Deep Concerns re Government Consultation

November 29, 2019

This is in regard to recent developments in our negotiations with government that are deeply concerning for the profession.

I want to provide you with information regarding what government has proposed, what work the AMA is doing to review these proposals and how you can contribute.

Consultation on Alberta Health and Alberta Health Services Proposals

On November 14, government tabled several proposals which, in their view, were outside the negotiations. They asked the AMA to respond by November 20 as to how we would like to be consulted.

In developing a response, the Board considered several factors. First, many of the proposals are in fact within scope of the AMA Agreement and would have to be dealt with as part of the current negotiations. Second, whether inside or outside negotiations, parties can always agree to consult. Third, given the severity of many of the proposals it was thought best to bring matters into the light of day for all members.

On November 20, the AMA informed government that it would consult with the entire profession. We also noted in our position that several of the proposals are within the scope of negotiations and have to be dealt with in our negotiations. We also noted that the December 20 timeline for final response would not be appropriate for all items.

The Proposals and Initial AMA Response

Please find below links to the following: 

AMA Review Process

  • Initial staff review, as per the AMA document noted above. 
  • The two documents noted above were provided to RF delegates, section presidents and section fee reps on November 25. 
  • The AMA Compensation Committee will review the proposals, as well as collate information from members, sections and others as needed. The committee had their first meeting November 27. 
  • The Physician Advocacy Group will consider what other steps may be undertaken. The group had their first meeting November 27. 
  • A special in-camera meeting of the Representative Forum has been scheduled for December 7 to consider this issue as well as others, such as implications of Bill 21.

Implications

While not wanting to pre-empt any comments from members or sections, I want to share some of the initial reactions so far:

  • The focus of the overall proposed cuts – roughly 85% – is on comprehensive primary care. This is counter to sound health policy, the government’s health platform and the interest of patients, particularly elderly ones, those with chronic and complex conditions, and those living in rural or remote areas of the province. There will be a negative impact on care for thousands of patients. Not so long ago, many Albertans were unable to find adequate primary care and a family physician of their own. As a profession we worked hard and successfully to address this short-coming through the development of primary care networks and the Medical Home for patients. The government proposals threaten to reverse the progress we have made in primary care. 
  • While less severe at this time, other specialists will also be impacted. For one of the items – payments from Alberta Health Services – the impact is unclear and could affect many physicians. 
  • Combined with Bill 21 (Termination of Contracts; Practitioner ID Restriction), these proposals paint a grim picture of the kind of relationship government would like with physicians. 
  • Some have questioned whether the proposals are more about posturing. Possibly, but if so it seems irresponsible. The proposals would be devastating to rural family practice, for example, a group that government in other venues purports to support.

Share Your Thoughts

Once you have reviewed the documents, you may wish to comment on specific items. As mentioned, sections are already reviewing the proposals so you may wish to direct that input to your section executive. Alternatively:

  • Visit the Consultation Feedback Tool to post your comments and view those of your colleagues on each of the proposals (LOGIN REQUIRED). This material will be collated and forwarded to the AMA Compensation Committee for review and presentation to the special RF.
  • Email your input to feedback@albertadoctors.org.

As always, you can reach me with any comments via president@albertadoctors.org or comment on the form below.

Concluding Comments

These activities by government are troubling and potentially divisive for the profession. Physicians have been through difficult times before. We have always come through on the strength of our commitment to patient care and our unity.

I want to acknowledge the hard work, excellence and innovation of all Alberta physicians. In particular this includes the role played by our primary care leaders. As groups such as the College of Family Physicians of Canada have recognized, they have made this province the national leader in implementing the Medical Home.

Our organization has endured for 114 years. With our firm commitment to our patients and to one another, we will continue to be a powerful force in the evolution of our health care system for many years to come.
I will let you know how you can help in the weeks ahead and into the new year.

In your service,
Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association

34 comments

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  • #1

    Jim Currie

    Physician

    7:14 PM on November 29, 2019

    The government gave away $4.3 billion and now has to make up the money by cuts to essential services.
    Their proposals will affect the health of all Albertans, but this time around the cost must not be borne by the doctors, and more especially the nurses of Alberta..
    Their proposals regarding physicians amount to nothing less than a declaration of war, and I for one will not surrender.

  • #2

    Mike Galbraith

    Physician

    9:31 PM on November 29, 2019

    I was raised and completed all of my medical education outside of Canada and moved to Alberta in 2010. I'm still at a loss why such a developed, progressive country such as Canada can't figure out it's health care system.

    How much more are physicians willing to take before we insist on real change in our health care system? What else needs to happen before physicians recognize that Canada's current system is broken? And that our system is expensive, has horrific wait times, poor patient satisfaction, and poor outcomes? Come on Canada! I’m tired of the lipstick on the pig over and over again! How many more sad patient stories do we need to share before we admit that there’s a better way to deliver health care than our current socialized system? Little tweaks in our system are futile.

    If Canada really claims to be a progressive, forward-thinking nation, then it's time to start acting like it. It's time we put away archaic, ineffective health care traditions and implement real, effective change. We need a system overhaul. Thank goodness we have other nations we can emulate that have much more effective health care systems, are less costly, have shorter wait times, and higher patient satisfaction.

    But, I'm done holding my breath for those physicians, legislators, and politicians that are rigid with tradition. I've learned that those in charge of the health care system in Canada aren't really concerned about patient care. They're concerned about politics.

    Dr. R. Michael Galbraith
    Lethbridge, AB.

  • #3

    Dr. W

    Physician

    12:55 AM on November 30, 2019

    Albertans need to make sacrifices. They can’t expect their government to balance the books and provide adequate public services. They must choose one or the either. Thank you to Jason Kennedy for making the hard choice. A lot of people would think supporting Albertans with quality education and health care is more important than the bottom line. Nothing is more important than $$$$. Not even our loved ones! Way to go Jason and UCP for foregoing the empathy and caring for Albertans that led to the NDP to failure.

  • #4

    Meghan

    Physician

    7:52 AM on November 30, 2019

    I understand that we need to balance the books. I have no interest in living in a province with massive debt and incredibly high taxes. However, I am confused about the process of these proposed cuts. Why doesn’t the government just give the total $ or % that needs to be cut to the AMA/AHS like it has to the CBE etc and let our institution decide how to make those cuts? Possibly a % cut across every billing code for all doctors (Family and Specialists) is a more sane and fair way to go?

  • #5

    Florence Henning

    Member of the public

    8:50 AM on November 30, 2019

    It is horrific what this government intends to do to healthcare. All sections of the “healthcare team” have to stand united against these changes. Physicians especially have to show a united front and not capitulate to the governments tactics of division within all aspects of physicians care. Divided you fall. Family physicians are equally as important as other specialists in the healthcare of their clients. The arrogance of Bill 21 is wrong. No profession should be dictated to as to where you practice. I wish you well as you fight this government to continue the excellent care all physicians provide to Albertans.

  • #6

    Dr George Lo

    Physician

    3:23 PM on November 30, 2019

    As a GP in private clinic. Situation: no raise for years, over head and computer time and cost is getting worse. I still believe fee for service the only good for MD and patient care. Bad economy out there, hope for a smaller cut to make them look good. There is no choice I can see.

  • #7

    Dr. W

    Physician

    7:17 AM on December 01, 2019

    These changes will destroy primary care. But that’s what ER is for. It’s harder to manage my patients in the community, and it would be a lot easier to manage their high blood pressure and diabetes if they were in hospital. The nurses (any that are left that is) could check their blood pressure and sugar level for me. And I could pop in once a day to check on them and bill better fee codes in hospital. And the patient would not have to work, and spend their life in a hospital because they can’t get their medical conditions managed in the community. Win - win - win. I like it!

  • #8

    Greg Sawisky

    Physician

    4:25 PM on December 01, 2019

    There are proposals here that will negatively impact the delivery of primary care to Albertans. Perhaps most egregious is the government's proposal to take away the complex care plan. As people age, their healthcare needs inevitably increase and the complex care plans enable us physicians to engage with patients and truly get them involved with their own care by approaching decisions collaboratively. While current times require fiscal restraint, I hope that the government chooses to work with physicians, not mandate to them.

  • #9

    Noel Corser

    Physician

    5:27 PM on December 01, 2019

    It's certainly an interesting set of proposals - unfortunately, it doesn't give the impression that AH understands much about what drives health-care system costs. As a family physician, I find that maybe 20% of my patients use up 80% of my time, and there's good evidence that the more effort I invest in those complex patients, the less they use ER and the hospital for high-cost/inefficient care. It's truly frustrating to docs like me to see the government wanting to chop support for comprehensive primary care - with the rationale that it'll save the system money!! (Perhaps a counter-proposal that AH fire it's current health economists/government advisors and find ones who know what they're doing is in order?) I readily admit that the current physician compensation system is out-of-date, lop-sided, and largely ineffective at producing patient-centered outcomes, but surely there are ways to reduce physician-related costs that don't actually increase the overall burden on the taxpayer?

  • #10

    Cris Gaetano

    Physician

    9:11 AM on December 02, 2019

    We need to make a strong stand on this. They're has been a systematic attempt to slander our profession in the politics across this country. Starting most notably with Kathleen Wynn's government in Ontario. If the AMA has discretionary funds they should be used to advertise the proposed changes and Illustrate the affect it will have on patient care. There is no rational for these changes other than to usher in privatization. The worse patient care becomes the more the public can be swayed. This needs to be stopped in its tracks and now. The public opinion of Kenny has already dropped to 42% support, we need to strike on this while the iron is hot. Illustrate to the public this is an attack on them and on primary care the most vital part of the health care system.

    As an aside the CPSA would do well to at least monitor physicians with suspect/over billing practices as it is these physicians the politicians will referencing when they are attacking us as a whole. A commitment to reign in poor physician practices will go far to improve our public perception. I have heard from patients several times about some of the care they get in certain walk-in clinics, it is not only sub-par but dangerous with numerous antibiotics being prescribed for example and little to no time spent with assessment and diagnosis (<5 min).

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