Cyber-bullying, government discussion on virtual care and stipends

March 20, 2020

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