About the RF, physician payments, AHS and CPSA

March 20, 2015

Dear Member:

The spring Representative Forum was held on March 13 and 14 in Edmonton. I thought that a President’s Letter describing the key discussions would be useful to you.

A wide variety of issues were discussed. I will focus on financial matters, relations with Alberta Health Services (AHS), and the ongoing communications with the College of Physicians & Surgeons of Alberta (CPSA) concerning out-of-hours coverage. I was very impressed by the level of debate and in particular by the level of social conscience reflected in the motions and in the discussions. The minister of health had a candid hour of discussion with members on a wide range of topics.

An update concerning the current state of discussions with government was given in the report from the Board of Directors. A number of meetings have occurred between the minister and myself, as well as among Alberta Medical Association (AMA), ministry and AHS senior staff. We have discussed things that can be done within our current agreement to improve efficiencies and cut costs while maintaining quality care. The AMA point of view is that we require a new partnership in addition to the existing agreement, focused on the needs of patients with shared decision-making and risk.

Through these discussions, there have been occasional comments concerning physician payments and fees. I must be very clear that there have been no explicit requests for reductions or changes in physician payments. This is consistent with government’s public statements that existing contracts will be honored.

There have been, however, other public comments that Alberta doctors are paid significantly more than our provincial counterparts. I have written to the minister this week to provide some more accurate information that shows a different picture.

You may have seen a recent feature article in The Medical Post showing that Alberta physicians are paid third-highest in the country and are only 6.1% above the national average. These results are similar to those from our own review of the same data. Additionally the AMA’s position is that when the 6.1% is adjusted to take into account Alberta’s extremely high overhead costs for staff, equipment, etc., actual net payment levels drop down to very near the national average. It would appear that we are meeting government’s stated objective to keep payments close to the national levels.

Another way to view the situation and general affordability is to plot the annual fee increases over time against the consumer price index (CPI). Alberta physician fees have been well below inflation for most of the last 40 years. See this chart containing this information and the aforementioned interprovincial data.

The key point is that we need to make health care decisions based on comprehensive, accurate information. We know that government will be consolidating public sector negotiations under a centralized structure in the future. My hope would be that this will allow for better collection of more accurate data.

We have been very consistent in telling government that we expect them to live up to the contract that took us three difficult years to negotiate. In that contract, government agreed to certain increases in rates (cost of living in the next three years) and they agreed that they were responsible for all other increases in costs related to increased utilization and other factors. Having said that, we can do a lot to increase efficiency and effectiveness within a new partnership with government and AHS, as I mentioned above.

Another board report topic at the RF was negotiations with AHS. There are many negotiations between AHS and physician groups. The AMA provides a large amount of support in this area. One of the biggest problems is the lack of a structured process, leading to ad hoc arrangements characterized by protracted discussions, widely varying agreements between sites for the same services and a lot of unhappiness for the physicians and for AHS. I believe both parties would benefit from agreeing to a structure that involves recognition, transparency, mutually agreed processes and a method for dispute resolution. This would help us bring a conclusion to current negotiations and hopefully develop a framework for more efficient bargaining in the future.

Finally, there was a very good discussion at RF with Dr. Trevor Theman, CPSA Registrar, and Dr. Jim Stone, President of the CPSA Council, concerning the college’s review of its standard related to out-of-hours coverage. Dr. Theman reiterated that the college was in no way suggesting that every doctor must be available for any type of request at any time. What the council does want is a mechanism for every physician, whether family doctor or specialist, to provide appropriate coverage for out-of-office hours. This means that: a surgeon needs a realistic way to answer calls concerning recent operative procedures; a doctor who orders a test must ensure that he or she can deal with a critical result; and that a patient who needs some advice or guidance should be able to find it in a reasonable amount of time. This may include the involvement of HealthLink and the use of practice groups who can provide basic information but also contact the primary doctor if more specific information is needed. The college is very ready to accept innovative ways to do this, but the bottom line is that there must be some way to fulfill these basic obligations. We will continue to discuss this with the CPSA, and also continue to work on projects such as secure email that might create ways to help with this problem.

There will be more discussions around finances, new practice models and physician stewardship of resources in the next few weeks. Certainly if an election is called, health care will be front and center in the campaigns. I will continue to keep you up to date through President’s Letters, and your board and I will work hard to protect your interests as well as participate in discussions to continue our goal of an affordable, efficient, high quality health care system.

Your comments are always welcome. Email president@albertadoctors.org or leave a comment below.

Regards,

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