS: Internally restricted (notes 2 and 10) 9,194,568 10,190,143 10,741,177 Investment in capital assets 2,804,222 2,919,652 3,059,617 Unrestricted 17,318,115 13,285,610 10,929,872 29,316,905 26,395,405 24,730,666 Commitments and contingencies (note 11) $ 40,365,590 $ 48,396,106 $ 35,152,914 SEE ACCOMPANYING NOTES TO FINANCIAL STATEMENTS.

On behalf of the Board: Dr James Busser, Honorary Secretary Treasurer, Dr Carole Williams, Chair of the Board


STATEMENTS OF OPERATIONS

YEARS ENDED DECEMBER 31, 2012 AND 2011

2012 2011

REVENUE:Membership dues $ 16,869,865 $ 16,142,169 Less: dues collected for Canadian Medical Association (3,800,060) (3,616,660)Membership dues 13,069,805 12,525,509

Government contributions for designated programs (note 9) 1,579,968 1,699,503 Insurance administration fees 1,689,330 1,513,372 Management fees 2,330,500 2,354,250 Investment and miscellaneous income 1,750,330 1,639,646 Building rents 931,938 930,954 21,351,871 20,663,234

EXPENSES: Building – rented portion 546,052 502,800 Committee costs 1,785,350 1,979,520 Consulting and professional fees 1,723,789 2,217,681 Designated program expenses and contributions (note 9) 1,579,968 1,699,503 Marketing and communications 487,480 427,505 Occupancy 598,604 597,203 Office 1,953,079 1,891,215 Physician health program 300,000 300,000 Salaries and benefits 9,456,049 9,383,068 18,430,371 18,998,495

Excess of revenue over expenses $ 2,921,500 $ 1,664,739 SEE ACCOMPANYING NOTES TO FINANCIAL STATEMENTS.



STATEMENTS OF CASH FLOWS


2012 2011

CASH PROVIDED BY (USED IN):

Operations: Excess of revenue over expenses $ 2,921,500 $ 1,664,739 Items not involving cash: Amortization 561,606 724,912 Amortization of bond premium 255,579 239,189 Change in accrued interest 35,693 (85,023) Earnings from BCMA Agencies Ltd. – (50) 3,774,378 2,543,767

Change in non-cash operating working capital: Accounts receivable (39,918) 23,193 Due from / to BCMA Collaboratives (987,324) 273,939 Prepaid expenses (133,772) 95,348 Accounts payable and accrued liabilities 8,086 320,799 Prepaid membership dues (543,190) 515,530 Group life premiums accounts 90,927 1,346,680 Group insurance accounts 467,612 (769,756) 2,636,799 4,349,500 Investing: Purchase of investments (5,425,587) (4,469,216) Proceeds from sale of matured investments 8,901,627 3,485,000 Purchase of capital assets (446,176) (584,947) 3,029,864 (1,569,163)

Financing: Employee future benefits – (1,497,007) Increase in deferred contributions 1,715,761 2,130,792 1,715,761 633,785

Increase in cash 7,382,424 3,414,122

Cash, beginning of year 3,827,127 413,005

Cash, end of year $ 11,209,551 $ 3,827,127 SEE ACCOMPANYING NOTES TO FINANCIAL STATEMENTS.


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NOTES TO FINANCIAL STATEMENTS


The British Columbia Medical Association (the “Association”) is a not-for-profit organization incorporated as a corporation without share capital under the Society Act of British Columbia. The Association promotes a social, economic and political climate in which its members may provide the highest standard of healthcare services. The Association assists all physicians practicing in the Province of British Columbia by negotiating fee schedules and benefits on behalf of those physicians who practice medicine on a fee-for-service, sessional basis or other alternative methods of payment. The Association is exempt from income taxes.

On January 1, 2012, the Association adopted Canadian Accounting Standards for Not-For-Profit Organizations in Part III of the CICA Handbook. These are the first financial statements prepared in accordance with Canadian Accounting Standards for Not-For-Profit Organizations.

In accordance with the transitional provisions in Canadian Accounting Standards for Not-For-Profit Organizations, the Association has adopted the changes retrospectively, subject to certain exemptions allowed under these standards. The transition date is January 1, 2011 and all comparative information provided has been presented by applying Canadian Accounting Standards for Not-For-Profit Organizations.

A summary of transitional adjustments recorded to net assets and excess of revenue over expenses is provided in note 13.

1. SIGNIFICANT ACCOUNTING POLICIES:

The financial statements have been prepared by management in accordance with Canadian Accounting Standards for Not-For-Profit Organizations in Part III of the CICA Handbook.

(a) Revenue recognition:

The Association follows the deferral method of accounting for contributions.

Unrestricted contributions are recognized as revenue when received or receivable if the amount to be received can be reasonably estimated and collection is reasonably assured. Externally restricted contributions are recognized as revenue in the year in which the related expenses are recognized. Contributions restricted for the purchase of capital assets are deferred and amortized into revenue on a straight line basis, at a rate corresponding with the amortization rate for the related capital assets.

Investment income is recognized as revenue when earned. Membership of the Association is voluntary and therefore member dues are recorded when received. Revenue from insurance administration fees, management fees, and building rents is recognized when the services are provided.

(b) Short-term investments and investments:

In accordance with the Association’s investment policy, investments and short-term investments consist of corporate and government bonds. In addition, the Association has invested in money market mutual funds holding a portfolio of similar investments.

Short-term investments are classified as such when they have a maturity date of less than one year.

(c) Capital assets:

Purchased capital assets are recorded at cost. Repairs and maintenance costs are charged to expense. Betterments which extend the estimated life of an asset are capitalized. When a capital asset no longer contributes to the Association’s ability to provide services, its carrying amount is written down to its residual value.

Capital assets are amortized on a straight line basis over the assets’ estimated useful lives as follows:

Years

Building 30 Building improvements 10 Furniture and fixtures 10 Computer equipment 3 Office equipment 5


(d) Employee future benefits:

The Association sponsored a defined benefit pension plan covering an employee. The benefits are based on years of service and the best three-year average salary.

The Association uses the deferral and amortization approach to account for its defined benefit plan. The Association accrues its obligations under the defined benefit plan as the employee renders the services necessary to earn the pension. The actuarial determination of the accrued benefit obligation for the pension uses the projected benefit method prorated on service (which incorporates management’s best estimate of future salary levels, other cost escalation, retirement age of the employee and other actuarial factors). The measurement date of the plan assets and accrued benefit obligation coincides with the Association’s fiscal year.

Actuarial gains (losses) on plan assets arise from the difference between the actual return on plan assets for a period and the expected return on plan assets for that period. For the purpose of calculating the expected return on plan assets, the assets are valued at fair value. Actuarial gains (losses) on the accrued benefit obligation arise from differences between actual and expected experience and from changes in the actuarial assumptions used to determine the accrued benefit obligation.

(e) Use of estimates:

The preparation of the financial statements requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the year. Significant items subject to such estimates and assumptions include the determination of useful lives for amortization of capital assets, carrying amount of capital assets, assets and obligations related to employee future benefits, and provisions for contingencies. Actual results could differ from those estimates.

(f) Financial instruments:

The Association’s financial instruments include cash, accounts receivable, short-term investments, investments, and accounts payable and accrued liabilities. Short-term investments and investments are solely comprised of bonds and money market funds.

Financial instruments are recorded at fair value on initial recognition and, other than investments in equity instruments that are quoted in an active market, are subsequently recorded at cost or amortized cost, unless management has elected to carry the instruments at fair value. The Association has not elected to carry any such financial instruments at fair value. Financial assets are assessed for impairment on an annual basis at the end of the fiscal year if there are indicators of impairment.

2. INTERNALLY RESTRICTED NET ASSETS:

The Association has set up internally restricted funds which are approved by the board of directors to support the following activities:

(a) Student bursary fund ensures that there will be adequate funding for the medical student bursary program.

(b) Staff reward and recognition fund is established to reward and recognize employee contributions to the Association.

(c) Professional development fund is designed to provide staff and officers with financial support when attaining graduate or post-graduate degrees.

(d) IT redevelopment fund is utilized for the rewrite of the membership database.

(e) Medical care fund is established to enhance the ability of physicians to provide quality medical care. These funds enable the Association to campaign for the economic rights of all physicians in the Province of British Columbia (the “Province”).

(f) Capital asset replacement fund is set aside to fund additions to capital assets.

The Board of Directors restricts the use of funds for operations by way of a resolution whereby only funds in excess of the internally restricted fund balances are available for the general operations of the Association. The internally restricted amounts may be used for special projects with the approval of the Board of Directors.



3. ACCOUNTS RECEIVABLE:

Accounts receivable includes allowance for doubtful accounts as at December 31, 2012 of $14,504 (December 31, 2011 – $12,346, January 1, 2011– $3,174). Accounts receivable also includes a balance owing from the Physician Information Technology Office (“PITO”) as at December 31, 2012 of $61,694 (December 31, 2011 – $56,938, January 1, 2011– $43,372). PITO is a program that is funded by the Province and by which the Association exercises significant influence (note 9(b)).

4. SHORT-TERM INVESTMENTS AND INVESTMENTS:

Short-term investments and investments are comprised of bonds and money market funds as follows:

Greater than Less than December 31, Yield 1 year 1 year 2012

Bonds 4.72% $ 20,668,325 $ 3,332,987 $ 24,021,312

Greater than Less than December 31, Yield 1 year 1 year 2011

Bonds 4.70% $ 18,512,959 $ 4,685,038 $ 23,197,997

Money market funds 1.16% – 4,590,627 4,590,627

$ 18,512,959 $ 9,275,665 $ 27,788,624

Greater than Less than January 1, Yield 1 year 1 year 2011

Bonds 4.71% $ 19,116,548 $ 3,297,664 $ 22,414,212

Money market funds 0.81% – 4,544,362 4,544,362

$ 19,116,548 $ 7,842,026 $ 26,958,574

The bonds mature between 2013 and 2019 (December 31, 2011 – between 2012 and 2018, January 1, 2011 – between 2011 and 2018).

5. INVESTMENT IN BCMA AGENCIES LIMITED:

The Association owns 100% of the share capital of BCMA Agencies Limited (“Agencies”), and has accounted for its investment using the equity method. Included in investment and miscellaneous income is the Association’s share of Agencies’ income in an amount of nil for the year ended December 31, 2012 (2011 – $50). As at December 31, 2012, Agencies had assets of $76,057 (December 31, 2011 – $4,638, January 1, 2011 – $1), liabilities of $76,006 (December 31, 2011 – $4,587, January 1, 2011 – nil) and retained earnings of $51 (December 31, 2011 – $51, January 1, 2011 – $1). During the year ended December 31, 2012, Agencies earned revenue of $241,952 (2011 – $41,373) and had expenses of $241,952 (2011 – $41,323), with cash provided by operations of $71,419 (2011 – $4,637).


6. CAPITAL ASSETS:

Accumulated Net book December 31, 2012 Cost amortization value

Land $ 1,000,000 $ – $ 1,000,000

Building 4,329,760 4,005,028 324,732

Building improvements 4,129,384 3,294,565 834,918

Furniture and fixtures 2,298,176 1,863,295 434,881

Computer equipment 1,381,433 1,244,697 156,736

Office equipment 152,955 120,588 32,368

Assets under development 20,686 – 20,686

$ 13,312,395 $ 10,508,173 $ 2,804,222

Accumulated Net book December 31, 2011 Cost amortization value

Land $ 1,000,000 $ – $ 1,000,000

Building 4,329,760 3,860,703 469,057





$ 12,869,126 $ 9,949,474 $ 2,919,652

Accumulated Net book January 1, 2011 Cost amortization value

Land $ 1,000,000 $ – $ 1,000,000

Building 4,329,760 3,716,377 613,383





$ 12,506,852 $ 9,447,235 $ 3,059,617



7. DESIGNATED HOLDING ACCOUNTS:

The Association holds funds in cash that are designated for specific contracts that the Association administers. The activities of these accounts are not reflected on the Association’s financial statements. The balance of these designated holding accounts is as follows:

December 31, December 31, January 1, 2012 2011 2011

Shared care and scope of practice $ – $ 474,439 $ 1,992,214

Specialist services committee – medical consultant services – 10,744,881 480,434

Benefit funds held in reserve 199,656 817,178 311,609

Other holding accounts 98,074 103,731 98,496

$ 297,930 $ 12,140,229 $ 2,882,753

8. EMPLOYEE FUTURE BENEFITS:

The Association sponsored a defined benefit pension plan (“Plan”) covering an employee prior to December 31, 2011. The benefits were based on years of service and the best three-year average salary. The employee’s contribution was 5% of salary and the Association was responsible for financing the balance of the cost. During the year ended December 31, 2011, the employee retired from the Association and as a result the Association’s contribution for the year ended December 31, 2011 was $2,255,878 (2010 – $20,582) in final settlement of the obligation.

The actuarial assumptions adopted in measuring the Association’s accrued benefit obligation were as follows:

Discount rate 5.00%

Rate of compensation increase 4.50%

Expected rate of return on plan assets 7.00%

The following table presents the difference between the fair value of the Plan assets and the actuarially determined accrued benefit obligation:

January 1, 2011

Accrued benefit obligation $ (1,945,174)

Fair value of Plan assets 283,315

Unfunded balance (1,661,859)

Unrecognized actuarial losses 164,852

Accrued benefit liability $ (1,497,007)


Components of net benefits costs recognized in the year in salaries and benefits expense are as follows:

2011

Employer service cost $ 108,804

Interest cost 94,710

Actual return on assets 17,088

Difference between actual and expected return on assets (36,518)

Difference between actual and recognized actuarial gains 27,476

Effect of final settlement 547,311

Net benefit cost $ 758,871

9. DEFERRED CONTRIBUTIONS:

(a) Deferred contributions represent unspent externally restricted contributions received by the Association from the government for the specific use for various purposes. Changes in deferred contributions are as follows:

2012 2011

Balance, beginning of year $ 3,258,351 $ 1,127,559

Add amount received in the year related to future periods 3,295,729 3,830,295

Less amount recognized as revenue in the year (1,579,968) (1,669,503)

Balance, end of year $ 4,974,112 $ 3,258,351

These deferred contributions consist of funds restricted for the following purposes:

2012 2011

Government funded committees $ 312,167 $ 315,542

General practice services committee 4,007,657 2,264,716

Protocol steering committee 83,155 254,258

Shared care and scope of practice committee 101,838 172,785

Specialist services committee 469,295 251,050

$ 4,974,112 $ 3,258,351

(b) The Association also administers various other programs that are funded by the Province for the benefit of those physicians funded by the medical services plan and alternative payments. Each of these programs is controlled by a committee, on which there is equal representation between representatives of the Province and members of the Association, as governed by the physician master agreement. The Association exercises significant influence over these programs by virtue of its equal representation on these committees. The activities of these programs are not reflected in the operations of the Association.

10. RESTRICTIONS ON NET ASSETS:

During the year ended December 31, 2012, the board of directors did not internally restrict any additional net assets (2011 – $550,000 for the IT redevelopment fund). Internally restricted amounts are not available for other purposes without approval by the board of directors.



11. COMMITMENTS AND CONTINGENCIES:

(a) The Association has committed to equipment leases until 2015. The minimum annual lease payments are as follows:

2013 $ 62,811

2014 13,856

2015 3,267

$ 60,512

(b) There are lawsuits pending in which the Association is involved. The potential amount of the claims against the Association is currently undeterminable and as a result, no amounts have been recorded as a liability on the Association’s financial statements.

12. FINANCIAL RISKS:

The Association manages its investment portfolio to earn investment income and invests according to a policy approved by the board of directors. The Association is not involved in any hedging relationships through its operations and does not hold or use any derivative financial instruments for trading purposes.

The Association believes that it is not exposed to significant interest-rate, market, credit or cash flow risk arising from its financial instruments.

Additionally, the Association believes it is not exposed to significant liquidity risk as all investments are held in instruments that are highly liquid and can be disposed of to settle commitments.

13. TRANSITIONAL ADJUSTMENTS:

(a) Net assets:

The following adjustments to net assets as at January 1, 2011 resulted from the transition to Canadian Accounting Standards for Not-For-Profit Organizations:

Net assets:

As previously reported under Canadian generally $ 24,996,365 accepted accounting principles, December 31, 2010

Transition adjustment to measure short-term investments (265,699) and investments at amortized cost (i)

Restated, January 1, 2011 $ 24,730,666

(i) Transition adjustment to measure short-term investments and investments at amortized cost:

The Association had previously classified short-term investments and investments as available-for-sale. In accordance with Canadian Accounting Standards for Not-For-Profit Organizations, all financial assets, other than investments in equity instruments that are quoted in an active market, are measured at amortized cost unless the entity elects to measure the financial asset at fair value. The Association has not elected to carry any financial assets at fair value.

(b) Excess of revenue over expenses:

Excess of revenue over expenses for the year ended December 31, 2011 decreased by $109,679 as a result of the transition to Canadian Accounting Standards for Not-For-Profit Organizations due to the transition adjustment to measure short-term investments and investments at amortized cost.

(c) Cash flow from operations:

Cash flow provided by operations for the year ended December 31, 2011 decreased by $46,250 as a result of the transition to Canadian Accounting Standards for Not-For-Profit Organizations.

(d) Transitional elections:

The Association has made no transitional elections as at the transition date of January 1, 2011 on the first time adoption of Canadian Accounting Standards for Not-For-Profit Organizations.


BCMA annual business session & general assembly—draft minutesPAN PACIFIC HOTEL, VANCOUVER, BC, JUNE 9, 2012 BUSINESS SESSION CALL TO ORDER

Mr Seckel, Chief Executive Officer, called the meeting to order at 9:35 a.m., introduced himself as the Chief Executive Officer of the BCMA, and welcomed members to the Business Session of the 2012 Annual General Meeting. He invited members to stand and observe a moment of silence in remembrance of colleagues who passed away during the last year. Mr Seckel then introduced those seated at the head table, Dr Nasir Jetha, President, Dr Shelley Ross, President Elect, Dr Ian Gillespie, Immediate Past President, Dr William Cunningham, Chair, General Assembly and Dr Mark Corbett, Honourary Secretary Treasurer.

1. ELECTION OF CHAIR

Mr Seckel called for nominations for Chair of the Annual Business Session. Dr Granger Avery’s name came forward and there being no other nominations:

Moved/Seconded Resolution AGM2012/06/09-01

That Dr Granger Avery is acclaimed as Chair of the 2012 BCMA Annual Business Session.

CARRIED

2. MEETING STANDING RULES

Dr Avery welcomed members to the meeting and gave an overview of the role of the Chair. He noted that the first order of business is to review and discuss the Meeting Standing Rules as they appear on the reverse side of the circulated Agenda. Dr Avery drew members’ attention to a revision at paragraph 1 describing the function of the Resolutions Committee at this meeting and inquired if there were any questions. There being no questions Dr Avery inquired if there was a motion to adopt the rules:


That the Meeting Standing Rules are adopted as circulated. CARRIED

3. ELECTION OF RESOLUTIONS COMMITTEE

Dr Avery invited nominations for members of the Resolutions Committee. Dr Sze of Kamloops nominated Drs Jim Lane, Marshall Dahl, and Alan Ruddiman as members of the Resolutions Committee. The nominations were seconded and there being no additional nominations:


That Drs Jim Lane, Marshall Dahl, and Alan Ruddiman are members of the Resolutions Committee.

CARRIED


2012 2013 ANNUAL REPORT DRAFT MINUTES

4. APPROVAL OF THE AGENDA

Dr Avery drew members’ attention to the agenda and inquired if there were any additions, or deletions, or other concerns. There being none the following motion was introduced:


That the Agenda is adopted as circulated. CARRIED

5. APPROVAL OF THE 2011 AGM MINUTES

Dr Avery noted that some of the discussion from 2011 was held in camera and he would bring forward the in camera minutes for consideration when the meeting moved to an in camera session. Dr Avery inquired if there were any errors or omissions with respect to the open minutes of 2011 as circulated and there being none:


That the open minutes of the BCMA Annual General Meeting of June 11, 2011 are approved as circulated.

CARRIED

6. PRESIDENT’S REPORT

Dr Jetha spoke of the importance of a unified association with a unified voice that has the power to effect positive change. He was saddened during the year that there was some division in the ranks as the profession can do best when it speaks with one voice and Dr Jetha challenged members to work together. He spoke of his pleasure that his term is ending on a positive note with the conclusion of the new Physician Master Agreement, which is a significant achievement in light of the economic times. The Agreement protects the provisions established in the previous agreement and preserves the structure of the joint committees between the government and the Association. This agreement will provide the support and stability to build on the successes of the last four years. The Agreement will go to referendum very shortly and Dr Jetha asked that each member give it very careful consideration.

Dr Jetha also noted that he is proud of the work of the Association in health promotion, especially with initiatives relating to encouraging children to be active every day and promotion of the development of good health habits for children in school programs in the province. He also highlighted the work of the Association in promotion of healthy habits, including physical exercise for physicians, and noted that the Physician Health Program has been strengthened and the governance structure is once again within the BCMA. Dr Jetha noted that his written report appears at page 5 of the BCMA Annual Report 2011-12 and in closing wished incoming President Dr Shelley Ross all the best.

Dr Avery inquired if there were any questions. Dr Chris Sedergreen noted that the written report makes only a brief reference to litigation commenced by Dr Wang and questioned why the BCMA Board appealed the judgment that found fault with the BCMA and failed to take a conciliatory approach to resolve the issue. He also inquired as to the costs of the litigation and whether, after receipt of judgment, if it is not in favour of the BCMA, an extraordinary meeting of the membership will be convened. Dr Sedergreen also inquired whether those members who came under criticism by Madam Justice Balance would submit their resignations. Dr Jetha reviewed the legal advice given to the Board relating to the appeal, and the decision taken by the Board, noting that it was a difficult decision and while some members may question the wisdom of that decision, the decision was taken by the Board of the day. With respect to the costs of the litigation, this will come forward under the report of the Audit and Finance Committee. With respect to resignations by individual Board members, Dr Jetha noted that as President he has neither the authority, or the right, to advise. Several other members spoke to the need to look at issues facing the profession today rather than looking back, and spoke of the challenges facing the profession as it moves forward. The following motion was introduced:


That the report of the President is accepted.CARRIED


7. STATUTORY NEGOTIATING COMMITTEE

Dr Avery advised that the report of the Statutory Negotiating Committee is to be held in camera and the following motion came forward:


That the meeting move to an in camera session.

CARRIED

7.1 APPROVAL OF 2011 IN CAMERA MINUTES

This portion of the meeting was moved in camera. One resolution relating to the minutes of 2011 was adopted.

Moved/Seconded In Camera Resolution AGM2012/06/09-08

Dr O’Brien-Bell requested that the meeting be taken out of camera and Dr Avery concurred and invited guests to rejoin the meeting. Dr O’Brien-Bell spoke of the many years of service given by Dr Brad Fritz on behalf of the profession, and the following motion was introduced:


That the BCMA formally thanks and congratulates Dr Brad Fritz for his many years of service to the profession.

CARRIED UNANIMOUSLY

8. CHIEF EXECUTIVE OFFICER

Mr Seckel spoke of the honor of being appointed as Chief Executive Officer of the BCMA and noted how much he has learned over the last seven months of how strong physicians can be when they remain united. Mr Seckel also noted that the position of Chief Executive Officer is one that relies on the efforts of many other people and he assured the assembly that they are well served by those who report directly to him. Mr Seckel also advised that he has interviewed many Board members and will continue this process with incoming Board delegates and he hopes to work with the Board to become even more effective in the areas of planning and oversight. Mr Seckel noted that his written report appears at page 7 of the BCMA Annual Report 2011-12 and inquired if there were any questions.

In response to questions from Drs Essak, Sedergreen, and Wang, Mr Seckel advised that, in accordance with the approved role of the Chief Executive Officer and the Constitution and Bylaws of the Association, he reports to the Board. His primary responsibility is to ensure that Board policy is implemented by the staff of the BCMA. The elected representatives are responsible to the membership to determine the direction of the Association and to instruct the Chief Executive Officer how to fulfil that direction.

Dr Courtice expressed appreciation for developments occurring in the Department of Physician and External Affairs and spoke of a future shortage of hospital-based specialists within the province.


That the report of the Chief Executive Officer is accepted.

CARRIED

9. REPORT OF THE BOARD OF DIRECTORS

Dr Gow drew members’ attention to his written report that appears at page 4 of the BCMA Annual Report 2011-12 and provided a verbal update. He noted that this has been his final year as Chair of the Board and he expressed his appreciation for all active members of the Association, not only those on the Board of Directors, but those who serve on committees, and to the general membership who have taken the time to attend this meeting. Dr Gow thanked the boards of the last four years and offered



special thanks to the Vice Chair, Dr Carole Williams, members of the Resolutions Committee, Dr Trina Larsen Soles and Dr Kevin McLeod, and to the Chief Executive Officer, Ms Martin, and Ms AhPin. The following motion was introduced:


That the report of the Board of Directors is accepted.

CARRIED

10. REPORT OF THE AUDIT AND FINANCE COMMITTEE

Dr Brodie advised that this is his last year as a member and/or Chair of the BCMA Audit and Finance Committee. He drew members’ attention to his report at pages 11 and 12 of the White Report and to the Audited Financial Statements commencing at page 12 of the BCMA Annual Report 2011-12. Dr Brodie introduced members of the Committee, including Dr David Jones, Dr Michael Curry, Dr Mark Godley, Mr Mike Hartwick, Dr Mark Corbett, and Dr Shelley Ross. He acknowledged the assistance of BCMA senior management, including Mr Allan Seckel, Ms Christiane AhPin, Ms Anne Keeble, and Ms Sarah Vergis. Dr Brodie also spoke of the prudent deliberations of the Board of Directors and applauded the work of the Executive Directors of the BCMA departments in conducting the work of the Association in a fiscally prudent manner. Dr Martin Dawes, UBC representative to the BCMA Board, thanked the Association, on behalf of UBC and the medical students, for the ongoing funding support through the BCMA bursary fund. Dr Brodie noted that currently the BCMA provides 150 bursaries of $1,750 each and he thanked the CMA for its contribution to assist the BCMA with this bursary program.

10.1 PRESENTATION OF THE FINANCIAL STATEMENTS

Dr Brodie provided an overview of the Financial Statements. Dr Brodie requested any questions that are to be held in camera come forward after he completed presentation of his report, and there was consensus to proceed in that manner.

10.2 APPOINTMENT OF THE AUDITOR

Dr Brodie introduced the lead auditors from KPMG and advised that the Committee has been very pleased with the services provided by this company and the Committee recommends that this firm be reappointed as auditors for the BCMA.


That the firm KPMG, LLP, be appointed as auditors for the BCMA for the 2013 fiscal year.

CARRIED ACTION: CHIEF OPERATING OFFICER

10.3 MEMBERSHIP DUES

Dr Brodie noted that last year membership dues were increased by 2% and he reviewed discussions that took place both at the Audit and Finance Committee and the Board of Directors on this topic. Initially it was thought that a dues increase would be requested as business costs increase every year. However, now that negotiations have been completed successfully and under budget, the recommendation is that there be no dues increase for 2013. The following motion was introduced:


That there be no dues increase for membership in 2013.



10.1 PRESENTATION OF FINANCIAL STATEMENTS CONTINUED

At this time the Chair invited guests to vacate the room to permit in camera questions relating to the financial statements.

After the meeting came out of camera the following motion was introduced:


That the audited financial statements for 2011 are accepted.


11. REPORT OF THE GOVERNANCE AND NOMINATING COMMITTEE

Prior to introducing the Chair of the Committee, Dr Avery advised that he had received two questions from members regarding process and he invited those members to speak. Dr Busser, speaking of the election of members-at-large of three members for the Audit and Finance Committee, noted that the Bylaws do not require these appointments to be brought forward by the Governance and Nominating Committee, nor by the Board of Directors. He suggested that the BCMA adopt a change in practice commencing with this meeting. He noted that the membership would prefer distance and objectivity in the nominating process for the members-at-large of the Audit and Finance Committee and that the nominees preferably would be members who have not recently retired from the Board, that the nominees be ordinary members of the assembly who may bring a different point of view to the Committee. He suggested that sometimes colleagues contemplating standing for one of these positions may have an apprehension that their names come forward in opposition to names supplied by the Governance and Nominating Committee and/or the Board of Directors. He suggested that the Governance and Nominating Committee and the Board of Directors refrain from nominating candidates unless there is a vacancy and nominations do not come forward. This would permit ordinary members to lead the process.

Dr Avery advised that it is the responsibility of this assembly to elect three members-at-large to the Audit and Finance Committee. The custom, to date, as Dr Busser indicated, has been to accept nominations from the Governance and Nominating Committee, and to also invite nominations from the floor. Dr Avery noted that the Bylaws do not direct that process, but it has been a custom for some time. Dr Avery suggested that those who would be in favour of continuing this practice raise their hands, while those who would like to adopt the method proposed by Dr Busser will be asked to raise their hands in a second round. Dr Avery requested those members who wish to continue the current custom to raise their hands. He then requested those who wished to adopt the process outlined by Dr Busser to raise their hands. As it appeared that the results were very close, Dr Avery requested a standing count. Dr Avery requested those members in favour of continuing with the current custom to stand. There were 63 members standing in favour of this proposal. Dr Avery then requested those members in favour of adopting the process outlined by Dr Busser to stand. There were 40 members standing in favour of that proposal. Dr Avery invited Dr Saunders, Chair of the Committee to present his report.

Dr Saunders drew members’ attention to the report in the White Report and thanked the committee members and staff for their support. Dr Saunders reviewed the work of the committee over the last year and specifically reviewed the recommendations from the committee that have been adopted as BCMA policy. Several members spoke of the relationship between governance and representation and the impact on the size of the Board. Speakers also noted the lack of specialist representation throughout the Association and the need to financially support the SSPS and the SGP in consideration of the work, particularly the economic work, they do on behalf of the organization.

Dr Avery, noted that while there were more speakers, there was a time certain for lunch. He advised that we would return to this topic following lunch, but before adjourning he introduced the newly elected officers of the Association.



12. INTRODUCTION OF NEWLY ELECTED OFFICERS

Dr Avery introduced the officers for 2012-2013: Dr Nasir Jetha, Past President, Dr Shelley Ross, President, Dr William Cunningham, President Elect, Dr Charles Webb, Chair, General Assembly, Dr James Busser, Honourary Secretary Treasurer.

18. ADJOURN

Dr Avery adjourned the meeting at 12:00 p.m. and advised that the meeting would reconvene at 1:30 p.m.

18.1 RECONVENE

Dr Avery called the meeting to order at 1:30 p.m.

17.1 NEW BUSINESS – RECOGNITION OF DR BRIAN BRODIE

Prior to returning to the orders of the day, Dr Geen rose to offer appreciation for the work of Dr Brian Brodie who has worked tirelessly and with great sensitivity for the members of the Association. The assembly rose in a standing ovation.

11. REPORT OF THE GOVERNANCE AND NOMINATING COMMITTEE CONTINUED

Dr Avery invited Dr Erik Paterson to speak. Dr Paterson inquired why the Governance and Nominating Committee is considering reviewing procedures for conducting meetings other than Roberts Rules of Order. Dr Saunders advised that there are other rules of order that other organizations use and the Committee is not suggesting that the BCMA move away from Roberts Rules of Orders, but it is suggesting that other processes be reviewed. There were no additional questions for Dr Saunders and the following motion was introduced:


That the report of the Governance and Nominating Committee is accepted.

CARRIED

11.1 ELECTION OF THREE MEMBERS-AT-LARGE OF THE AUDIT AND FINANCE COMMITTEE

Dr Avery invited Dr Saunders to present the nominations for the three members-at-large of the Audit and Finance Committee. Dr Saunders advised that the Governance and Nominations Committee presented three names to the Board, and the Board ratified the nominees as follows: Dr Mark Corbett, Dr Michael Curry, and Dr John Falcon.

Dr Avery inquired if there were additional nominations. Dr Larry Collins nominated Dr David Jones. Dr Avery inquired twice more if there were any additional nominations, and no additional nominations came forward. Dr Avery invited each of the candidates to speak to their nomination. Ballots were distributed and following the count:


That the members-at-large of the Audit and Finance Committee are Drs Michael Curry, Mark Corbett, and David Jones.


A motion to destroy the ballots was introduced:


That the ballots for the election of three members-at-large of the Audit and Finance Committee be destroyed.

CARRIED


13. REPORT OF TARIFF COMMITTEE

Dr Avery noted that Dr Brian Winsby, Chair of the Tariff Committee had to leave and advised that Dr Robin Routledge would give this report. Dr Routledge drew members’ attention to page 34 of the White Report. There were no questions arising from the report and the following motion came forward:

Moved/Seconded ResolutionAGM2012/06/09-19

That the report of the Tariff Committee is accepted.

CARRIED

14. REPORT OF THE CONSTITUTION AND BYLAWS COMMITTEE

Dr Nasir Jetha reviewed the work of the Committee over the last year, and thanked the members of the Committee and the support staff. Dr Sedergreen requested that in future the Board reconsider its policy with respect to materials sent to the membership on future referenda to amend the Bylaws to include the recommendations of individual members who propose Bylaw amendments. Dr Avery noted that this is a request for the Board to review a process at a future date and he would not call for anyone to respond at this time. There being no additional questions or comments, the following motion came forward:


That the report of the Constitution and Bylaws Committee is accepted.

CARRIED

15. REPORT OF THE SOCIETY OF SPECIALIST PHYSICIANS AND SURGEONS OF BC

Dr Avery invited Dr Dalal, President of the SSPS, to review his report. Dr Dalal noted that the written report appears at page 46 of the White Report and stated that he had no additional comments. Dr Dalal introduced the incoming President, Dr Andrew Attwell. There being no questions:


That the report of the Society of Specialist Physicians and Surgeons of BC is accepted.

CARRIED

16. REPORT OF THE SOCIETY OF GENERAL PRACTITIONERS

Dr Avery invited Dr Peter Barnsdale, President of the SGP, to review his report. Dr Barnsdale invited members to see his written report at page 45 of the White Report and noted that it has been a good year and that the SGP Board has worked hard on behalf of its membership. The SGP has found the BCMA to be a receptive and collegial body to work with over the last year. Dr Barnsdale introduced the incoming President, Dr Tracy Monk. There being no questions:


That the report of the Society of General Practitioners of BC is accepted.

CARRIED



17.2 NEW BUSINESS – RECOGNITION OF RETIRING BOARD MEMBERS

Dr Sanjay Khandelwal drew the assembly’s attention to the contributions made by Board members who are retiring at this time, including Dr Ian Gillespie, Dr Robin Saunders, Dr Alan Gow, Dr Bakul Dalal, Dr Mark Corbett, Dr Yusuf Bawa, Dr Peter Barnsdale, Dr Shao Lu, Dr Tod Sorokan, and Dr Keith White. Dr Khandelwal also spoke of the outstanding performance of Dr Mark Schonfeld who recently retired from the BCMA. The assembly joined in applause to recognize the contributions of these members.

17.3 NEW BUSINESS – IMPACT OF NOISE ON SOCIETY

Dr Avery invited Dr O’Brien-Bell to speak to a motion he had brought forward through the Resolutions Committee. Dr O’Brien-Bell noted that during the 20th century, the number one health hazard investigations were smog, fog, smoke, smoking and respiratory diseases. In the 21st century, it is noise, whether it be from transport, from radio, or any aspect of life, it is getting worse and worse. He suggested that the profession develop terms of reference for a national investigation into the cause and impact of noise on society. Noting that it was not feasible to do the investigation, he suggested that it is possible to develop terms of reference that could go forward to a future CMA General Council. Speaking in support of the proposal Dr Erik Paterson spoke of the negative effect of noise on humans and noted that efforts have been made to make quieter automobiles, but much more work is necessary.

Dr Oppel, Chair of the BCMA Council on Health Promotion, reviewed the current CMA policy on noise pollution. There being no speakers in opposition to the proposal, the motion came to the floor.


That the BCMA develop terms of reference for a national investigation into the cause and impact of noise on society and how that impact might be addressed.

CARRIED ACTION: S MARTIN – BOARD AGENDA JUNE 10, 2012

19. ADJOURNMENT

Dr Avery inquired if there was any additional business. Dr Angus Rae advised that the Association of Clinical Faculty missed the deadline for publication of its report in the White Report, however, copies are available at this meeting. He thanked the BCMA for all efforts on behalf of clinical faculty. Dr Rae expressed his opinion that when the BCMA negotiates on behalf of its members with a third party, at the conclusion of the negotiations a referendum should be sent to the affected members. He did not propose a motion for consideration. There being no additional business a motion to adjourn came forward at 2:05 p.m.

Moved/Seconded Resolution AGM 2012/06/09-23

That the business session of the Annual General Meeting is adjourned.

CARRIED

GENERAL ASSEMBLY

Dr William Cunningham, Chair of the General Assembly, called the meeting to order at 2:06 p.m. and drew members’ attention to the White Report that contains the reports that will come forward in this session.


20. REPORTS OF THE STANDING AND AD HOC COMMITTEES

Dr Cunningham drew members’ attention to the reports of the Standing and Ad Hoc Committees at pages 4 through 35 of the White Report and invited questions. A member, referring to the report of the Geriatrics Committee, requested the BCMA position on physician assisted suicide. Dr Cunningham undertook to ensure the member’s question "was followed up. No additional questions came forward.

21. REPORTS OF THE BCMA SECTIONS

Dr Cunningham drew members’ attention to the reports of the Sections at pages 36 through 46 of the White Report 2011-12 and invited questions. No questions came forward.

22. REPORTS OF THE AFFILIATED SOCIETIES

Dr Cunningham drew members’ attention to the reports at pages 48 through 49 of the White Report. There were no questions arising.

23. NEW BUSINESS

Dr Cunningham inquired if there was any new business. Dr Mark Corbett invited the assembly to express its appreciation to Dr Avery for Chairing the Business Session and the assembly joined in a round of applause.

24. ADJOURNMENT

A motion to adjourn was introduced at 2:08 p.m.


That the General Assembly is adjourned.

CARRIED



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Documents

BCMA 2012-2013 Annual Report