We have a lot to talk about
September 8, 2023
Dear Members,
The Board meets next week in final preparations for the September 22-23 Representative Forum. The RF’s guidance will be more important than ever at this time and in this environment.
Family medicine practices and clinics are dying and we must address those needs now. Planning for the future matters, but first we must stop primary care from bleeding and help restore Alberta’s brand as a destination of choice for physicians. Practical solutions that we have been calling for, for months, need to be implemented yesterday. New payment models are a longer-term option. Expanding multi-disciplinary teams in the future makes sense, but we need to support today’s teams. To engage physicians to expand their teams and change the way they practice, they need to know first that they won’t go broke doing it. There is no Alberta advantage and the disadvantage is growing rapidly.
It is a tradition to meet with the Minister of Health at the fall meeting. The Honourable Adriana LaGrange has accepted my invitation to attend for a candid, confidential discussion with physicians. We appreciate that she is making the time to do this.
After years of effort based on RF direction, the Income Equity Initiative full measure is complete and ready for review before moving to the next phase. If supported, next steps will include implementation of a dispute resolution process followed by member ratification.
In 2013, the RF considered the health-related recommendations of the Truth and Reconciliation Commission of Canada. That meeting led to establishing our Indigenous Health Committee and our Policy Statement on Indigenous Health. The RF will include a viewing of the film The Unforgotten and include interaction and discussion with leaders of our Indigenous health community.
There are other topics and we will report back. This will be an important RF. Conversations will not be easy, but I anticipate the usual wisdom and guidance from the forum.
You are always welcome to share your thoughts with me. You can email me via president@albertadoctors.org. You can also comment on this letter on the AMA website.
Regards,
fred Rinaldi, MD, CCFP, FCFP, LLB, MBA, MPA(HSA), BCom
President, Alberta Medical Association
"Fate whispers to the warrior, 'You can not withstand the storm.' The warrior whispers back, 'I am the storm.'"
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GE Searles
9:21 PM on September 11, 2023
There is a version of a Yiddish folk tale about a Bialystok horse. To summarize, a peasant has a reliable horse he uses to bring passengers to and from the city of Bialystok. One day, to maximize profits and efficiency, he decides to feed the horse less and less food and water. Initially, he is wildly successful and thrilled with his miracle horse. One does not need to be a veterinarian to see how it ends: The horse grows weaker and dies.
Primary Care in Canada generally, and in Alberta especially, has become a Bialystok horse.
Evidence-based medicine, clinical practice guidelines, and algorithm-driven care have dramatically expanded the scope of primary care practice. Primary Care has become responsible for many medical issues that used to be the purview of specialists. You are tired of being told that “simple” topics are suited to your management, as if you are incapable of doing hard things. You fume as you read specialists’ letters, which cast aspersions on the prescribing choices of nameless “PCPs.” You dislike the language that some issues are “not worth” the specialists’ time, as if their time is a valuable resource and yours is not. The expanded scope of primary care is profoundly time consuming.
Many express that they are experiencing burnout in primary care and are leaving for concierge practice or industry.
Everyone wants a Bialystok horse; very few people want to be the horse.
Health care systems still rejoice in their ability to ask primary care doctors to manage an ever-growing list of conditions in a finite amount of time without noticing that the horses are growing weaker. As a community, we need to rethink what we ask, what we pay, and how we talk about primary care. To encourage bright young trainees to enter primary care, we must build respect, schedules, and financial reimbursement that justify their efforts.
If we do not change course, these Bialystok horses will become a vanishing breed.
Extracted from an essay: "Primary Care Physicians: The Bialystok Horses of Health Care?"
Ann Intern Med.2023;176:1135. doi:10.7326/M23-1353