Government consultation proposals: action to date

December 16, 2019

Dr. Christine Molnar, AMA President

Dear Members:

I am writing today to provide a brief update of the work and activities that have taken place since the Special RF on December 7.

Consultation proposals

I want to thank everyone who has provided feedback on the Alberta Health and Alberta Health Services Insured Services Consultation proposals. To date, we have heard from over 1,250 of you. This includes responses sent directly to myself, to the feedback email, as well as responses posted via the online tool.

Based on feedback from sections and individual members, the AMA’s formal response to government is being drafted and will be shared with all members once it is submitted on December 20.

Engagement

All section presidents were contacted in an effort to encourage members to participate in a letter writing campaign. In addition to the letter writing campaign, members are also being asked to seek meetings with local MLAs.

I want to thank members who have been advocating at the community level and have already met with their MLAs. We have heard there are a few reoccurring themes that are surfacing during these meetings:

1) Communicating the impact of the proposals

We have heard that MLAs do not know the scale of the proposed changes. If enacted, these changes would equate to an average loss of over $47,000 per physician, per year. The amount varies by group. For example, the reduction to family medicine is $61,000 per physician, per year; and that would be even greater in rural Alberta. Further information on the real-world, dollars and cents impacts are captured in the economics paper, linked below. I encourage you to read it and share the facts with your MLAs and community members as you see fit. It is very important to talk about the impact on your practice and your patients.

2) Promoting Alternative Relationship Plans over fee-for-service

Some members were told that one of the goals of the proposals was to encourage entry to Alternative Relationship Plans (ARPs) by dis-incenting fee-for-service. In response to this, you may want to communicate a few things:

  • There is no single perfect payment system and there are pros and cons associated with all models. For example, there are very successful medical homes operating in Alberta right now under fee-for-service.
  • There are many elements required to change from a fee-for-service model to an ARP. This is not a simple undertaking and would require significant change management supports at both the clinic level, as well as the patient level in terms of access, etc.
  • Our understanding is that even if all of the factors were in place to move a large number of physicians over to an ARP, Alberta Health does not have the capacity to make this happen early in 2020.

Therefore, it seems disingenuous to push an alternative before it is ready to be properly implemented.

3) Remaining united

It is vitally important that we remain united in the face of any attempt at fragmentation. A number of members who have met with MLAs have indicated how important it is to deliver a united message to MLAs and to let them know that these proposals are concerning to the entire profession.

Informing government

We believe it is important for MLAs to hear directly from physicians. Please share individual stories about your own situation, as it is often the personal stories that are most powerful in helping MLAs to understand the impact.

We suggest you share information with your MLAs, and to help you with this outreach we have prepared the following materials:

  • Instructions and MLA template letters (for both urban and rural physicians)
  • Key talking points
  • An economics paper, including key aspects associated with physician compensation in Alberta that were missed by the MacKinnon report
  • The latest version of the AMA’s assessment of the Alberta Health and Alberta Health Services Insured Services Consultation proposals (this version includes some of the specifics with respect to the real-life impacts the proposed changes would have on physicians and patients)

These resources are available on our How you can help web page.

Again, we are urging all physicians to take part in this important campaign so that MLAs heading home for the holidays will do so knowing that physicians are active and united.

Other plans

The Physician Advisory Group has been active and there are plans underway to reach out to and engage the public, including through social media. I want to thank members for the number of suggestions and ideas I’ve received with respect to public campaigns and other activities. These are all being considered and we will provide further information on our strategy soon. In the meantime, I encourage all members to use your own channels to share the tools and information provided in this letter.


Thank you again for your advocacy. It is absolutely critical that we maintain momentum and focus. I will write again soon to share further updates and plans for outreach.

Please let me know what you think in the following ways:

  • Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org.
  • Comment publicly, below 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).

NOTE: While I am reading all correspondence, due to the amount of incoming email, my responses to you may be delayed. I sincerely appreciate your understanding during this busy time.

In your service,

Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association

5 comments

Commenting on this page is closed.

  • #1

    Michelle Hart

    Physician

    11:56 PM on December 16, 2019

    As a family physician in an urban office with 2 newer grads still building their panel, I am very concerned about my ability to stay afloat if the proposed changes come into affect. The calculated 30 - 40 percent reduction in my income as I currently practise and take care of 1800 panelled patients will make it impossible to make ends meet.
    I have strived to create a medical home for my patients with help from our local PCN to deliver care to patients that prevents emergency visits, reduce referrals to specialists as everyone can work to their full scope of practise and thorough preventative care with reminders to patients about screening maneuvers due by optimizing my EMR and utilizing my support staff. In working like this I put in about 60 hours a week of which at least 15 is not face to face patient time, but managing staggering amounts of paper work that follows them. If the proposed changes take place most of these things will be un-affordable, and I will need to practise medicine like we did in 2003 - 2006 when I started working in rural Alberta - one complaint per visit and minimal preventative screening. Family doctors are specialists in comprehensive care, not general practitioners that can field off only the most pressing issues while leaving patients to fend for themselves and leaving the vulnerable patients who cannot advocate for themselves or seek help in the right places, in a worse state than they are now.
    Medicine has gotten so much more expensive and highly specialized and it gets wore with every decade that passes, and the technological miracles medicine and surgery can provide. Medicine is increasingly technical and therefore that we need more generalists to prevent specialist care and buffer the specialists form needing to see patients by managing as much as we can by ourselves without blocking up the already inappropriately long waiting lists. We can provide cheaper and more pragmatic and more general care to the patients than a system based specialist who only focuses on one organ system and therefore do not know the whole patient story or be able to translate it into terms the patient can understand.
    We also see all of the patients all of the time, as the patients need referrals to the correct specialist and this can hopefully be done discriminately to streamline treatment so the right patient has the right care by the right person at the right time.
    Unfortunately I am not a visionary or a health analyst or a public health system fixer, just a doctor in the trenches trying to do the best for each patient as they sit in front of me, and I hope the decision makers will be wise to protect comprehensive preventative care and keeping the vulnerable patients in mind.

  • #2

    Michael Jacka

    Physician

    9:22 AM on December 17, 2019

    To the President and the AMA

    For discussion:

    1. governments come and governments go. However we live in a rules-based society because some of us and certainly many of our foregoing know the danger of living in a world governed by fiat (also known as 'whim'). Breaking of contracts to satisfy financial goals may in fact satisfy some of these financial goals. Breaking of a contract however destroys the essential trust relationship necessary to govern a stable society. The consequences of this are unknowable and dangerous. The AMA and others need to stand firm on this principle by showing the leadership that they are showing.

    2. Alberta Health through the Ministry of Health and the current government has indicated that it wishes to restrict physician practices to certain areas of need. Possibly noble in intent. At the same time it has proposed to reduce the earning capacity of those serving these underserviced areas by possibly 25%. This is an enormous risk to the sustainability of rural medical practice and in fact to practice in this province. With the foregoing risk to an established contract, the practice environment in Alberta will be unappealing for Alberta graduates and most others for years to come.

    3. the AMA needs to continue to show leadership and bring this government to understand the consequences of these proposals and their possible long-term effects

  • #3

    Noel Corser

    Physician

    8:53 AM on December 18, 2019

    Many family docs are interested in how they can improve their practices to better reflect the Patient's Medical Home model. My understanding has been that fee-for-service is insufficient to support this model.

    Could you please share which practices are "very successful medical homes operating in Alberta right now under fee-for-service"? Would love to chat with them. Thanks!

  • #4

    Dr. W

    Physician

    10:51 PM on December 18, 2019

    In response to Noel Corser [comment #3]

    Great question! I know personally that Westgrove is fee-for-service and am 95% sure Bonnyville is as well.

    https://acfp.ca/membership/member-excellence/award-recipients/

    Winners of Alberta College of Family Physicians Outstanding Family Practice - This award recognizes excellence and leadership in patient and community
    care while exhibiting the principles of the Patient’s Medical Home:

    1. Westgrove Medical Clinic, http://westgroveclinic.ca/,
    Westgrove Clinic
    #201 - 505 Queen Street
    Spruce Grove, AB T7X 2VO2
    Phone: (780) 962-9888
    E-mail: administration@westgroveclinic.ca

    2. BONNYVILLE MEDICAL CLINIC
    https://bonnyvillemedicalclinic.ca/
    (780) 826-3346
    ADDRESS
    101, 4610 50 Street
    Bonnyville, Alberta
    T9N0G2

    Now another good question to ask our Health Minister:
    What other options are available other than FFS to provide an excellent patient medical home?

    Assuming his answer is still ARPs, then my follow-up:

    Ok, assuming every family doctors wanted that, how many clinics can sign for an ARP in 2020?

    And finally, what guarantees do we have that we won't end up like Ontario:
    Step 1: Gut fee-for-service, forcing docs into ARPs to get possible reasonable compensation.
    Step 2: Compare savings of gutted fee-for-service compared to now more expensive ARPs.
    Step 3: Gut ARPs, forcing docs into fee-for-service to get possible reasonable compensation.
    Step 4: Rinse and repeat.

    Thanks for listening!

  • #5

    Dr. W

    Physician

    10:58 PM on December 18, 2019

    I applaud my colleagues for caring so much about this issue. When Albertans realize how destructive this will be to their lives and those they love, I hope it is not too late.

    Physicians will suffer, yes.

    But patients and families will suffer so much more.

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.