Dr. R. Michael Giuffre remarks to the Nov. 29 EZMSA emergency meeting

November 29, 2012

Dr. R. Michael Giuffre, AMA President

Good evening and thanks for coming out tonight. This is an important meeting. We are facing an unprecedented situation as physicians in this province. This was the case when I spoke to your Calgary colleagues last week. Today I had my meeting with Minister of Health Fred Horne and will update you on that shortly.

So let’s start with where we are: first taking a look at some of the big issues that our situation raises then second the AMA’s plans for moving forward. I then want to hear from you and I look forward to your comments and questions.

As you know the ending of negotiations followed by a forced settlement or imposition that the minister announced on November 16 has infuriated the profession. In about 1,000 emails in the past week or so, members have told me about their anger their disappointment and their frustration. Some members have taken their anger to the editorial page or the media. Different physicians are expressing their anger different ways but the anger itself is universal and uniform. The minister should know that he created a problem. This was fueled by government’s newspaper and radio ads.

Please recall that this occurred with a background of a signed agreement in principle between the AMA and this government. The minister signed a document before the provincial election. This signed AIP signaled that the agreement in principle consisting of all important elements was a reasonable arrangement for government, physicians and the system.

Then, on April 23, apparently the rules changed when government won the election. And when the minister came back to complete the agreement he had promised in writing to finish he changed his mind. In effect he walked away from the AIP.

I am not going to spend time tonight tracing the history of the past weeks and months because they all led to that same announcement of the imposed settlement on November 16. Most details have been shared with you in President’s Letters. If you have any queries about any particular step or stage I will be happy to answer them during our question-and-answer time.

I think, though, that you will be more interested to know what happened this afternoon in a meeting with the minister that I publicly requested via a news conference last week. As you know I was very clear about what the AMA needed from this meeting:

  1. We asked the minister to rescind the imposed settlement and return to the negotiations table. 
  2. We said we wanted a negotiated agreement to be complete by December 31.
  3. If we couldn’t complete an agreement by December 31 then outstanding issues would be referred to dispute resolution to arbitration because we need to get this done and that is how things get done in disputes like this.

The minister and I met at 2 o’clock this afternoon and stayed talking for almost two hours. I took forward the three things that I have just listed and I must say that the minister had an interest detailing a discussion that allowed us those key points. We are in the process of drafting a letter of understanding that gives both parties comfort in moving back into negotiations.

We have made some progress but we are not yet out of the woods. There will be more work done overnight and into tomorrow and that’s why our Executive Director Mike Gormley is not with us here this evening. I will update everyone tomorrow.

If we are back into a negotiation then all aspects of the agreement are under negotiation and the past letter from the minister of November 16 is not in play. Obviously, being back in negotiations is better for patients, physicians and the government. In fact it’s better for all Albertans.

Am I optimistic? I would say “cautiously optimistic.” I’m not going to speculate how far the minister will be willing to go at this stage, but he showed willingness to proceed.

But I think the minister does “get it” that physicians are really, really angry. I have told him that he added fuel to the fire and astounded us when he would chose to spend $130,000 on advertising that attacked doctors and misled the public.

I really hope that we are moving forward. I DON’T want to be forced to say that we have a minister of health who thinks that the best way to run a health care system is for his office to issue ministerial edicts, orders and directives.

We need to KNOW that he does care about the input of physicians who work on the front line and that he will listen when we tell him what we know about this health care system. 

I think it’s important that we keep the pressure on and end up back negotiating.

I will be talking later about plans for the short and long term now that we know the minister’s response. But let’s remind ourselves why this imposition needs to be withdrawn. Over a five-year period it contains:

  • Lower fee increases.
  • Termination of critical programs with no guarantees for the security of the funds they provided to physicians. 
  • Downward adjustment of a cherry-picked list of fees or across-the-board fee cuts for some sections that the minister arbitrarily selected.

The imposition that the minister previously described was laid out as if it was a gift for physicians but is not what it seems. He hasn’t accounted for planned take-aways. He is also not saying that money he is removing from programs does not have to go back to physicians and could instead be used for family care clinics or other things. And, there are other, even more-serious issues.

So let’s look at those issues and why we must respond so deliberately and forcefully. I have five major points to make.
One: The minister’s decision to use an imposition and ministerial authority to conclude negotiations is a big issue and one that should worry everyone. It deals with the basic rights of physicians which the whole idea of an imposition deals with in a disgraceful fashion. Can you think of any other group being told: “Here is what you are going to be paid for the next five years and that’s it and there is nothing you can do about it?” Five years is a huge increment of a professional life span. This is unprecedented. 

This imposition would mean that the minister is taking the money away from you that you have received from the Business Costs Program and the Retention Benefit. Not only won’t he promise to give you that money back and it’s your money but he’s using those funds as a lever against you. “I may give you some of that money back,” he says. “If you cooperate with what I want to do.” And what he wants to do through things like family care clinics or arbitrary fee schedule changes will affect how you deliver care how all of us deliver care and will come between physicians and the patients we serve. EVERYONE should be concerned about this.

In doing what he has done the minister has ignored provisions of the Canada Health Act and requests from the AMA to name an arbitrator (not to mention fighting us in court on that front).  He is moving more and more of what we have had from areas of processes for decision making to the world of ministerial authority. If you don’t like that, you can expect more in the future if we don’t stand together.

Let’s look at his plans to adjust that set of fees. The AMA has said many times that we are not afraid to look at reviewing fee relativity. But we want process and evidence-based decisions and appropriate input from the physicians affected. The minister cannot just arbitrarily pick the fees he thinks are no longer appropriate.
Two: The minister is challenging the unity of the profession. This imposition is all about splitting us apart. The minister will deny this, but I have heard from hundreds and hundreds of you in the past few days. To most of us, the intent of the imposition is plain. He is trying to drive wedges between us and this will not stop and it may get more intense. We must stand together we must think of our collective needs as a profession. Don’t let government divide you. Don’t let him use tradeoffs and backing off here and there and I will say more about that in a minute. My point here is: We are all in this together. Unity speaks volumes.

Three: When I talk about backing off I mean that I wouldn’t be surprised if as a tactic the minister eventually backs off on parts of the imposition. He may try to offer concessions to one group hoping the bigger picture may be lost. He may offer to change small items but it would be a disaster for our profession if we let him do that without also addressing all the other fires that he has set. We must not be distracted by short-term particulars when the major fundamentals are still in question. That’s what the minister will ask you to do. We can’t kid ourselves. It has happened before and will happen again.
Four: When we are talking about fundamentals let’s look at what’s happening in the system. Over this last year we have seen government pushing a lot of change. They are trying to reshape primary care. They want to change the way patients move through the system including secondary and tertiary care. And they are making plans and decisions without us. They have bureaucrats who have never been involved on the front lines developing 100-page documents about how family care will be delivered. They are keeping these documents secret and sharing them with a hand-picked few. There is no emphasis on relationships. There is no trust. There is no respect. And I, for one, simply cannot see how anyone can hope to make the system better or even maintain what we have without these things. This is a problem for all of us and that includes the minister.

Five: When I spoke in Calgary last week, I posed a question for Mr. Horne. I asked if he really thinks he can run this health care system without the confidence of physicians? Based on the conversation today I am more confident of his answer. Again we are not out of the woods and we must not accept watered-down success but I hope he begins to see that a system that does not have a well-engaged medical profession will not succeed. And his actions in these negotiations have really damaged that confidence. He’s going to have to repair a lot of lost ground no matter how the next 24 hours work out.

Does the AMA think an arbitrated settlement is the best solution? No! A negotiated agreement is always better because arbitration has risks for both sides. That’s why although everyone else has it it is rarely used. 

But arbitration is a basic right that physicians are being denied. And it’s a way to end something that has been going on and on. And will go on and on. 

Refusing to allow dispute resolution is non-sense. The minister says there are no provisions for arbitration. That is non-sense. Private parties use mechanisms like this all the time to resolve disputes. Other professions and governments and individuals do as well. The Canada Health Act says arbitration must be available to physicians. There is no reason on earth why the minister can’t just decide to make it so.

These are matters of fairness of basic rights. If the minister thinks his imposition will end his problems with the profession I disagree.

So where does this leave us and where do we go from here?

In the short term I’ve told you what’s happening or may be happening tomorrow and the next few days. But we still need to keep our planning in motion. We will agree to a facilitation and a mechanism of dispute resolution.

To prepare for all eventualities we had called a special meeting of the Representative Forum for December 15. This is a rare thing and we don’t do it lightly because it involves 135 of our physician leaders from across the province. I think that meeting is still going to be timely.

There will be more information on all of this in the days ahead before the special RF and for the remainder of the month and right into the new year.

The stakes are still very high. We must first remove the imposition and see this as a signal that the minister is truly ready to work with us. We must negotiate an appropriate agreement that may include an independent third-party arbitrator to work out the differences. Bottom line I think we made some progress today and I will inform you further of any changes over the next weeks.

Thank you.


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