Dear Members,
As we enter the final quarter of the 2022–2026 Master Agreement, it is deeply frustrating that issues raised consistently by the Alberta Medical Association for more than four years — the end of stipends, modernizing alternative relationship plans, implementing new payment rates and eligibility under the Physician On-Call Program, completing a fair and timely market rate review and determination of the Year Four increase — are only now being addressed. A medical bulletin released on Friday highlights upcoming changes regarding stipends, on-call and the Market Rate Review. In addition, our Year Four arbitration hearing concluded this past Friday, and a decision is anticipated by the end of February.
It didn’t have to be this way. Government inaction has left some of these matters unresolved, perpetuating inequities in physician compensation and reliance on outdated ARP and stipend structures. Fair and competitive physician compensation is essential to attracting and retaining skilled doctors, which directly leads to better patient care and more timely access to services. These are outcomes that benefit everyone, regardless of differing opinions on government budgets.
Whether by design or oversight, government’s recent approach reflects the “Law of Diminishing Intent.” This prolonged inaction has transformed predictable challenges into urgent crises and forced these critical matters into the next Master Agreement cycle, extending the financial uncertainty that affects your ability to provide patient care.
With the current Master Agreement scheduled to expire March 31, 2026, the timelines for the MRR, Year Four arbitration and successor agreement negotiations make it clear that the current agreement will end before negotiations conclude. We provided the requisite notice to begin 2026 negotiations last fall, but government’s flawed initial approach to the MRR created a cascade of missed dates and resulted in our current situation. To protect members during this transition, the AMA is working with government on a Memorandum of Understanding to extend the current terms until a successor agreement is signed. Several significant roadblocks remain, however.
- ARP modernization: While the methodology is largely agreed upon, government intends to delay implementation of modernized rates and processes until the new agreement. This ensures Alberta’s ARP uptake and retention (clinical ARPs and Academic Medicine and Health Services Program) will continue to lag behind the rest of Canada.
- Stipends: Because specialist physician groups have not been offered reasonable alternatives or due process, these stipends will be extended into the next fiscal year/negotiation period. According to the bulletin, family medicine hospitalist groups are not being offered reasonable fee-for-service arrangements (e.g., standby, transfer-of-care fees) for those who wish to remain on FFS when stipends end. We have been clear: physicians will determine what is "reasonable" for their specific circumstances.
- System refocusing: The increased complexity of the "refocused health system" is further undermining compensation. Processes that should provide fair, competitive, sustainable and scalable compensation remain inconsistent and, in many cases, less clear than at the start of the current agreement.
For the past 10 months, compensation modernization priorities have been driven less by urgent system and patient-care needs, and more by delayed government decisions on reasonable alternatives to stipends. Over the term of the current Master Agreement, physicians and AMA staff have invested thousands of hours developing and refining solutions to improve physician compensation and advance stewardship initiatives intended to reduce low-value-care costs. These recommendations were offered in good faith to strengthen the physician workforce and improve system performance. While we all agree the design and implementation of the Primary Care Physician Compensation Model was a great success, concurrent issues in acute care needed to be addressed. We advocated ceaselessly for this.
What is increasingly concerning is that the burden of developing these solutions has fallen largely on the AMA and service providers, rather than on government in its role as the Alberta Health Care Insurance Plan Administrator and Payer. Government has forgotten their core role as the health insurance plan and resource provider, instead focusing on defining front-line health-service delivery without requisite health system or clinical training. This shift has contributed to inefficiencies and operational challenges that continue to plague our system.
Insufficient focus on health workforce resourcing and investment has now left multiple ministries and provincial health agencies ill-informed on health workforce realities. The result: compensation models that lag behind how care is delivered today. The lack of sustained internal capacity and early, embedded physician co-leadership, has meant that government remains unable to properly codesign physician compensation solutions in a timely manner that are viable, attractive to the workforce and responsive to patient needs for clinical services.
As we prepare for the next Master Agreement, government must recognize the increasing demands on physicians, the challenges facing care delivery in Alberta and the need for wise, high-value investment in physician-led care. Health care delivery is a provincial responsibility, and the AMA requires a partner that treats it as a vital public service rather than a budget constraint. To move beyond ongoing uncertainty, Alberta needs long-term health care solutions that extend beyond four-year election cycles. Without them, we are all hindered in establishing a collaborative environment, truly focused on patient-centred care.
While the current situation is understandably frustrating, the AMA remains committed to addressing ongoing compensation challenges and negotiating a new Master Agreement that delivers meaningful outcomes for physicians, patient care and the health system. We will continue to advocate on your behalf with clarity, strength and transparency.
Our resolve is grounded in the professionalism and dedication of Alberta’s physicians and in the belief that a modern, equitable compensation framework is essential to a stable and sustainable health system. Thank you for your continued engagement and trust as we move forward together.
Regards,
Brian Wirzba, MD, FRCPC
President, Alberta Medical Association