Cyber-bullying, government discussion on virtual care and stipends

March 20, 2020

Dr. Christine Molnar, AMA President

Dear Members:

Cyber-bullying is NEVER ok!

It has come to my attention that things were said yesterday on social media and outside of it that are deeply troubling. Whether you agree with public officials or not, making personal attacks and threats on them and their families is never acceptable. It’s cyber-bullying, plain and simple; it’s not who we are as physicians, and it must stop. The comments, which I will not dignify by repeating or referencing here, did not originate from an AMA member, though some members may have shared or liked them. We cannot allow our passion for and anxiety about our patients and practices to devolve into this sort of behaviour, nor can we allow or accept others doing it on our behalf.  Our disputes with government will be settled by focusing on facts, not personalities, and I am asking members to take this into account in their own online behaviour.

I fully understand and acknowledge the pressures you are under – I feel the same serious concern. In a matter of a few weeks, all Albertans and physician practices will be in a very different place and a rare circumstance, as I have heard from so many members. The added pressure of COVID-19 means people are actually worried about their livelihood in the short term. It’s extremely stressful for all Albertans and AMA members are wondering what to do. Accordingly, strong advocacy with government officials at a policy level is needed. I encourage any member to take that approach and present arguments with facts and expertise that you can bring to bear. Many members have done so in social media with great success. I would ask, though, that arguments are expressed reflecting the professional standards we all abide by and for all of us to remember that shifting into personal attacks and intimidating comments is wrong. The AMA does not condone it. Our principles and who we are as an association should guide us.

Having said that, there is progress to report, which leads me to the rest of this letter.

SUPPORT FOR VIRTUAL CARE IN THE COMMUNITY

Yesterday I wrote to you about what is needed in Alberta to enable virtual care for patients during the pandemic. I feel a sense of urgency as I hear from so many members that you need more support to provide care for your patients: care with continuity and integrated within a patient's pre-existing or new clinical needs.
 
The 03.01AD code (see Alberta Health bulletin issued yesterday) was a start, but as I have heard from so many of you, it cannot adequately address the needs of patients with, for example, chronic diseases, or mental health needs.

The AMA, Alberta Health and Alberta Health Services all recognize the need for a more robust virtual care schedule, along the lines of what is being done in other provinces, and are working on this on a priority basis. The support and direction from the Minister has been critical in moving forward with this.

In addition, yesterday a government news release announced that the TELUS Babylon product will be made available: “Albertans can use the service to check symptoms, book appointments, see a doctor, and get prescriptions and referrals for diagnostic imaging and specialists – all covered by Alberta Health Care.”

It is helpful that there is a new mode of care available to patients who do not have a regular physician. We know that continuity of care arises from established relationships between patients and their physicians and most patients will prefer to obtain their care that way. Combined with the virtual codes schedule being developed, however, the Babylon option will help to ensure access for all Albertans.

PHYSICIAN FUNDING FRAMEWORK: STIPENDS

In my previous letter, I reported that in view of the pandemic, government has delayed the planned implementation of changes to the Complex (Time) Modifier. It will not go into effect March 31. This was a critical concern within their Physician Funding Framework for so many colleagues.

Stipends paid for availability within Alberta Health Services facilities were another problematic issue in the framework. Late Wednesday, Alberta Health Services physicians were advised that, due to the COVID-19 crisis, stipends will not be stopped before August 2020, with the exception of some physicians who may already have been notified otherwise.
 
In the midst of the building storm that is COVID-19, these announcements are good news for patients and physicians. As for the remaining elements of the Physician Funding Framework, I have asked that it be placed on hold at least until the pandemic has passed, including Medical Liability Reimbursement and the daily cap on visits. At this moment, we need time to focus on our patients. At the end of the day, we require a formal, structured agreement that defines roles, responsibilities, accountabilities and authority.  
 
The Minister and I continue to work through our issues. We do this professionally and with respect.
 
However, there is only one battle right now and that is COVID-19. We need to work together. 
 
I will stay in touch. 
 
In your service,
 
Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association

5 comments

Commenting on this page is closed.

  • #1

    Jesse Heyland

    Physician

    7:08 PM on March 20, 2020

    Dear Dr. Molnar,

    I appreciate your call to civility as you are right, there is a lot of "passion" in cyberspace. Please try to remember that so many community physicians feel incredibly alienated, not understood and vulnerable. So many clinics are closing. Many young physicians like myself are still very financially vulnerable as we have many debts and were not anticipating a roughly 90% decrease to our incomes.

    I for one struggle with the lack of details regarding the steps that are necessary to take in order to raise a fee code. We have received many updates saying 'we are working on it and will keep you posted." The problem that many of us are facing is that the financial situation is critical. Clinics are closing right now. Concrete details, as much as you can provide, with as many timelines as can be revealing, as well as a detailed discussion regarding any barriers you are facing, and crucial peaces of information.

    I am a husband, single income family, father of three children, hard worker, heavily in professional debt, committed to patient care, and deeply anxious and concerned about this specific issue. I am willing to be called to go above and beyond to help the fight in the pandemic, but we need this information at this time.

    This would go a long way to enhancing "physician wellness" as per the AMA mantra.

    Kind regards

  • #2

    Darrell Palmer

    Physician

    8:45 PM on March 20, 2020

    TELUS appears to be profiteering off of the pandemic. If they are so innocent and virtuous why didn’t they first offer this to their own EMR clients instead of setting up this virtual clinic with their own special deal with the government? While we struggle without hope of paying our overhead. If they just provided the tools, free of charge, to Alberta physicians at this time of crisis they would have done a lot more good. I would hope you would understand and communicate the collective outrage — civilly of course.

  • #3

    Jason Luan

    Member of the public

    11:47 PM on March 20, 2020

    I am a colleague of Minister Sandro and know him well through our work together. He is a very honest and straight forward person, with high integrity & hard working ethics. I am very sorry to see him and his wife being attacked personally online. No one should be treated like that, no matter what different opinions we hold about public policy. I understand that AMA needs to advocate for its members’ benefits. However, I am very impressed by your association’s professionalism & firm stand on anti-bullying. You have earned my respect. Thank you Dr. Molnar for your leadership. Looking forward to working with you & your members to serve Albertans better.

    Jason Luan, Associate Minister of Mental Health & Addiction, MLA Calgary-Foothills

  • #4

    Concerned AB doc

    Physician

    3:08 AM on March 21, 2020

    At what time was this letter posted to the website? I got the email at 6:02pm and Minister Shandro’s 8 tweets posted at 6:15pm.

    Did Minister Shandro get an advanced draft prior to the letter being posted.

    If so, did he send back revisions?

  • #5

    Sonya Regehr

    Physician

    9:12 AM on March 22, 2020

    Today’s Calgary Herald said Telus got 1.5 million for providing Babylon app support for 40,000 patient visits. My math says that’s $37.50 per visit. Why aren’t community docs getting that for helping our own patients via virtual methods?

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