DOCTORS & LODGES

Dominion, Volume 9, Issue 2744, 12 April 1916, Page 6

DOCTORS & LODGES

A VEXED QUESTION

MEDIGALMEN'S SIDE IN THE ■K-y .;;■;;'CONTROVERSY ' / v ■ ;

"CARBYING THE LODGES ON HIS BACK."

■: "Thei'doctors^'side*;of;:the'..argjrnjent'">in ■ the,conflict f between 'Jledical £.#Watiori;and'tho'.friendly sbbietiesvas '■■, to;the , >tenhs .'on wh'ibh;the,doctoix','shall ;.BervS\ the .lodges was-presented *'t& 'the . Minister;'6f public: >; W : -Bussell) -yesterday -by" Si deputation the'-/jßritjsfr-^iledical; \ Association; " The f:: : friendly.'.societies''had- put-their«side of ';■ the';ciisß;,,b'e'fore.;,tlie,Minister a"few days I''previously; i"i '" '; :■ ■ -'•,- ■-■.. ..'.-■''.. ■■■:•'.-■ y: -:?Cploiiel-S.C<»llins,7 ; N.Z.ar.C.,- was- 'the •/leader, of; the deputation/. He said that n the vexed question of the paymeut of [V, doctors.: bvVfriendly societies had. been [ ..considered.vary carefully by the doctors, i :•'find-.theylad come to the conclusion that |;' it would ; be >ise to try now to come to 1. •Eonie'definite and more satisfactory. agreef.,:.jnent,as"tO'the remuneration to be.given i : ; to doctors for their services. A nieniort ..aridum had, he. said,- been prepared seti ting out the .case .from, the doctors' point 1; of view, anii this memorandum he 'read 5' to the Minister as follows :— ./The'Doctors Resign. ' p. X"ln .response to the-suggestion of the !:. Hon. Mr. Russell that tfie doctors should [■ -present a statement;from their point of butiw.iof the present dispute with the Wei- [': lington.- friendly societies, the following l=: : memorandum is, placed before the Minisi; ter by, the Wellington Division of the ji! British" Medical Association. [' . "The Wellington lodge doctors, being long t.'dissatisfied with the terms.of \the; agree- [ mint .under which they, were working, gave [• Botice'to all,the'lodges--in- August last [/•that they were unwilling to continue to l : net'- except;. under • e. new agreement. ! Toward the end. of ..August a meeting of ['■representatives' of lodge "' doctors 'and !>,'. friendly .societies was. ffdW at which a i'.proposed new agreement • (produced) was f-:. submitted By: the. doctors. ■; At. the," end t; of the'month the doctors sent in .written f resignations -of their position as'lodge f" doctors '.under the old agreement, these [-.resignations to.'take effect at the end of (•three months. The old. agreement reK mained 'in force until terminated at the ' •'-. end, of -a ; quarter by three months' .pre-f.-,vious notice, delivered •■in.:':, writing' by. I' cither party.' , The,lodge doctors cons'.tinued to act to the;end nf the three I months, carefally, complying : with the i?-stipulation.- : : '•'• .' - K ..Negotiations with Lodges. 1' ''"During the last, months of 1916 negoi' tiationa proceeded .between the" repre- ■ sentatives' of the'two : bodies concerned, I..'and..!several" meetings were held. ; The Y lodge - representatives'i submitted a. new i agreement ; (produced), on their part, .but ! : jas-.the old rate of 15s. per member, per f innuin .was 'offered again without any inr. -urease,,this agreement -was declined by I' lie lodge doctors. By the. end ot the 'r r :;7ear'certain'l6dge3. entered, under fa. .hew i-. ; agreement (produced)'with the lodge doc-' [■'''tors'-on?'terms' .'fairly' satisfactory ; to' the 1 ■:'• ibctdrs,", so' these': lodges'"have' had . coniV'tiiiuity of : medical attendance without any i. breach whatever.-' Moreover;"they'negci/'tiated with ho.other than the Welling- [: ton lodge 'doctors, so far as we know. [■ Theremaining lodges decided on a differl :snt course, of action, and consequently i v jt the end'of three months,- as provided i' : '%' the: old agreement, .the resignaf .'iionr took effect';' as' far as they ;: vere concerned. ,:,The 'Wellington division ["; emphasises thepoint that the lodge doct-'. tors scrupulously' observed'the- terms of ;' tho old agreement, because of Mr. Burke's ['remark, (published "on..April 4) that the i doctors/would-aip" longer ] carry, .put...their i agreement with-the different'lodges..-',-The i[ •■ terms'of theold. agreement", were 'precisely •-.observed .it "was not treated as a scrap '• of paper/ Further, lodge doctors v offprpd to . treat the families of lodge t.- members : absent : at ■ the .v/ar at the. old !, rateVof- las.

| '...i ...i/Several "Misstatements;",'- ' '■ . | : "The' Wellington i division wishes to eor-, Krcbt. several; misstatements made by. the ! .'lodge representati-yes who- waited as a 1 deputation on. the 1 Minister on ;April. .1. [ "(1) >Mr. Burke states that the original I .agreement had been -in force 'from 1906,' i-'.-.but.. he; omitted to state;'that there; had I-■ been no : . inorease 'in..: the 15s.' rate per f member.'for about 25 years. !Por 15s. per {'"annum, attendance,was .given, at any, time, i, ■ day or night if; necessary,., to. members, i. their wives, their children.; -legitimate ':. and 'adopted," up .to lli. years-for males 'and 18 years for '.females,',' as fwoll"- as -the : widowed/mothers"' of 'single''members. ;The average number of people thus pro-. vided .for- works- out' tit'-four -por,.lodg» , inember.L Por 15s. -per annum, medical was' provided for. all: [.. .operutiohs,. and' anaestke- [•. .tics.'cxoepted. - : In Great Britain,, under l'. the ;NationaMnsurance scheme, each in- !, .dividualpays' 7s: : per annum for medical 1 .benefit to himself only. To provide niediS ■ oal,' benefit "there for ."four.' persons would t .cost-28s. per. annum, • yet., wages. ..are f higher here. ■ Under, the old agreement !', 3Ju. per week was" paid, by each member. ; 'The lodge doctors asked an'inorcase of •'2d."per week; The Minister-must surely r think that the wages of lodge'members in i New Zealand are not in a satisfactory ' condition if each one" cannot afford 5Jd. ! per .week, i.e.; less, than the cost of a f packet of cigarettes, to obtain medical : benefit , for 'an average of four, persons. ! Por every £IW a lodgo doctor receives he, |. does-.work in visits, and ',' "consultations'" !'■ worth; from'je3oo;to if estimated by .the, fees current ! in private practice. Bxi, pressedin another way,"for overy~lss. per ■;■. member 'which a, doctor receives he doi-o j' I ,from. 455. to 60s,': worth, of -work. o He ! : gees ;a' long' way' towards carrying:.. the \ lodges .on his back, being really, by; far 'the largest■ contributor their success, : -and a much sweated . individual. One ';•' lodge representative admitted that with- ■ out medical benefit the lodges could not • obntinue.' The sum" paid per annum for \ .the wholefamilyis less than tho cost; of ■'." an 'ordinary-pair of boots. "The wonder is j (editorial"' 'N.Z.M.J.,' December, .1915)' f-. that lodge members consider it in the [least advisable to have underpaid - and--1., dissatisfied doctors to,attend ; them/., ;;..,..-, >•■■;* "(2) the special fee of' ss.' : for night 1' visits ; is intended here,' as 'in .the Hew r: South Wales agreement, to discourage iin--I.necessary night calls. It is a slight step !, towards an equitable "payment for over- : ;■; time. :■•' ';''(3) The fixing the mileage-limit of two ! miles instead of three miles isf in accord- ' . anqe with tho rate in private practice, r all-over New Zealand and the New South J '.Wa!«s agreement. i. '. ; "(4) Mri Burke states .thai; ii; was underi stood that two guineas was the charge for [ rriaternity cases. There is no mention pf [this in the, old agreement. The charge [for, accouchement cases in the printed ! scale of fees (produced) in private prac- ;-"■ ticei begins at three guineas. Where uo I charge is specified in a lodge agreement, j the; Medical Association's scale of fees is I the guide for doctors to go by. '(■'. ;'"(5) It was also stated that the lodges : offered 18s. per member in their counter; • agreement, but as will be seen by their I agreement (produced) the rate specified I was the old one of 155., and no increase r whatever, hence the deadlock. . ; '-"(G) Regarding the statement that a ceri tain doctor had not been allowed to como i to the Wellington division ;•'' has'no knowledge whatever either of who i the doctor was or of,who approached him. . ,"(7) Regarding another doctor who did : come and accept service with the lodges, ■; the fact is that he left of his own accord, " after one week's experience of the situai: tion. ' .';'.-' • :, No Boj-cott, ?"(8) Mr. Burke states that the B.MJA.is i' attempting to boycott the friendly socio-' i .ties. This is entirely untnie. The lodge - doctors have gone to a great -deal of i 'tiWible in the negotiations, and'are ivill- : ing to undertake the onerous duties at- ; tached to lodge work provided the terms ; are made loss unreasonable. The belliger- \ entvfriendly societies did actually boycott ; -the'four representatives of the lodgo 1 doctors when electing by ballot eight", '•'"-dfictors to attend lodge members as prii- vatq patients for .tie present. Their i names were purposely omitted from the list "of ten doctors at the lodge ballot. ; These -eightidoctors in loyalty to their

brethren promptly repudiated the selection as having been made'without their knowledge, wish, or consent.' In prirnte conversation with doctors, many lodgo members speak in terms of disapproval of tho action of their representatives. .The Cost of Living. "The Wellington division would emphasise the fact that.the question of tho cost of liviug affects the doctors as well as other people, especially in respect of tho expenses in connection • with tho carrying on of privato practice..-'Petrol is more than double the price it was, wages, 6tabling, or garage fees, the cost of repairs, have all increased. In the old days of gigs and horses, when a contract with a stable was the rulo, extra travelling did not. entail extra expense, whereas now every individual visit means cost in petrol, tyres, and wear and tear. Owing to the hilly nature of Wellington and its environs, it comes about that thecost to a lodge'member of medical service and visit to a place on the hills is considerably less' than : the authorised taxi-cab fare to the same place. ', ' "The fact that there is universal dissatisfaction among lodge doctors throughout Australasia is a'proof that the existing terms are inequitable. The New South Wales agreement is giving fair satisfaction to the doctors there. The terms asked' for here are similar to those settled in New South Wales .after the conference in 1912 between representatives of. .the B.M.A.- and the friendly societies there,- under, the presidency of the Hon. Frederick Flowers, M.L.C., .and also in accordance with tho agreement (produced) approved by the New Zealand Branch of the B.M.A. in Wangamii in 1913, and 'finally adopted in. Auckland in 19H. We have at present omitted the income limit, which is defined and incorporated in both the aforementioned aereements," ; A Big Rise. The Minister said he would like to arrive at some basis on which a reconciliation between.the societies and the.doctors could be effected. He had thought of suggesting a conference between representatives of .the profession and of the Friendly; Societies. : As;thß,onix of tie; dispute appeared; to-be-the 'question- of- whether, payment .was.'to be at. the.rate.of 2-ts. per member, or something less, he wished to ask' the medical profession'.whether they were prepared to meet tbe societies in any way by adopting l a lower rate. Of course, it.'-must'be .recognised, that a rise from 1554t0'.-245.: was a very big rise. He was nbt ; .dißcussing. whether it.was.a fair one or:,not:.'*.Perhaps'./th,e,medical men in past years had been undiily; liberal". He was most'anxious to see, tlie breach healed. In his'-iet.ter' to tie"B.M.A. : lie, had emphasised two that-we were now at .war;;and(2)'that thero has been a very large inprease in. the,cost of living. . Dr.'Collins said that the medical men were, quite anxious to have a settlement, but-so many doctors lad gone to the wa: that were.left had to work extremely hard. Indeed, some of them would not be able to stand.the strain. -They Could not carry on their lodge duties as well as,their private practice. Tho doctors felt ■ that x they had been working at a very low wage fm- the friendly societies,' and the temptation was to 'drop the low-paid work. Mr. F„ussell: I, understand that there are some lodges that have already come-into agreement with theiinedical. profession? : Colonel Collins: That is so.

; Mr. Eussell: I don't know the basis of that agreement, but ,if that agreement were general, would that be satisfactory? The information I have is that the price per member, under that agreement is not 245. '•• ",' .' ' " ' '/:

, Colonel Collins: No; it is 21s. :,'Members of the deputation: -lor reasons. Mr. Hanan.- s What are the reasons for differentiation?., ,

Dr. Gilmer: We came down' from 2is. to 21s. on the distinot- understanding that this rate would be for He war period only.

Mr. Hanan: Will you settle with the 'others for-this? .

Dr. Gilmer: I don't know that we will now. The other societies have behaved in a way that has.got the doctors . up. They have done their best to browbeat us.. .... '

Mr."Eussell: There is no conciliation about' your '"attitude. You are inclined to fight/ ■-■:,■■ Dr.,Gilmer: Yes, sir, to a finish.

Other doctors: We are with him. Dr. Gilmoi-: When I say I am inclined to fight I know.,that the rest of the profession are witli' me. ,- .'.

. .-'Notan/Opportune Time. . Mr: Russell'suggested that any tiiau within the last 25 years would have been a better opportunity to ask for an increase in rates than the present. Dr. • Gibbs said he differed from this opinion. Although there was an increase in the cost of living .now, the Dominion had never been richer, and unemployment had never been; less in evidence. The working man was better off now than, ever before. '"'■"• '■■': '• -' Mr. Russell: I can't agree with'you. The purchasing power of the sovereign has gone down, tremendously during tho last three or four years. Dr. Gibbs: But as against that men are more constantly employed. ■'. They are getting more money. It is because of the present conditions that change is necessary. Whilst in the ordinary run of work medical men wero able to manage private practice and lodge lyork, although thoy knew they, were; working under' a great deal of oppression .and inequality, it was only when the,war broke out that what was bearable before became unbearable. Doctors felt that they, had to give -up something, and they were inclined to give up their lodge work. The Typical Lodge Member. Dr. Tolhurst said' it was yery difficult " to come ' to any agreement with lodge executives. He maintained that they did not represent' one-tenth of the members. It was very rare for. a member of a lodge to attend a meeting 'at all." -..V'A's a'ty'pical 'case, he had heard this said by a member "I have never been near a meeting since I was initiated. I didn't Jiko the look of the crowd there." Another 'man would say "Well, doctor, when Vtkc wife or. children are ill I am ':going. : to have you.,' I am not going to have any' blackleg doctor to attend me." This was the spirit among ordinary members of the.lodges. ■: !Dr. Lang- said the remuneration for lodge work was inadequate in consideraation of work done. Mr. Eussell: Do-you seriously contend 'that, there , are.', four patients for every 'member of every lodge? Dr.'Collins: We are liable to have to attend to as many, as that. . " How It Works Out. Mr. Eussell: Has any test been made, to show, assuming there is a lodge with 100 members in it, > how many patients would (call for medical service in tho year? . . Dr. Lang: It has never been made out in, terms of- patients, ' but it has been made out in' terms of .work done. , I was working for a small lodge,, and' in | six months I put down every visit and every consultation, and estimated to the lodge the value of the work for those six months. ..This worked out at an average for the year of 50s. per member, at tho ordinary B.M.A. rates. Dr.; Giesen said he had kept a record for a period, and had found that lodge fees for consultations, and visits averaged barely ,Is. per attendance, and these attendances were often'at Brooklyn, Karori, and one was at Khandallah. Dr. Gibbs said that three or four years ago he had sent a circular asking for this information from every member, of tho B.M.A. in New Zealand. He received from. 150, to 170 replies, and theso showed that the average remuneration attendance was about lOicl. Somvwere paid apparently well, and some received as little as 3d. or sd. Mr. Hanan's Opinions. The Hon. J. A. Hanan, who was present as Minister in Charge of Friendly Societies, said that the doctors had nSado an agreement with some lodges at 21s. per member, and the presumption was that in tho opinion of the profession this was a reasonable charge to make. Br. Gibbs: No. It is only tentative. Mr. Hanan said, the deduction must bo that I he doctors considered tiffs a reasonable chaTge to make. Dr. Gibbs: No. it is a concession. Mr. Hanan said that in Dunedin, Christchurch, and Invcrcargill tile vale 'was 18s. AVhy should it be higher in Wellington P Dr. Gilmer: Wellington ir. the most difficult town in New Zealand to work. Mr. Hanan: Why should this concession be given to one lot of lodges and not to others? The hint dropped is that be-

cause hostility is shown by them they must pay 3s. for thnir hostility to mem. hers of the profession. That is a matter for the medical profession, but no doubt.the public will say this, that this is not the timo when vindictive feeling should be manifested. I bolievo these people have acted to some extent foolishIy, but I think, under tho circumstances, if I might put it to you as high-minded gentlemen, that you might lot this go, having regard to the poor position of tboso who are members of' societies. It woujd lie, a gracious. act, and it would certainly place the profession higher than it is, and it does occupy a- high position in the estimation of the community at this time. We are told by inference tly.it by reason of a number of medical men going to the front you have a lessened amount of competition amongst the medical mon in Wellington, and therefore, taking advantage of that lessened: competition, that an ■ opening arises to increase feos.

Dr. Collins: It is because of the increase of- work. \

Mr. Hanan recognised that there must be increased work. He would urge that the medical profession could afford to sink their Strong • feelings and get down to this rate of 21s. He'believed that this was the wish of the public, and the wish of the leading medical men of Wellington. The older medical men of Wellingtod should use' their influence to bring the parties together. Dr. Lang explained that the "belligerent" lodges had never made any offer but that of 15s. The Oddfellows did offer 205., and after that offer was received the doctors consented to accept 21s. The Oddfellows always stuck to tho local doctors, and never tried to get in others. Mr. Russell Replies. The Hon. G. W. Eussell said he quite realised that circumstances had changed during the last 25 years, and he realises the truth of what had been said by Dr Collins that the low scale of fees had been allowed, to go on because of circumstances that had accrued from time to time rendering it impracticable to raise the' rates. The absence of so many doctors at the war had reduced competition to a minimum, and he would ask the doctors to consider this aspect of the matter.. None of them' had been under any compulsion during the last 25 years to carry on the lodge work. He presumed that they retained it because directly or indirectly it paid. This was a fact which had to be considered in connection with the demand for the very large rise asked for now. In Dunedin and Invercargill the rate was. ISs., and in view, of this ho could not see how Wellington doctors could demand 245. Dr. Gilmer:. They are waiting for a lead from us. They are not satisfied either. Mr. Eussell .said that ho thought the members of tie B.M.A. should not give a decided opinion until the matter had been further considered. He was not going to express an opinion as to the rate at which they should settle. Ho was prepared to admit that, 15s. was not enough. Equally he was prepared to say that 2is. was too much. He asked that he should be allowed to call a conference of delegates from friendly societies and from the B.M.A; If such a conference were arranged, he would preside, and would endeavour to help the delegates to arrive at a modus vivendi. Ho put it to them that they could not reasonably insist on the rate of 245. seeing that they had o-greed to serve one lot of lodges lor 21s. He loped that if the two contending parties would agree to "split the difference," an agreement could be reached. "I realise," he said, "that my position as Minister of Public Health places upon o me tie necessity of finding .niedical service for every part of the country where I am. able to do it. I have that responsibility for tho back-blocks, and for the city as well. If I-find that there is a large body of people who can prove that- they are unable to find medical service at a price they can afford to pay, then I have a responsibility on me to find some method by which that difficulty may be solved. I am not going to look at it from that point of view yet." Mr. E-ussell said ho would ask tie doctors to meet the societies in a spirit of conciliation, and not with a desire to extract everything even that they, were entitled to. have. Ho would ask them to realise that tie country was passing through, a most unfortunate time, and that this was a time when we ought to try to meet one another in every possible way, provided it could be done in a way not unfair to either side., .

Dr. Collins.' said that the association wonld considir the Minister's suggestion regarding a conference.