April 23, 2013, President's Letter

April 23, 2013

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Dear Member:

In this letter:

• Tentative agreement has been completed on schedule.
• Special Representative Forum and board decision on ratification to follow.
• Agreement creates opportunities: physicians are ready for the challenge of making the system better for patients.

Tentative agreement has been reached

I am pleased to report today that Minister of Health Fred Horne and I have signed off a tentative agreement, drafted this past week on the basis of the memorandum of understanding that I announced April 15.

I am gratified to reach this milestone and I would like to thank the minister and his negotiators who have worked very hard this week with the Alberta Medical Association (AMA) team to bring this tentative agreement to reality.

The next step now is the ratification process.

• A special meeting of the Representative Forum (RF) will be held Saturday, May 4, to review the tentative agreement in detail and provide advice to the Board of Directors on their decision whether to proceed with the ratification vote. The board will make this decision immediately after the RF meeting.
• Assuming the board agrees to proceed, ballot packages will leave our mailing house Wednesday, May 8. Your package will contain a copy of the tentative agreement and everything you need to cast your vote. The vote deadline will be end of day on Wednesday, May 29. The count will take place Thursday, May 30. (Please note we are working to make the tentative agreement document available on the website as early as due process allows so you can have a look at it while waiting for your ballot package to arrive. I will let you know as soon as possible.)
• I will be touring the province to answer your questions and talk about the tentative agreement and what it means. Tour dates, times and locations will be available soon for in-person/videoconferencing.

Thank you to physicians

On Thursday, April 18, about 200 physicians joined AMA Executive Director Michael Gormley and me at the Edmonton Zone Medical Staff Association (EZMSA) annual general meeting. When originally scheduled, this meeting was intended to discuss ways to bring government to the table to complete an agreement. Clearly, the sudden advent of the memorandum of understanding meant a change of agenda.

I spoke about the elements that now comprise our tentative agreement. There was a good question and answer session and it was a valuable meeting.

For me, though, it was a very welcome opportunity to say thank you directly to so many physicians for the unwavering support the profession has provided to the AMA and me through these difficult negotiations. I want to repeat those words now about how much it has meant to see:

• 3,000 emails of solidarity during the November imposition.
• 450-plus letters and emails to MLAs in the last two weeks.
• Calls and emails of personal support and encouragement to me.
• Grassroots physicians speaking out in open letters, meeting with editorial boards, talking to reporters, purchasing advertising.
• Resounding support and communication with government from the Primary Care Alliance, primary care network (PCN) physician leads, section presidents, past AMA presidents and our current Canadian Medical Association President Dr. Anna Reid.

You and your colleagues have made a huge difference. We are a galvanized profession, we have proven once again that we are a force to be reckoned with and that we have a voice that demands respectful attention.

But what now?

Media editorials in recent days have uniformly noted what we have been saying all along: these negotiations were about far more than money. By staying together and walking the talk, I think we have shown everyone that the dispute was about having a voice in making decisions that affect patient care. It was about creating a stable environment in which health reform can truly move forward without tumbling over a cliff every time an agreement expires.

Now, we have a choice.

An agreement like the one that has been achieved creates a great deal of stability over a long time with the seven-year term and all the evergreen and continuance provisions. The risk of dealing with pressures of increasing population in Alberta has been assumed by government. Our valued Business Costs and Retention Benefit programs have been maintained. Our overhead costs will be covered for the foreseeable future. And, when this agreement expires in 2018, the role of the AMA and a number of key programs will continue.

In that relatively safe environment, it would be easy to settle down comfortably within the walls of the agreement and let the world around us move forward as it will. I think, though, that we must do more than that. I hope that the passion and commitment members have demonstrated in these negotiations will flow seamlessly into the challenge that now faces us.

We have been given a venue and the appropriate channels to make our voice heard. We have been given that seat at the table. We can get our mind off fighting through negotiations and on to more important things. Now: What can physician contributions do to improve care for patients?

I will be saying much more about this in the weeks ahead, but let me make a few points to get you thinking about this.

I will illustrate with some of the opportunities that are facing us with a ratified agreement through 2018.

• The Physician Compensation Committee, which will provide structure and transparent decision making as we tackle issues like modernizing the fee schedule in a fair and data-driven manner that reflects the reality of modern practice and draws upon the extensive work physicians have already led in internal fee relativity.
• The Alberta Health/AMA/Alberta Health Services initiative to find efficiencies in the system. We have a way to make improvement that really starts on the front lines. I’m sure each of you could name any number of potential areas to improve efficiency in your immediate practice area or in your hospital or zone. Focusing on both quality and funding, we will identify opportunities for efficiency and savings while ensuring that resource allocations:
  • TO health care are based on best evidence about how they can contribute to a better system, healthy economy and health objectives of patients.
  • WITHIN health care are allocated on best evidence about what is most effective and efficient to meet health care needs.

I am energized by the new possibilities before us and there are more – from evolution of PCNs to a new provincial electronic medical record strategy. We must really grasp the brass ring and take the leadership role that has been given to us – and from which I know we can demonstrate results.

I look forward to hearing from you, as always, through the ratification period and on the other side of the vote. Email president@albertadoctors.org or post a comment below.

Regards,

R. Michael Giuffre, MD, MBA, FRCP, FRCPC, FACC, FAAC
President

P.S. Among the physicians attending the EZMSA April 18 meeting were a number of academic alternate relationship plan (AARP) physicians. These individuals spoke strongly about challenges facing academic medicine as the universities are hit with additional cutbacks.

I have received many emails on this subject and it is a critical one. While the tentative agreement and its rate changes applies to the clinical component of AARP work (and those physicians are all fully eligible for benefits and services under the agreement), the other pillars of academic medicine – teaching, research and leadership/administration – are under threat from a variety of sources.

At the suggestion of EZMSA President Dr. Robert W. Broad, more detailed discussion was tabled until a dedicated meeting on the topic of AARPs can be convened in the near future. The AMA will be there of course and I will keep you informed about developments that greatly affect our academic colleagues.