Further progress toward income equity

June 17, 2022

Dear Members,

I’m writing today to provide members with an update on the Income Equity Initiative (IEI). A comprehensive physician compensation framework remains a key priority for the AMA. We have kept our commitment to membership and have continued our work on income equity so that we can be ready to incorporate it into possible outcomes of an agreement, such as allocation of new monies.

What’s new

In the fall of 2021, the Representative Forum directed the Board to develop an interim approach to make progress toward income equity using best available evidence, while remaining committed to the completion and implementation of the full IEI. In close consultation with sections, the AMA Compensation Committee (AMACC) developed an interim measure, which was approved at the Spring RF meeting in Calgary.
 
The interim measure will help us to quantify our progress toward achieving income equity and will help guide the allocation of any new monies obtained in an agreement with government. If any such allocation is given, the AMA has requested that five sections receive particular attention given their low ranking in the interim income equity calculations: Family Medicine, Neurology, Obstetrics and Gynecology, Pediatrics and Psychiatry. The calculations used for the interim measure use the best information available today, and this will change over time as data evolves, for example once the AMA Hours of Work Study results are available.

This video provides a helpful overview of IEI, the interim measure and the factors used to compute each section's equity measure. I encourage you to check it out.

We recognize that all physicians have had to deal with significant challenges over the past two years and that you are looking for support in an agreement. While the amount gained or how that gain is achieved may vary, the AMA will strive to have all physicians see some benefit and have their key issues addressed in a new agreement.

With respect to income equity, within a new agreement the AMA will seek to ensure the following:

• There is no reallocation under the interim measure.
• Reallocations among sections will be assessed and potentially implemented only once the full IEI project is completed and ratified.
• Inclusion of the AMA’s IEI principles and the goal of improving income equity over the life of an agreement.
• The use of the interim income equity measure, as developed by the AMACC, in order to: (a) measure progress in the attainment of income equity goals and (b) significantly inform the allocation of any new monies under an agreement.
• Support for the completion of the full IEI, as defined in the IEI Implementation Plan and as directed by the RF.

Please remember that differential allocation of new monies among sections is not new. Over the years, the AMA has used several formulas for developing an allocation recommendation to maximize value for patients and fairness to physicians. On that note, as per RF direction, there will be no movement of monies from one section to another (reallocation), reflecting that this is an interim measure only and the full study – with member ratification – is yet to occur. Reallocation will be considered as part of the overall IEI study.

What happens next

The AMACC is finalizing a technical report that will show each section’s relative ranking on the interim income equity measure, as well as an overview of how the measure is calculated. This information will be provided to each section’s executive in the coming weeks.

The Negotiations Committee has raised the income equity issue with government at a high level and they have agreed to include consideration of income equity in the current negotiations – that is positive because this is not a goal that the AMA can pursue on our own. The AMA cannot unilaterally make changes to the Schedule of Medical Benefits or the Physician Services Budget.

Physicians are key stewards of the limited public health care dollars that are available in Alberta. Inequitable payments can skew the delivery of services, whereby some services are more likely to be provided while others are neglected. Addressing income equity is one tool we can use to improve patient care and access because it can help ensure that services are appropriately remunerated and available across the continuum of care. Income equity by itself isn't going to fix the health care system, but it is a key policy lever that can be used to increase value for patients and fairness to physicians.

For further information, you can visit the IEI page (login required) of the AMA website or email equity@albertadoctors.org. 
 
As always, if you have questions or thoughts to share with me, please reach out. You can contact me any time in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org.
• Comment publicly on this President’s Letter (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member). 

Sincerely,

Vesta Michelle Warren, MD, CCFP, FCFP
President, Alberta Medical Association