Taking the right steps in 2015

December 31, 2014

Dear Member:

As 2014 draws to a close, I want to bring attention to what I consider the major challenge facing us in the year ahead. How do we balance quality of care, including timely access, with sustainability, including affordability and appropriate levels of human and other resources?

The new challenge is in many ways the old challenge; indeed it is an on-going challenge that faces all health care systems. Alberta is at a crossroads, however, and there is an opportunity to look anew at how care is identified, organized and delivered. Any meaningful change will require the combined efforts of all parties, including government, patients and physicians.

Government needs to do three things: be clear about the extent of the public program and what public can expect of it; establish public policy in line with those objectives; ensure that the appropriate financial resources are available.

I want to focus on the last point. I am not sure the public is aware of how much of the current problems are related to poor planning and how poor planning, at least partly, is related to unpredictable levels of funding. This is true in every province, but especially Alberta where government is so dependent on resource revenues. We require a public discourse on the nature of health, which requires a long-term vision and commitment in the building of infrastructure and the development of human skills. A sustainable, predictable source of revenue is required, whether that be a re-introduction of health care premiums or some other means.

I also want to mention one thing I think government has to stop doing. To be blunt, they need to get out of the delivery of care and play their part in depoliticizing the system as much as possible. In my own view, family care clinics were an example of this: ill-conceived out of political expediency, with failed implementation that lost focus. Governance matters: the public and providers should pay close attention to the report of the Alberta Health Services Official Administrator coming out early 2015.

For patients and the public in general, there are also responsibilities. Some of these are fairly obvious, such as participating in flu vaccine programs, the appropriate use of emergency rooms and doing their part to follow treatment regimes.

There are other less obvious ways that patients can participate. I want to mention one, which is the establishment of a stronger attachment between each Albertan and a primary care physician. The best evidence available – and there is a lot of it – is that strengthening these attachments pays off in terms of overall system quality and efficiency. For this to happen, Albertans will need to commit to that relationship and accept a focusing of their major entry point into the system. I understand and accept that strengthening the patient-physician relationship is a two way street: additional resources at the primary care level will be required.

This brings me to physicians. We have always seriously taken our role of delivering quality care to each patient. This needs to remain our major focus, both in our delivery of care and in advocating for the system. We must be committed to our profession and its ideals. Recently, the Section of General Practice and the Section of Rural Medicine sent out to their members the College of Physicians & Surgeons of Alberta’s standards of referral and consultation. We should all pay attention to support such standards.

Finally, there is the issue of stewardship. Back of the envelope calculations vary, but up to 85 per cent of health care system resources are mobilized as the result of decisions made by physicians. There is no way around it: getting the most out of scarce health care resources will ultimately require the engagement of physicians. We need to be open to new ways of informing, incenting and making us more accountable for our decisions.

No one thing will do it – an extensive information system or simply more of what we have – and no one party can do it. If I have one wish for 2015 it’s that we re-affirm and re-establish the necessary partnerships between government, the public and physicians in moving forward.

I wish all of you a Happy New Year and look forward to your comments.

Email president@albertadoctors.org or leave a comment below.

Regards,

Richard G.R. Johnston, MD, MBA, FRCPC
President