Report from the Board of Directors

Download the Reports to the AGM (PDF, 76 pages).

This report represents a retrospective accounting of the challenges, opportunities and accomplishments experienced by the AMA over the course of the 2019-20 fiscal year (October 1, 2019–September 30, 2020).

The Report from the Board of Directors to the Annual General Meeting has three main sections:

  • The Big Picture: Contextual considerations for reviewing the activity reporting by the AMA on behalf of members.
  • Year in Review: A timeline of the major milestones and events that impacted the AMA on strategic and operational levels, including negotiations and our relationship with government, the AMA’s advocacy efforts and the COVID-19 pandemic.
  • Performance and the Business Plan: Highlights and updates related to the AMA’s Business Plan performance in the Key Result Areas: Financial Health; Well Being; System Leadership and Partnership.
  • Relationships and Other Matters: Brief commentary on some relevant topics that are not specifically addressed in the Business Plan.

The Big Picture

As the report will amply demonstrate, 2019-20 was a year of unprecedented turmoil in our relationship with government. Added to that was the impact of the COVID-19 pandemic. In supporting members through both of these challenges, the AMA also continued to pursue important activities under our Business Plan that are key to our mission and vision.

The commentary details many events and activities that can easily be viewed as individual events, but taking only that perspective would be short-sighted. By looking at the larger picture, we can see that the fundamental relationship between physicians and the public health care system was challenged this year from every direction, including:

  1. The relationship between the profession and government: Termination of the AMA Agreement; Bill 21 allowing government to terminate any future agreement between physicians and the Crown; loss of rights to arbitration.
  2. Self regulation: New legislation making 50% the regulatory councils of all health professions ministerial appointees; discussion paper contemplating government taking over of licensing, registration and complaints/discipline from all health professions.
  3. Foundation of the Canada Health Act: New legislation that (i) shifts away from the linkage to physician services (or dentist services) as the defining criteria for “medically necessary” care; and (ii) establishes new entities that may contract with government. Moving care into the community and seeking new partnerships to improve system performance are worthwhile goals. For physicians, however, a number of important principles will need to be upheld.
  4. Physician supply and mobility: Bill 21 provides for implementation of PRAC ID restrictions in 2022; the Minister has called for a review of provincial medical staff bylaws, fundamentally involving privileging.

Between all these forces, never have the connections between physicians and the public system been challenged so completely and with such great potential for a tectonic shift, that would result in massive changes to patient care.

In this report, you will see this context and perspective reflected in the AMA's response to events, in our approach to negotiations and in our work with others in the system.

The Board of Directors particularly wishes to record our sincere appreciation and gratitude for the unwavering support of the Canadian Medical Association, who have been at our side under our Memorandum of Understanding with added advocacy and significant financial support for many of the activities

Year in Review

In 2019-20, many major government decisions and actions directly and negatively impacted the profession. When looking back, it is important to consider the interconnected nature of government’s actions. None of these actions existed in isolation and each one – both on its own and in combination with others – has had, or will have, a far-reaching impact on physicians, patients and our health care system. At the heart of the complex issues we faced were a number of questions: Who makes the decisions about what happens in the health care system? On whose behalf and to what end are they made?

Throughout the year, the Minister of Health demonstrated a desire to exercise control over decision-making within the system. Additionally, from the earliest days of the administration there has been a continuous narrative that Alberta physicians are overpaid for mediocre performance and collaboration with the AMA was kept to a minimum.

Key events of the past year appear in the condensed timeline below.

Note: Links to supplementary information and related President’s Letters have been provided within each topic.

AMA Negotiations and Government Relations Timeline

September 3, 2019: MacKinnon Blue Ribbon Panel Report released

October 28, 2019: Bill 21 tabled

November 14, 2019: Consultation proposals tabled, formal negotiations commence

December 20, 2019: Response to government proposals

January 2020: Mediation began

January 2020: Elimination of various AHS stipends

February 15, 2020: Voluntary mediation not successful

February 20, 2020: Unilateral termination of AMA Agreement

March 16, 2020: COVID-19 lockdown initiated

March 31, 2020: Unilateral imposition of Physician Funding Framework

April 9, 2020: AMA files constitutional challenge

April 15 – 21, 2020: Virtual Representative Forum

April 24, 2020: AMA Response to Provincial Announcement on Support for Rural Health Care

April 27, 2020: Medical Liability Reimbursement

May 1, 2020: Telling the UCP to get back to the bargaining table

May 5, 2020: Declaring the AMA as the official representative of physicians

May 15, 2020: Physician representation in Alternative Relationship Plans

June 24: Member survey conducted

July 6, 2020: Government introduces Bill 30, the Health Statutes Amendment Act

July 15, 2020: 'Take Yes': AMA publishes details of our most recent proposal to government

July 16, 2020: Minister sends letter to CPSA regarding ‘job action’

July 21, 2020: Alberta's physician leadership call for confidence vote on the Minister of Health

July 24, 2020: News about changes to AMA grant programs

July 29, 2020: Bill 30 comes into force

July 29/30, 2020: Members declare non-confidence in Minister, AMA reached out to the Premier

August 6, 2020: Possible changes to Health Professions Act: Self-regulation concerns

August 21, 2020: Correspondence with government

September 9, 2020: Release of Sunshine List regulations

AMA Advocacy

The AMA undertook extensive government relations and advocacy activities as part of an overall approach to the breakdown in negotiations. Political advisors and a polling firm were retained to advise on how to overcome the impasse with government and advocacy campaigns were designed and executed to help inform Albertans and mobilize their support for Alberta’s physicians.

While the Board sets direction for the organization in terms of public messaging and strategies, the input of members is always essential to making the best decisions. In fall 2019, the Physician Advocacy Group was reactivated. PAG is a small working and focus group for the Board, comprised primarily of RF delegates. PAG met several times and provided valuable advice for member communication and engagement in the early months of negotiations.

With the tearing up of the AMA Agreement in February, members across the province were speaking up against government decisions and in support of the AMA. Observing the scale of need and the many differing advocacy opportunities through these loyal members, the AMA spun up a staff team (communications, logistics, media support, etc.) for two groups that eventually were able to streamline their efforts into a single entity. The Family Medicine Task Force (Sections of Family Medicine, Rural Medicine, primary care networks, local physician leaders) and the Specialty Care Task Force (Specialty Care Alliance) eventually were merged into the Joint Task Force. The AMA is also working with the Zone Medical Staff Associations through the JTF. The self-formed Facebook group, ABDocs4Patients, has been active and effective and, through the JTF, the AMA shares messaging and content to promote alignment of our activities.

With the guidance of the JTF, the AMA has developed a wide range of advocacy tools and support such as MLA talking points, townhall toolkits, office posters, social media content and media training sessions.

Meanwhile, since the spring, the AMA launched three public relations campaigns to support our objectives.

This year the AMA radically changed its approach to social media. The Twitter environment has been the frontline through which the Minister, Premier, MLAs and government “issues managers” communicated to and about the AMA and Alberta’s physicians. The AMA has actively engaged in such conversations through our corporate account.

Since August 2019, the AMA’s Twitter followers grew 1,200%, gaining 6,617 followers. 2488 more people liked our Facebook page, an increase of 531%. While we saw a gradual increase starting in December 2019, likely owing to an increased focus by the AMA on social media, followers exploded in late January with January - August 2020 accounting for 95% of our growth.

THANK YOU to the hundreds of self-initiated individual members and groups such as ABDocs4Patients who were also active in social media, poking holes in government arguments, keeping issues alive and expressing support for the AMA and unity of the profession. Their tireless contributions, passion and advocacy were as encouraging as they were effective.

Equity, Diversity and Inclusion

The Healthy Working Environments initiative continued this year, in three dimensions of: Leadership; Psycho-Social Wellness and Safety; Diversity and Inclusion. The AMA also ‘walked the talk’, establishing a Board Working Group on Nominating Committee Processes. This group will continue its efforts this fall, due to a hiatus due to the COVID-19 pandemic.

Board Working Group on Nominating Committee Processes

Under the terms of reference, this project should contribute to ensuring that:

  • The AMA has access to the necessary level of physician workforce talent to advance our mission and vision
  • Members can see themselves reflected in the leadership structures of the AMA
  • Members have appropriate opportunities to participate in the AMA’s physician workforce

Mandate of working group

The product of the project will clearly articulate:

The AMA also took the opportunity speak out against systemic racism in response to a 2016 racist incident in Grande Prairie that gained public attention, especially in the context of the rising Black Lives Matter movement. On June 3, the AMA released the following statement on social media:

Each of us has a role to play in opposing systemic racism. As physicians dedicated to serving patients, we believe a healthy environment strives for equity and embraces, respects and values our differences. Inclusive cultures strengthen our country, and our health. This supports a sustainable system in which all Albertans share the benefits - patients and their families, physicians and all health care team members. With system partners, we have a commitment to co-creating safe, healthy, equitable and inclusive cultures where all are respected, valued and supported fairly to achieve their full potential.

AMA & the COVID-19 Pandemic

Like businesses and organizations across the world, the AMA was hugely impacted by the arrival of the pandemic, which influenced much of the AMA’s work and focus in the second half of the 2019-20 fiscal year. At time of writing, Alberta was in the second stage of government’s relaunch strategy. This second stage began on June 12 and allowed additional businesses and services to reopen and resume operations with physical distancing requirements and other public health guidelines in place.

The AMA remained committed to supporting physicians as they cared for their patients, their families and themselves during the pandemic. In an April survey, members told the AMA that they wanted the Association to support their needs related to the pandemic, while also continuing to advocate for them in negotiations with government.

Community Supports Working Group

This collaborative stakeholder group, chaired by Alberta Health, was established during the pandemic at the request of the AMA to maximize community physician contribution in addressing patient and physician safety, providing access to care and ensuring pertinent information was communicated. The group included representation from the AMA, AHS, the College of Physicians & Surgeons of Alberta, Alberta College of Family Physicians and the Office of the Information and Privacy Commissioner.

Originally meeting once a week, at time of writing the working group was meeting monthly to discuss and facilitate resolution of issues related to Personal Protective Equipment, COVID-19 testing, relaunch guidance, etc.

COVID-19 Virtual Care Codes

Following advocacy by the AMA, government introduced a set of virtual care codes, initially available only for the duration of the pandemic. On June 8, with the urging of the AMA, the Minister of Health announced that the new pandemic virtual codes would be made permanent. The accompanying Med Bulletin 231 provided little detail on how the codes would be integrated into the SOMB.

In general, Alberta Health took a relatively rigid stance on the new COVID-19 virtual codes, modeling Alberta's fees after Ontario's virtual schedule that contains only a few basic fees without modifiers. AMA believed that complex modifiers should be paid on these services (along with the Business Cost Program and the Rural Remote Northern Program payments). Government was firmly opposed to paying for any modifiers associated with non-face-to-face time. In a June 22 discussion with a Fort McMurray physician group, the Minister of Health suggested that the government might be willing to discuss modifiers for these codes, and on June 30 the AMA provided a formal request to reinstate the use of modifiers for virtual codes, citing the Fort McMurray discussion.

The AMA continues to advocate for a more comprehensive set of virtual codes at multiple levels:

  1. The AMA’s has brought together a Virtual Care Working Group and developed a strategy for integrating virtual care into clinical practice (focusing initially on the patient care aspects, but also on barriers and enablers including technology and physician payments). An initial strategy was presented to Alberta Health in July, and it was positively received. The Working Group is now further developing its proposal by seeking input from AMA sections.
  2. Recent discussions with Alberta Health regarding the Schedule of Medical Benefits, via an economics group, AMA has proposed various improvements, most notably:
    o To allow complex modifiers to be billed with virtual care codes
    o To include prolonged visit and consultation codes in the virtual care codes
    o To allow for virtual team conferences o To remove the restriction limiting to virtual care to in-person time only
    o To review restrictive rules which may be a barrier to virtual care o To align with strategy being undertaken by Virtual Care Working Group
  3. Through provincial negotiations for an AMA Agreement.
  4. Through the Physician Compensation Advisory Committee.

Business Continuity Support for Physicians

In April, the AMA submitted a proposal to government for a program similar to those in place in Nova Scotia and Newfoundland, whereby physicians would receive 80% of their typical earnings during the pandemic, provided they are willing to be redeployed, as necessary, to meet any COVID-19 needs. In a June 12 letter, the Minister declined the AMA’s request, pointing to significant job and business losses across the entire economy.

Webinars and Other Supports

As a profession, physicians endured rapid and unprecedented changes in 2020. The pandemic presented extraordinary challenges to members and the operation of the AMA itself, but the AMA remained focused on maintaining value for members. Very early on, the AMA committed to delivering relevant information to members and developed an ongoing series of webinars titled Maintaining and Optimizing Your Practice During Times of Rapid Change. These webinars offered an effective method to deliver tools, resources and advice to members in a safe, virtual manner.

Personal Protective Equipment

The pandemic Community Supports Working Group extensively discussed the critical issue of Personal Protective Equipment and on May 26, Alberta Health Services moved to providing PPE for community-based physicians on a cost-recovery basis. Their procurement assistance and their ability to buy in bulk helped to ensure the best pricing, especially given a rapidly fluctuating market. Physicians also have had the option to source their own PPE. Government has been unwilling to provide PPE for physicians (or other health professionals) practicing in community settings. The AMA continues to point out this inequity and to seek solutions as the ongoing nature of the pandemic becomes better understood.

COVID-19 Webpage

In addition to offering webinars, the AMA created a COVID-19 (2019 novel coronavirus) page on its website that served as a resource centre, providing physicians with easy access to information and resource links to help them as they worked to care for patients and themselves during the pandemic. The page included re-launch information, links to Alberta Health Services and information about various business and financial supports for physicians. AMA staff continuously updated the page as new information became available.

Performance and the Business Plan

Reporting on the Business Plan

The AMA’s business plan goals for 2019-20 aimed to deliver value to physicians by remaining true to the AMA Mission (physician leadership and support) and striving to our Vision (a high performing health care system for Albertans).

Under the AMA Mission, the Board established goals for the organization that were categorized into three broad Key Result Areas:

  1. Financial Health for physicians and their practices;
  2. Well Being (personal, workplace, community);
  3. System Partnership and Leadership.

There are currently nine overarching goals, three under each Key Result Area, and several related activities. The activities are linked by both the 2019-20 AMA Business Plan and our agreements.

Achieving the goals under the three Key Result Areas requires a healthy, vibrant and sustainable AMA. “Healthy AMA” underpins the entire business plan and focuses on core organizational capabilities in the areas of governance, workforce, financial, relationships and knowledge. While elements of Healthy AMA activities are covered under the three Key Results Areas and their supporting goals, a summary of Healthy AMA progress during 2019-20 is also provided at the end of this document.

The following content provides a summarized update on the activities under each goal within the Key Result Areas, including highlights, progress and challenges.

Key Result Area 1 – Financial Health

Goal 1: Physicians are fairly compensated for their skills and training in comparison to other professionals.

The first priority for the year was to negotiate a new AMA Agreement and financial reopener. The "Year In Review" section of this report provides a timeline covering the attempts to negotiate a new AMA Agreement and all of the related surrounding events.

With respect to compensation issues specifically, the Physician Funding Framework was government’s alternative to an Agreement and the Physician Compensation Advisory Committee (PCAC) was government’s alternative to the long standing Physician Compensation Committee. The AMA warned that the framework – mostly a reiteration of government’s 16 consultation proposals – was not only short-sighted, but an ill-conceived scheme that would diminish the medical care of Albertans. It also threatens the viability of community medical practices across the province that form the backbone of health care for patients. Despite the AMA continually stressing our strong objections to the imposition of the new framework, government unilaterally implemented it on March 31.

With pressure from physicians, communities and general public, the government has either reversed or postponed many of the Physician Funding Framework cuts that were implemented, including changes to complex modifiers, to overhead charges for hospital-based services (withdrawn for rural, postponed for urban), and to the Medical Liability Reimbursement (also especially in rural practices). Several items remain such as capping, loss of ability to submit good faith claims, loss of Continuing Medical Education benefits, increased MLR deductibles for many specialties, and over-taking administration of the MLR program. The government's imposition of the Physician Funding Framework remains in place, along with the lack of certainty, clarity and collaboration in government’s approach. The AMA continues to call on government to repeal the remainder of this framework.

As a part of the Physician Funding Framework, the Physician Compensation Advisory Committee was created by the government (with the intent of replacing the PCC)to conduct reviews of rates for services under the SOMB and make recommendations to the Minister.

The AMA recommended three physicians to sit on the Physician Compensation Advisory Committee. Two of the physician recommendations (Dr. Melanie Currie and Dr. Jeff Way) were accepted by the Minister of Health. At time of writing, only two meetings had taken place. AMA staff have been excluded from the meetings, but we are in close contact with our representatives and are able to provide support.

Represent interests of Academic Medicine Health Services Program

The AMA represented the interests of the AMHSP Council’s Negotiating Committee in the development of the new Academic Medicine Health Services Plan (AMHSP) Master Agreement to take effect April 2021.

940 physicians in 14 AMHSP arrangements were supported by the AMA this year.

We have established the AMA AMHSP Council. The Council’s Negotiating Committee met with Alberta Health and Alberta Health Services May 27, 2020 and August 31, 2020. The Committee advanced a negotiating proposal that has objectives as follows:

  • Strengthen AMA and participating physician engagement with respect to improvement of AMHSP contractual arrangements and governance structures
  • Advance transparent policy development processes
  • Advance a Just Culture by promoting physician wellness and procedural fairness
  • Encourage innovation and entrepreneurship

The Faculties of Medicine are engaged in discussions with government and AHS regarding the new AMHSP Master Agreement through existing governance structures, including the North and South Sector Committees and Provincial AMHSP Operations and Strategy Committees. The interests brought forth by the AMA are being discussed in these venues as well.

  • It remains to be seen which issues are addressed through contractual changes in the Master Agreement, the ISA Template or through operational policies that support the two agreements. At time of writing, Alberta Health had expressed the view that the AMHSP Master Agreement is simply a grant agreement that covers the flow of funds from AH to AHS and the Universities. Further AMA input will therefore emphasize content within the Individual Services Agreement which is between AHS, the University and the Participating Physician.
  • At this point, the intent is for there to be one Master Agreement, covering North and South Sectors in place for April 2021.

The AMHSP Council met June 25, 2020 and discussed the above, as well as the results of the AMHSP Review, completed by Nichols Applied Management Inc. There were 22 recommendations grouped around the following program components:

  • Legal framework
  • Purpose and goals
  • Strategic and funding framework
  • Governance and program support
  • Performance monitoring, accountability and continuous improvement

This report serves as a further input into the development of the next AMHSP Master Agreement.

Negotiations and support for ARP physicians

Government cancelled meetings of the Physician Compensation Committee in January and as a result there was little progress regarding decision-making around ARP rates and methodologies. Cancelling the PCC halted further progress on clinical ARP rates and methodology, which seems counterproductive given government’s obvious interest to advance ARP uptake in the province. Furthermore, in August government provided verbal notice that it would be cancelling funding for the ARP Physician Support Services office. Loss of this unique program, along with its highly talented staff, will create a vacuum in physician awareness, advocacy and support for any new or existing clinical ARPs. AMA is working to fill the gap as a priority in our business planning process.

In mid-February, AH announced a new expedited 6-week process for approving ARPs, but this has not yet shortened the significant timeframes needed for approval processes.

The AMA and AHS met regarding plans to create a provincial hospitalist program, but AHS was non-committal regarding a possible implementation date.

The AMA continued its active involvement in the development and refinement of the Blended Capitation Model. Key areas of focus in 2019-20 included negation rules, development of a draft rural model and development of an evaluation framework. The AMA also remains prepared to support physician groups interested in implementing new capitation-based models and continues to advocate for improvements to the model.

Physician Contracted Groups within AHS

The AMA was increasingly occupied with advocating for the needs of colleagues working within AHS, both in groups and per individual contracts. The Strategic Agreement, by which groups of physicians could choose to be represented by the AMA within AHS, expired March 31. The AMA worked with several groups under contract with AHS and subject to stipend arrangements. Many of these contracts are in the process of renegotiation and the applicability of the Strategic Agreement is being considered. AHS agreed to extend all stipend until March 31, 2021 to allow the parties time to negotiate in good faith.

List of groups affected

Edmonton Zone Surgical Hospitalists; Calgary Pediatric Plastic Surgeons ACH, Calgary Trauma Surgeons, Chinook Regional Hospital (Lethbridge) General Surgeons, Edmonton Trauma Surgeons, Edmonton Zone HCT Physicians, Fort Saskatchewan HCT,

  • Lab Physicians Working Group
  • Lethbridge General Surgery
  • Medical Officers of Health
  • Northern Lights Hospital (Fort McMurray) Code Blue (Emergency) Physicians
  • South Health Campus Obstetrical Anesthesia/COVID-19 Intubation Physician Group
  • South Zone Palliative Care
  • U of A Clinical Faculty (FFS Physicians)

Prior to March 31, 2020, notices to advance to arbitration were sent to AHS for all of the groups (except Pediatric Plastic Surgery ACH, and CancerControl). Other groups are inquiring and collecting opt-in forms for AMA representation. Increasing numbers of individual physicians continue to receive AMA assistance in reviewing/renewing their contracts.

WCB

AMA representatives completed negotiations with WCB this year. The new agreement was ratified by AMA membership, and is in effect as of April 1, 2020 to December 31, 2024. This was a great accomplishment and a refreshing reminder of the value of collaborative and interest based negotiations.

Goal 2: Physicians’ practice management decisions are based on sound management advice and best practice.

The AMA supported well-functioning practices in Alberta from many different angles this year.

One element was helping physicians to bill appropriately and efficiently for their services. Support through our Billing Services unit and Fee Navigator® were popular choices with individual members. Fee Navigator is now being linked to Connect Care and being used by the Locum Program for the launch of e-reporting.

At a system level of audit and peer review, the Peer Review Committee worked hard to review billing data and consult with sections concerning anomalies. The PRC strongly recommended to AH that a third-party be retained for direct communication with individuals who remained unaffected by education and awareness. This request was tabled as part of our negotiations proposals. To further support this work, the AMA has been seeking to obtain access to billing profiles, beginning with a pilot profile of the Section of Family Medicine, based on desired elements for monitoring provided by the section itself.

The Physician Compensation Committee had nearly completed a methodology to review and implement new rates for clinical ARPs in Alberta. With the government cancellation of the AMA Master Agreement, the PCC was discontinued in February. An AMA Clinical ARP Working Group composed of ARP representatives from across Alberta was appointed to develop a common understanding of the needs and concerns of cARP physicians and to advocate for changes to address those needs and concerns. This group met with AH representatives at the end of June 2020. Discussion included AH’s perspective on cARPs and an open dialogue on ARP successes and barriers.

Goal 3: Reliable and best-in-class financial products are available to all members

As part of keeping physician finances healthy, the AMA’s insurance agency, ADIUM, completed a thorough competitiveness review of its products and successfully transitioned to a new carrier, Manulife Financial. This involves group Disability, Professional Overhead Expense, Term Life, Critical Illness, Accidental Death & Dismemberment and PARA Group Disability & Life Insurance Plans. The carrier change provides greater plan stability and better pricing for members. A strong marketing and awareness campaign for our group insurance plans resulted in increased in member uptake and market share. Greater participation improves plan stability and helps to maintain low rates for members.

The links below provide access to information for members to further augment their understanding and use of beneficial financial products:

Insurance

Retiree health & dental benefits are now available to AMA members

Effective July 1, members covered under the AMA Health Benefits Trust Fund will have two options available to them to convert their AMA HBTF Core Plan coverage.

  1. Alberta Blue Cross Retiree Benefit Plan
  2. Alberta Retired Teachers’ Association Retiree Benefits Program

Both options are available without proof of good health when transferring from AMA HBTF. The appeal for retired AMA members will be more comprehensive extended health care and dental options as compared to the AMA HBTF Core Plan, plus emergency medical travel coverage available beyond the age 75.

The AMA is not endorsing either program; we are simply providing options for retired members to choose from. Members may remain on the AMA HBTF Core Plan as long as they want. More information is available on the AMA HBTF website under “What happens when I retire?”

Calgary hailstorm affects AMA members

TD Insurance Meloche Monnex, AMA’s endorsed home and automobile insurance provider, has advised that they have approximately 9,000 residential policies and just over 17,000 auto policies in the area most heavily impacted by the hailstorm that hit Calgary on June 13. To-date, they have received 6,390 residential claims and 6,628 automobile claims for a total of 13,018 claims. There have been 29 claims made by AMA members.

ADIUM’s paramedical provider now open for home visits

Dynacare Insurance Solutions, the company that provides medical testing for ADIUM Insurance Services’ disability and life insurance applications, has resumed in-home visits after the COVID-19 closure to complete the necessary testing needed to underwrite applications. Since March, ADIUM has only been able to underwrite applications through telephone interviews which has limited the amount of coverage members can apply for. Members may now apply up to our plan limits ($5M Life, $25K Disability) but there is expected to be significant delays due to the backlog of orders.

Commercial Office Insurance not responding to COVID-19 office closures

The COVID-19 pandemic has caused the closure of hundreds of thousands of businesses across Canada, including the closure of thousands of medical clinics. We have been informed that the “business continuation” provision in most commercial office policies are not responding to pandemic claims. There was some confusion as to whether these policies would respond as many had a “communicable diseases” section. Insurance companies are now issuing policies with specific exclusions for pandemics.

Key Result Area 2 – Well Being

The AMA supports members in maintaining healthy work-life integration, including being a leader in the development of a comprehensive physician health program. The AMA promotes and supports physicians contributing to the broader community through activities like the AMA Youth Run Club and Emerging Leaders in Health Promotion grant program. The AMA also supports physicians in their efforts to attain safe, healthy and equitable work environments.

Goal 1: Physicians are supported in maintaining their own health and that of their families

Physician and Family Support Program

On July 22, the AMA was informed that the grant funding the AMA receives for PFSP will continue for the period of April 1, 2020 - March 31, 2021. During the timeframe, Alberta Health will review options for future delivery of this program. This is obviously a significant concern. Ongoing work will be done to express the criticality of this program residing within the AMA on the basis of best practice and past effectiveness.

PFSP statistics and other important updates

With the tragic killing of Dr. Walter Reynolds, PFSP expanded its services to include debriefings for groups of physician affected by the tragedy. Physicians can continue to access peer-to-peer support as well as be able to access individual therapy sessions for themselves and their family members.

PFSP statistics for the period of January to July 2020 showed 1399 total callers to the 24-hour Assistance Line. Of this number, 478 were new callers (down 2% overall from this same period last year) and 921 were callers who had previously accessed this service (up 19.3% overall in this same period from 2019). Total callers for the year was up by 11% overall. Case Coordination services have experienced a 32% increase compared to this same period last year.

At the onset of the pandemic, adjustments were made to the services PFSP offers to physicians:

  • provided updated resources for the Assessment Physicians to use with callers to the line;
  • found alternatives for physicians who would otherwise be attending treatment out of country;
  • ensured therapists with expertise in treating trauma were ready to provide group crisis therapy as required
  • network of therapists provided therapy by phone or secure video link

Although in-person education sessions were cancelled, additional efforts were made by PFSP to provide services through online forums (podcasts and webinars) for physicians feeling distressed. In the most recent example, Dr. Jane Loehr (Calgary Family Physician, PFSP Assessment Physician) and Fleur Yumol (MSc., MSW, RSW, unify consulting managing director), discussed the personal impact of the tragic loss of Dr. Walter Reynolds and how personal grief might manifest in response to this tragedy. A recording of this discussion is available on the AMA website.

There were some significant trends in calls to the Assistance Line during the first half of 2020. Early in the year, when the government declared their intent to impose changes on physicians, calls to PFSP increased significantly with a 34% increase in call volume in January and February compared with the same months last year. Then in March, when the pandemic was declared, the call volume dramatically decreased, by about 15% compared to March through May last year.

While there were fewer total calls, the complexity increased and time spent on each call increased by 40%. Despite the lower number of calls, PFSP saw an increase in calls from rural physicians and learners, and a slight increase in calls regarding mental health concerns, work related stress and substance use. As of May 2020, calls to the Assistance Line began to increase each month; it is notable that the complexity and length of time spent on each call remained at a higher than usual level.

PFSP continues to communicate and collaborate with our stakeholders across the province, including Well Doc Alberta, Alberta Health Services, Faculties of Medicine and College of Physicians and Surgeons of Alberta.

WellDoc Alberta

PFSP continued to work with Well Doc Alberta throughout 2019-20 to develop a collaborative and synergistic approach for delivering physician wellness related education.

In 2018-19, Well Doc Alberta became the first program supported under the Memorandum of Understanding between the AMA and the Canadian Medical Association. Working with and in parallel to PFSP, the program continued to evolve, in particular supporting wellness and self care for physicians during COVID-19.

2019-20 Well Doc updates

In November 2019, PFSP partnered with Well Doc Alberta to offer two events with guest speaker Dr. Jillian Horton: Patients First, But What Next? Inciting Useful Dialogue Around Civility and Mindful Practice Workshop for Physicians. In January 2020, at the invitation of WellDoc AB, a PFSP staff member was a guest speaker in the training for Calgary Urgent Care physicians, who are implementing their own Peer Support program.

PFSP collaborated with Well Doc AB to create a series of three podcasts directed to support physicians in these extraordinary times, all three are available online:

On June 16, 171 participants joined the AMA webinar on Physician Health-Feeling Distress, Understanding Loss and Finding Meaning. This was a collaboration between AMA and Well Doc Alberta and was a Continuing Medical Education accredited webinar. It was part of the AMA webinar series Maintaining and Optimizing Your Practice During Times of Rapid Change. The format provided a new method of engaging participants during the session and was well received.

Goal 2: The AMA is a broker in bringing together physicians, patients and families toward healthy communities. Physician and community contributions are supported and celebrated.

We All Make a Difference

Alberta has some of the finest, hardest-working physicians in the country. Even in the face of incredible adversity and challenge over most of the past year, our members remained committed to serving their patients and helping build a sustainable, successful and innovative health care system.

In celebration of that hard work and dedication, as part of “We All Make a Difference”, the AMA introduced the Shine A Light and Community Connections physician recognition programs.

Shine A Light

Initiated by Dr. Alison Clarke during her 2018-19 term as president, the Shine A Light program recognizes and celebrates AMA member physicians who are making a difference through their incredible dedication to their patients and their inexhaustible work ethic.

Nine physicians were celebrated through Shine A Light in 2019-20. Although nominated by patients and colleagues for a variety of reasons, these physicians all have one thing in common - their complete dedication to their patients and their passion for medicine.

As Alberta’s physicians continue to advocate and care for their patients during this ‘perfect storm’ of a global pandemic and endless professional challenges and stress, the Shine A Light mailbox overflows with emails from grateful patients compelled to express their gratitude; enough to fill Alberta Doctors’ Digest for many issues to come!

Community Connections

In 2019, the AMA’s former Many Hands™ program was expanded and re-developed into Community Connections, profiling AMA members who advocate on behalf of their patients and their communities. Nominated by their fellow physicians, doctors recognized by Community Connections are committed to improving peoples' lives – individuals, community groups or entire populations – and through strong leadership, regularly go “above and beyond” to Make a Difference.

Our first outstanding physician nominated for Community Connections’ recognition was Airdrie family physician, Dr. Fozia Alvi. For years, Dr. Alvi has dedicated herself to the terrible plight of the Rohingya refugees who were forced to flee Myanmar. A passionate and articulate advocate, Dr. Alvi continues her work with the refugees amidst COVID-19. In June, Dr. Alvi was nominated for the Nobel Peace Prize in recognition of her humanitarian work. Quoted in an article in AidrieToday.com, Dr. Alvi said, “My philosophy is always, we cannot change the whole world, but we can change the whole world for one person that we are helping.”

Dr. Esther Tailfeathers is another Community Connections’ physician hero. Since 2000, Dr. Tailfeathers has been back home, serving the people of the Blood Tribe from the Stand Off Clinic, a mere four blocks from where she grew up. Accompanied by two young Indigenous physician colleagues also from her community – Dr. Eagle Bear and Dr. Fox – the three physicians provide the kind of health care that is so desperately needed in Indigenous communities across the country. In her work, Dr. Tailfeathers sees the effect of inter-generational trauma and poverty and the resulting, complex health care challenges. She has received many rewards recognizing her work, including the 2019 Dr. Thomas Dignan Indigenous Health Award from the Royal College of Physicians and Surgeons of Canada. While there are no easy solutions, Dr. Tailfeathers is sure of one thing: “We need more Indigenous physicians, who understand the history of trauma and won’t pre-judge people who are most in need of help.”

Youth Run Club

2019-20 was a strange and wonderful year for the AMA Youth Run Club. We were fortunate to enjoy the continued financial support of Alberta Blue Cross as a Gold Level Sponsor and MD Financial Management as a Silver Level Sponsor. Like so many activities and programs, the Youth Run Club had to rejig, re-position and in some ways re-invent itself because of COVID-19.

2019-20 YRC updates

The creative and dedicated YRC team at Ever Active Schools took the YRC online, with a Virtual Run Club. By the end of May, the YRC’s Virtual Run Club was up and running, offering online resources to facilitate home-based physical activities for both families/households and schools. In early July, 761 individuals and 49 schools were participating in the Virtual Run Club.

While the AMA Youth Run Club has always strived to be an inclusive, school-based club open to students of all ages, intellectual and physical abilities, in spring 2019 – thanks to many, generous donations made by AMA’s member physicians to the YRC charity – additional funding enabled the YRC to develop an inclusivity strategy. Working with community partners (including the Paralympic Sports Association), Ever Active Schools developed learning and training resources for coaches and schools, helping them offer adapted physical activity to interested students. The YRC’s inclusivity strategy extends to introducing the program to more Indigenous school communities.

What began seven years ago as a school-based running club has become so much more, as it listens and responds to the needs and ideas of its member participants and schools. The best place to “see” what the YRC is all about today is on the faces of the students and teachers, right here in the AMA Photo Gallery.

Emerging Leaders in Health Care

The Emerging Leaders in Health Promotion grant committee received 21 applications and approved seven projects from medical students and residents for funding in 2019-20. This program encourages medical student and resident physician members to collaborate with physician mentors to develop public health promotion activities in the community.

2019-20 Emerging Leaders in Health Care projects

The following projects were funded through the Emerging Leaders in Health Promotion grant program in 2019-20:

  • Multilingual perinatal video and website by and for Edmontonian immigrant women Uilst Bat-Erdene & Claudine Lebosquain, U of A Medical Students
  • Empowering children in the foster care system: A needs assessment & toolkit to improve care Dr. Rebekah Baumann, U of A Resident, Pediatrics
  • Women's reproductive health: Self-empowerment through art and education Dr. Lindsay Drummond, Dr. Kristin Black, U of A Residents, Obstetrics & Gynecology & Dr. Anneline Slabbert, U of A Resident, Family Medicine
  • Training South Asian Youth Mental Health Ambassadors Dr. Harleen Hehar, U of C Resident, Psychiatry
  • Young Chefs: educating and empowering youth to combat food insecurity Dr. Zach Levacque, U of C Resident, Family Medicine
  • Agency through words: An integrated knowledge translation partnership between literacy instructors and women's health experts Dr. Stephen Macumber, U of A Resident, Obstetrics & Gynecology
  • The Re:Pro Health Podcast - discussing pro-health topics in women's reproductive and general health Angela Messer, Daphne Cheung & Sabrine Garrison, U of A Medical Students

AMA Awards

In recognition of the extraordinary circumstances caused by the pandemic, the AMA’s regular annual awards program was paused for the 2019-20 year. Instead of presenting our annual awards for Distinguished Service, Compassionate Service and the Medal of Honor, we took the opportunity to recognize the exceptional contributions of our public health physician members during the pandemic.

During the Fall 2020 RF and AGM we recognized and celebrated our Long-Service and Member Emeritus Award recipients.

AMA Long-Service Awards recognize physicians with 10 years of AMA service who contribute their knowledge, skill and time to the advancement of the profession. Their work, whether on the Board of Directors, its committees or service within their sections of medicine, supports and encourages the Association’s development.

AMA Member Emeritus Awards recognize significant contributions to the goals and aims of the AMA, seniority, long-term membership and distinguished service (20 years) based on criteria determined by the Board of Directors.

The AMA placed ads celebrating these outstanding physicians and Edify Magazine (Edmonton). The ads will appear in early October.

The ad also celebrates Alberta physicians who were recognized by the CMA through their own awards program, including:

  • Honorary Membership
  • CMA John McCrae Memorial Medal
  • CMA Award for Young Leaders, Resident Physician category

Goal 3: The AMA is committed to working with and for physicians to address system issues which impede attaining a safe, healthy and equitable working environment.

Healthy Working Environments

There are three main dimensions of the AMA’s Healthy Working Environments framework: Psycho-Social Wellness and Safety; Leadership; and Diversity and Inclusion. This framework, along with a preliminary identification of potential strategies, was advanced through our new Healthy Working Environments Advisory Committee. The Committee continued to meet and progress their work in 2019-20.

Healthy Working Environments update

The AMA Board endorsed the CMA Policy on Equity and Diversity in Medicine at their July 2020 meeting. Adoption of this policy provides a solid grounding for current and future AMA initiatives and moves the system toward a common terminology and expectation of equity, diversity and inclusion. It further advances the response to RF resolution RS19S-01 THAT AMA sections are encouraged to incorporate diversity and inclusivity in recruitment for section leadership.

The development of the CMA policy followed a rigorous consultative process including an extensive review of relevant literature and other key documents and publications. This led to the development of a draft policy with recommendations, as well as a supporting ‘backgrounder’ document. The CMA also hosted an online dialogue to help shape the policy, and disseminated the draft for consultation to all CMA members, affiliates and PTMAs, receiving several hundred comments. The HWEAC members remarked on the consultation process as a particular strength of the policy.

The policy captures and provides high-level guidance in a number of areas that have been identified by the Healthy Working Environments Framework including areas such as policy and process review, capturing member data, developing learning opportunities in diversity and inclusion and particularly, promoting and recruiting a representative AMA.

The policy recommendations are intentionally written as aspirational, rather than prescriptive, allowing the policy to be relevant across national contexts and for actions that derive from the policy to be resonant locally. The policy and background documents align with other programs and strategies that share similar goals wsith the HWE initiative and support the development of the HWE Business Plan in terms of specific actions and outcomes that achieve the goals of the HWE initiative.

The policy provides an anchoring vision of a diverse, equitable and inclusive workplace and underpins the work of the HWE.

The AMA’s PFSP program and Well Doc Alberta collaborated in June to offer a webinar with the following goals:

  • To validate that our physician members and their families had experienced loss and that it is normal to experience emotion around this.
  • To build a sense of community, to enhance literacy and provide tools, to allow for self-reflection, and to try and provide meaning to the suffering and create hope and opportunities for empowerment.

Physician leadership

As a result of the COVID-19 pandemic, the AMA was only able to provide four of the eight leadership development courses to the general membership this year. Courses were offered in Edmonton and Calgary. This year’s topics included:

  • Team Dynamics and Communication for Health Care Professionals
  • Walk Your Talk: The Three Levels of Diversity & Inclusion
  • The Spectrum of Behavior in Health Care; Communicating with the High Conflict Personality and Resolving Disruptive Behaviour
  • Errors in Decision Making; why we make the wrong decisions with the “right” facts

To continue its support of leadership development in the AMA Board, six members of the Board were scheduled to attend the CMA Leadership Conference in Vancouver. The conference was cancelled due to the ongoing pandemic.

Key Result Area 3 – System Leadership and Partnership

The AMA supports members in their role as leaders within the health care system. This includes supporting physician leadership in developing innovations in care delivery and integration of primary and specialty care. Other activities include the AMA’s key role in developing and implementing the physician payment strategy for the province; several programs aimed at quality improvement; activities related to eHealth; and supporting the development of physician leadership skills.

Goal 1: Working with Alberta Health, Alberta Health Services and other partners, lead and influence positive change in the delivery of services.

Patient’s Medical Home

The AMA continued work to strengthen the Patient’s Medical Home for all Albertans in 2019-20.

The Accelerating Change Transformation Team continued training and network support for practice facilitators and physician champions, with workshops and follow up support in the field. ACTT program staff worked with PCN boards and physician leaders to accelerate understanding the value of the health transformation workforce and the transformational support they provide to primary health care and Patient’s Medical Home advancement.

ACTT also supported CII/CPAR implementation through project leadership with stakeholders, removing barriers for clinics, supporting implementation by training improvement facilitators and setting up PCNs to support their member clinics to implement.

The AMA continues to work toward improving system supports to members, clinics and their PCNs to enable the full delivery of the PMH model to all Albertans.

Integration

ACTT continued to support the Primary Care Alliance in their leadership consultations and recommendations and the Specialty Care Alliance with a synthesis of evidence for better transitions of care.

In 2019-20, ACTT provided guidance to AHS Primary Health Care Integration Network on appropriate consultation approaches and partnership role development for Home to Hospital to Home guidelines and implementation. ACTT supported PCNs with their planning and implementation of current primary care changes to support Home to Hospital to Home processes and behavior changes, as well as new provincial level primary care supports.

PCN Framework

ACTT supported PCN physician leaders provincially and within zones to understand the environment around shared services, as well as the benefits and risks of implementing the various opportunities for standard shared services.

As a member of the PCN zone support team, ACTT supported the PCN zonal committees, specifically the PCN physician leaders. ACTT also continued to work with NPC boards and their partnership with AHS as the joint venture of PCNs.

ACTT also supported PCN leads executive in renewing the Provincial PCN committee ministerial order to be extended with new and ongoing provincial priorities.

ACTT uncertainty

Unfortunately, since the spring and end of negotiations, the grant agreement remained unsigned, which meant all involved programs were left in limbo. Given the importance of these programs to physicians and the health care system, the AMA ceaselessly pushed for clarity on their future and underscored the value of retaining them within the AMA.

On July 22, the AMA was informed that the Accelerating Change Transformation Team grant to the AMA would continue to be funded for the period of April 1, 2020 - March 31, 2021. During that timeframe, Alberta Health will issue a Request for Proposal for the services that are currently provided by ACTT. The AMA will have the ability to submit a proposal to the RFP.

The grant to the AMA will include a wind down provision if ACTT does end or delivery is moved to other organizations after March 31, 2021.

Goal 2: Key incentives and supports for physicians are aligned with the delivery of care and toward overall system objectives of timely access for patients to quality care.

Income Equity Initiative

The Income Equity Initiative fits within the context of the AMA’s Physician Compensation Strategy. The Compensation Strategy emphasizes value for patients and fairness to physicians while identifying physician compensation objectives of equity, quality, access and productivity. The strategy also considers how other factors (such as informatics, peer review, etc.) have a role to play.

The AMA Board remained committed to the principles and aims of the Income Equity Initiative throughout 2019-20 in accordance with the components and milestones endorsed by the RF and Board. IEI studies continue to proceed with the Overhead Study and Market Assessment progressing, while the launch date for the Hours of Work study was delayed until the pandemic crisis and the resulting demands on physician time have passed. While it was anticipated that all IEI information would be gathered by the end of 2020, these timelines will need to be adjusted due to the impacts of the COVID-19.

The Overhead Working Group continues to engage members through a section representative panel to discuss and approve the Overhead Approach methodology. A similar approach will be used for the Hours of Work Study when it resumes. Section presidents and fees representatives, along with AMA Board members, have participated in the second Hours of Work Pilot.

Despite achieving ethics approval, AH expressed privacy concerns with the requested data for the empirical phase of the Market Assessment study. The Institute of Health Economics and AMA staff have developed a sampling strategy to address AH concerns. IHE is currently waiting for data from AH in order to proceed with the analysis

Informatics

2019-20 recognized the advancement of key information management/information technology initiatives supporting continuity of care through improvements in data sharing. These initiatives included Connect Care, Community Information Integration/Central Patient Attachment Registry, Virtual Care, PrescribeIT and MyHealth Records.

Informatics update

The AMA business plan for 2019-20 included working to support initiatives that connect Albertans with enhanced service in areas such as e-care, virtual care, schedule modernization, and appropriateness management.

Virtual care has become a fixture of care in the community and this report has spoken to their presence as a result of AMA advocacy. Patients are being encouraged to partner in their own care and expansion of the patient portal via MyHealth Records is a sign of this trend. With facilitation by the AMA, community electronic medical record vendors have expedited development of patient portals to those systems, providing more ways for patients to communicate with physicians.

This single instance of multiple systems for similar purposes speaks to the need for increased integration in e-health systems. The AMA has backed strategic and tactical initiatives that improve informational continuity and enhance information integration in the system. There are many ways in which these objectives can be pursued and the AMA will focus its activities by monitoring and tracking where our input has made a difference as discussion leads to decision making by government and AHS. The year-end update explains what we have been doing:

  • Working with CPSA, AH and other key health system stakeholders toward a Virtual Care Strategy for Alberta.
  • Successfully advocating for community physician needs in the continuation of eDelivery results and clinical reports arising from Connect Care implementation.
  • Working with government to advance Central Patient Attachment Registry and Community Information Integration: the chosen vehicle to integrate community EMRs with two-way data flow.

Obtaining a one-time grant from government to develop privacy-related support for community practices

Physician Supply

The AMA firmly believes that a needs-based plan is a lever that can be used to manage the budget.

The Physician Resource Planning Advisory Committee was a ministerial committee made up of Alberta government, Alberta Health Services and the AMA. Part of that committee’s mandate was to develop a needs-based plan that would effectively and fairly manage that supply and distribution of physicians in Alberta. Government dissolved the PRPC and regulations around implementing PRAC IDs are expected in the fall. To date, the AMA has not seen a draft of these regulations.

All of our negotiations proposals called for a budget management model. At time of writing, our latest proposal committed the AMA to managing the budget and covering utilization from existing physicians.

As of 2022, government’s legislation to control physician billing numbers will mean that they will have direct control over the number (and location) of new doctors. Since Bill 21 gave the Minister exclusive control over new physicians entering Alberta, the AMA proposed that government be responsible for paying for any “net new” physicians.

Both parties recognize that there are always challenges with getting physicians to all the places where they are needed. Managing physician supply is a complex matter, and that’s why our AMA proposal included a provision for the AMA to work with government on their physician supply strategy. We offered to continue to help develop a needs-based plan to identify the optimal number and distribution of physicians across the province.

The move to PRAC ID restrictions is obviously of critical importance to learners and early career physicians who must make decisions about where to study, match, train and transition to practice. While the COVID-19 situation distracted from work that might have been done in anticipation of the regulations, the AMA is planning work with PARA and the medical students associations as we move into fall.

Appropriateness and evidence-based practice

With the dissolution of the Appropriateness committee, the parties involved in supporting Choosing Wisely Alberta (AMA, Alberta Health, AHS and CPSA) met with representatives from U of C Physician Learning Program in the summer. The four organizations agreed to form a new Steering Committee to meet the needs of Choosing Wisely Canada. A terms of reference for the committee was developed and an inaugural meeting was held in September.

Goal 3: Physicians and the AMA, in partnership with patients, play a leadership role in advocating and promoting a system characterized by Patients First®.

Albertapatients.ca

At time of writing, Albertapatients.ca had 12,739 members and was on target to exceed 13,000 patients by year-end. These numbers represent healthy growth of the community over the past year. The community continues to gather tracking of patient feedback on their primary care experiences (conducted roughly twice a year) and has now completed benchmarking of patient experiences with specialists as well. Over the past year, topics have ranged from childhood vaccination to diagnostic imaging experiences, as well providing unique insights from patients about their health and health needs during the COVID-19 pandemic, including their thoughts related to virtual care and in-office visits during the pandemic.

Albertapatients has also been helpful in our ongoing issues with the provincial government. While not directly advocating the AMA’s position through the platform, it did provide a very solid base of initial public participation for the patientsfirst.ca initiative by notifying members of the community. The platform also captured some timely and valuable information from patients relating to the early elements of the government’s Physician Funding Framework (most notably comparing patient views on the Minister’s approach vs. AMA’s approach in relation to complex modifiers). The community provided us with a thorough assessment of our Share the Care/#stayhealthyab campaign (which performed very well) and helped to leverage research efforts of other important stakeholders like AHS (Vaping/Smoking cessation study) and HQCA (COVID-19 study).

Indigenous Health

The Indigenous Health Committee approved work on a series of videos and articles that will focus on Indigenous approaches to health and wellness. The videos and articles will highlight some of the experiences, opportunities and challenges of providing health care in Indigenous communities. These videos/articles will be showcased in upcoming issues of Alberta Doctors’ Digest and other AMA platforms.

The IHC continues to collaborate with AHS to offer feedback and support in devising ways to increase the uptake of AHS’ Indigenous training course. The IHC also supports the idea of the AMA offering its own Indigenous course as part of its Health Care Leadership series to give greater access to physicians to complete this important training.

The following areas were identified as crucial to the work of the committee in 2020 and beyond:

  • Increasing awareness of the positive side of Indigenous health care by showcasing positive stories and experiences via various AMA media
  • Identifying gaps in health outcomes between Indigenous and non-Indigenous populations
  • Continuing the work of the North Zone sub-committee to address the lack of access to primary care in Indigenous communities, particularly in the north
  • Better understanding Jordan’s Principle to determine how the AMA can support Indigenous populations in this area.

Healthy AMA

Governance

As part of the 2019-20 business planning process, the Board reaffirmed the KRAs.

The AMA’s Healthy Working Environments Advisory Committee, with the support of experts from the Colbourne Institute for Inclusive Leadership, is developing a tool kit for Sections, Zones and others.

A broad range of leadership skill development support was offered early in the year, including direct leadership course offerings by Judge Heather Lamoureux and Elaine Seifert. Many planned development events and conferences in the second half of the year were put on hold because of COVID-19.

Workforce

A review of the AMA’s job evaluation process was also completed in 2019-20. A market evaluation was to be undertaken as a second phase, but given the financial challenges faced by members and the Association, a 5% staff salary reduction will be implemented effective November 1, 2020 and the market evaluation will be put on hold. We will also be conducting a position by position review of duties with an eye to shifting duties to cover gaps due to attrition, increasing workload and new priorities in the most cost effective manner.

A staff engagement survey was completed and organizational and branch results shared with staff. Organizational and branch priorities for improvement were identified, but much of the work was put in abeyance as internal capacity shifted to respond to COVID-19 and the urgent need to shift all staff to a remote work environment to satisfy public health requirements.

Due to the COVID-19 pandemic, the AMA made the decision to shut our offices and on March 16, AMA staff began working remotely. Like many businesses and organizations across the world, the AMA quickly responded to the challenges of working remotely and used virtual solutions, such as Zoom, to maintain connections between leadership and staff during this challenging time.

Financial

Development of an enterprise risk management framework was put on hold with finance capacity pivoting to respond to the unilateral program changes implemented by government, including the transfer of MLR administration to government and the wind up of the CME program.

The AMA is in good financial health with fully funded Board reserves. As part of the business planning process this year, a number of direct savings and efficiencies were identified and incorporated into the upcoming budget, including a 5% reduction in staff salaries, committee honoraria rates and personal service contract rates, as well as a wide range of operational savings including travel and facility costs savings.

All accountability and reporting requirements related to external agreement funding are being satisfied.

Relationships

AMA/CMA Relationship

The strength of the AMA’s relationship with the CMA was critical during the challenging 2019-20 year. The AMA is very appreciative of the support and assistance the CMA demonstrated in many tangible ways.

The CMA came out publicly on several occasions to denounce the actions of the Alberta government and support our call for a fair negotiations process. CMA President, Dr. Sandy Buchman, personally raised concerns about the breakdown in negotiations with federal Health Minister, Patty Hajdu, both one-on-one and as part of a joint meeting with the presidents of the provincial and territorial medical associations. Dr. Buchman also attended the AMA’s Special Representative Forum meeting on July 18, 2020.

In addition to its public advocacy and support, the CMA doubled its initial financial commitment to help support the AMA's legal, research and advocacy efforts. An open letter of support to Alberta physicians was published on August 20. The letter asked all CMA members, and members of the public, to send an email to the Alberta government as part of a new letter writing campaign. The CMA continues to work with all the provincial/territorial medical associations on other ways to lend support to Alberta. Alberta’s physicians are extremely grateful for this strong support at the national level.

Working closely with the CMA, AMA members were given a choice with respect to continuing CMA membership in 2019/20. The AMA was pleased to see that roughly 90% of members maintained their CMA membership.

In addition to the Well Doc initiative already funded under the auspices of the AMA/CMA MOU, other opportunities were pursued, including a project supporting the AMA’s diversity and inclusiveness initiative and an initiative to support increased capacity in health policy.

AMA/Alberta Health Services Relationship

AHS Review

In February, government released a long awaited Ernst & Young summary report of the Alberta Health Services Performance Review. The report highlights the need for an approach to health care that is based on continuous quality improvement. The report has 57 recommendations and a potential savings of $1.9 billion.

The AMA’s response was around several themes, as detailed in Dr. Molnar's February 3 President’s Letter. The need to involve patients in decisions about their care and in the implementation of the report’s recommendations was key. Though empowerment of grassroots leadership has not been a hallmark of AHS, the AMA outlined physician engagement as another necessary success factor. Provider wellness is a final element for system transformation, and this requires focused attention as the Quadruple AIM model for health care improvement shows.

An implementation plan for the report recommendations was expected in late summer but had not been released at time of writing. There are likely to be significant implications.

Changes to Laboratory Services

AHS announced that in the fall of 2020 they would be seeking proposals from third-parties for the provision of community lab services in Alberta. A third-party will facilitate the Request for Proposal process, and in June AHS posted an RFP to source a facilitator. The Alberta Society of Laboratory Physicians was interested in being involved in both of these decisions and the AMA helped explore how to best accomplish this.

Provincial Physician Liaison Forum

The PPLF is a senior advisory forum between AHS administration and the AMA. Representation from AHS includes the Vice President Quality and Chief Medical Officer, Dr. Francois Belanger, and a number of senior medical and quality affairs staff. Representatives from AMA are:

  • Michael Gormley, Executive Director and Co-Chair
  • Dr. Christine Molnar, President, term ends September 2020
  • Dr. Shelley Duggan, Board of Directors appointment, terms ends April 30, 2023
  • Dr. Ernst Schuster, Council of Zonal Leaders, terms ends December 2020
  • Dr. Michel Sauvé, Representative Forum, term ends March 31, 2022
  • Vacancy, Representative Forum, term ends September 30, 2023

Since the Spring 2020 RF, PPLF has met on June 19. The next meeting is scheduled for October 30.

The following items have been discussed:

  • AMA Representative Forum Resolution
  • MRI/CT/Endoscopies
  • Physician Supply
  • COVID-19
  • Clinical Stipends and Z Codes
  • Overhead Costs in AHS Facilities

Knowledge

With COVID 19 limiting opportunities for face-to-face events, the AMA offered webinars to support members in the areas of physician wellness, clinical ARP’s, business viability and virtual care. Over 3,500 members participated in the webinars.

Development of the AMA’s information management platform “Compass” continued with the new Membership and Accounting modules moved to production during the year. The implementation of new learning management and event management tools helped improve the AMA’s capability to deliver our mission and serve members.

A survey of members identified a number of opportunities to improve member’s website experience. This will allow us to focus on content and tools that are of highest priority to members. The selection of a content management tool is underway, with redevelopment of the website to begin in the new year.

Other Matters

Canadian Medical Association updates

The 2020 CMA Annual General Meeting was held virtually on Sunday, August 23. This marked the 153rd Annual General Meeting of the CMA. The 2020 AMA delegation consisted of 34 representatives:

  • President-Elect
  • Immediate Past President
  • Speaker or Deputy Speaker
  • Thirteen representatives from the Board/Representative Forum
  • Eleven representatives named by the Nominating Committee
  • Two deans of medicine (U of A and U of C) or designates
  • One student representative
  • One PARA representative

During the CMA Annual General Meeting, Dr. Ann Collins was installed as the CMA President for 2020-21.

Dr. Collins runs a full-time family practice in Fredericton, New Brunswick, which she started after serving three years with the Canadian Armed Forces in Kingston, Ontario. In addition to providing office and hospital care, she also provides nursing home care and was a family medicine residency teacher at Dalhousie University from 1998-2019. Dr. Collins graduated from Dalhousie University in 1985.

Dr. Collins has served as president of the New Brunswick Medical Society (NBMS) and spent five years as chair of the NBMS Board of Directors. She has led two NBMS governance reviews and served on the 2008 CMA Governance Review Committee Task Force. Her community involvement has been highlighted by a six-year term (two years as chair) on the board of governors of St. Thomas University, a leading liberal arts school in Fredericton.

President’s Letters

In terms of member communications, there were 78 President’s Letters to members throughout 2019-20.

Member Surveys

In 2019-20 the AMA took the opportunity to reach out to members through two member surveys.

From April 14-24m the AMA conducted a detailed member survey, Urgent Needs and Preparing for What Comes Next 2020, to understand how members felt about critical issues facing the AMA. Almost 4,500 members (32%) responded. The results gave the AMA a clear picture of what was important to members and provided a foundation for our advocacy and planning. There were over 550 pages of verbatim comments and these thoughtful responses from members were greatly appreciated. A May 19 President’s Letter captured the major findings of the survey.

As many physicians struggled to keep afloat in their professional, financial and personal lives, the AMA conducted a member survey from June 30-July 3, Your Practice, Your Plans: Tell Us How You’re Doing, to take stock of how physicians were coping during these exceptionally difficult times. The survey yielded an excellent representative sample, with over 1,472 responses received. The results are accurate within +/- 2.4 percentage points. Meaning 19 times out of 20 the survey results are what they would be had the entire population of Alberta physicians participated. The July 9 President’s Letter provided members with an overview of the results. On July 10, the AMA issued a media release, Looming physician exodus from Alberta caused by failed provincial funding framework, to inform the public about the concerning findings of the survey.

Alberta Doctors’ Digest

Alberta Doctors’ Digest continued to be a valuable and informative resource for members. From August 2019, the site was visited 60,000 times, regularly seeing over 2000 page views alone on the launch day of each issue, from a total of 31,000 unique visitors. This represents an increase of 10,000 pageviews over the previous year, and 15,000 new, unique visitors.

Board of Directors, Executive Committee and Representative Forum

During the 2020 AMA AGM, Dr. Paul Boucher will be installed as president for the 2020-21 year.

Dr. Boucher is an intensive care specialist in Calgary where he is also a clinical assistant professor in critical care medicine at the University of Calgary.

Dr. Michelle Warren was the AMA Nominating Committee’s nominee for president-elect 2020-21.

2019-20 Board of Directors:
  • Dr. Christine P. Molnar, President
  • Dr. Paul E. Boucher, President-Elect
  • Dr. Alison M. Clarke, Immediate Past President
  • Dr. Shelley L. Duggan, Board member
  • Dr. Howard Evans, Board member
  • Dr. Tobias N.M. Gelber, Board member
  • Dr. Sarah Hall, Board member
  • Dr. Robert Korbyl, Board member
  • Dr. Lloyd E. Maybaum, Board member
  • Dr. Derek R. Townsend, Board member
  • Dr. Wendy Tink, Board member
  • Dr. Rick Ward, Board member
  • Dr. Jennifer J. Williams, Board member
  • Dr. Zia Saleh, PARA representative
  • Khadija Nasser, MSA observer

The Board met as follows in 2019-20 (“*” denotes the regularly scheduled meetings):

2019

October 24-25*
November 6
November 20
December 5-6*

2020

January 9
January 20
February 6-7*
February 17
February 20
February 24
March 2
March 4
March 8
March 11
March 13
March 17
March 23
April 1
April 6
April 8
April 11 (prep sessions for RF Breakout Groups)
April 23-24*
April 27
May 25
June 4-5*
July 3
July 8
July 16-17*
August 6
September 16*

2019-20 Executive Committee Officers:
  • Dr. Christine P. Molnar – President
  • Dr. Paul E. Boucher – President-Elect
  • Dr. Alison M. Clarke – Immediate Past President
Executive Committee Board Representatives
  • Dr. Sarah Hall, Board Member
  • Dr. Jennifer Williams, Board Member

The Executive Committee met as follows in 2019-20 (“*” denotes the regularly scheduled meetings):

2019

October 7*
October 29
November 15*

2020

January 3
January 17*
January 23
January 30
February 13
February 27
March 5
March 19
March 20
March 26
March 28
April 3*
April 9
April 16
May 7*
May 21
May 28
June 11
June 26*
July 9
August 20
August 25*
September 3 – scheduled – TBD at time of writing
September 10 – scheduled – TBD at time of writing

2019-20 Representative Forum Information:

The Spring 2020 RF March 13-14 was cancelled due to COVID-19. An RF Information Session was held on April 15 and ten follow-up Board RF Breakout Group sessions were held between April 17-21. A Special RF Session was also held on July 18.

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.