Government discussions concluded – Tentative amendments to AMA Agreement reached

August 30, 2016

Dr. Carl W. Nohr, AMA President

Dear Member:

I have written to you previously about the issues of stewardship and professionalism and their linkage to the ongoing discussions with government. Our current negotiations began in February under a Memorandum of Agreement that laid out the terms and objectives. The top priority issues were:

  • Immediate financial viability of the health care system.
  • Shared stewardship of limited health care system resources.
  • Enhanced opportunities for physician participation in health care system decision making.
  • Governance issues.

We also focused on some longer-term issues, working together to improve access and quality care for Albertans. To guide the negotiating team while working on some proposed amendments to the existing agreement, the Alberta Medical Association (AMA) Board of Directors agreed on the following principles. New arrangements must:

  • Improve patient care.
  • Improve access.
  • Enhance efficiency.
  • Decrease costs to the system.
  • Avoid duplication.
  • Keep practice viable for physicians.

In my July 28 President’s Letter I indicated that it might not be long until we saw a conclusion to these discussions. Today I am pleased to tell you that our talks have resulted in a proposed package of amendments to the 2011-18 AMA Agreement.

I would like to remind you, as I have said in previous communications, that any amendments to the ongoing AMA Agreement require ratification by both parties. For members of the AMA, that means a vote by physicians.

About the tentative amendments package

The AMA Agreement remains in force through March 31, 2018. In terms of the tentative amendments package, there are three components.

First, the proposed amendments to the agreement seek to control the rate of growth in expenditures for physicians, while maintaining quality of care. Expenditures have been growing at a rate well above the combined impact of inflation and population growth for a number of reasons: population aging; patient expectations; technology; increased physician supply; and changes in clinical practice. It should be emphasized that the goal is to reduce the rate of expenditure growth, not to cut expenditures.

Managing utilization growth and quality of care will require the joint effort of government and the profession. Responsibility and risk have to be shared according to levels of accountability and authority. There also needs to be a level of stability in the system. By stability I mean: the amount available from government and how it can be adjusted; how the parties will work together and resolve disputes; and the limits of any risk sharing, e.g., what happens if things don’t work out and how we would limit any impact on the prices for clinical services.

Second, while we will be seeking to work on all the priorities in the short term, the bigger value for patient care and sustainable funding will come in the long term. The tools and initiatives included in the tentative amendments package include:

  • Information at the practice level to help physicians more fully understand and improve what we do for patients.
  • A needs-based physician resource plan that links the needs of Albertans to the supply, mix and distribution of physicians.
  • Moving forward on the next phase of primary care transformation, including the further development of primary care networks.
  • Working toward system integration.

Third, stability in our relationships is important. The continuance of the AMA Agreement is an important element of this. Additionally, we require better ways to represent the interests of physicians who contract with Alberta Health Services. I have previously written to you on this subject in my President’s Letter of October 2, 2015.

What happens next

Tomorrow morning I will participate in a joint news conference with Associate Minister of Health Brandy Payne to formally announce reaching the tentative amendments package.

Thereafter we will follow our established process. The Board of Directors will consult with the Representative Forum (RF) at a special meeting to be held the evening of September 8 from two linked videoconference sites. Based on the advice of the RF, the board will decide if the tentative amendments package warrants being sent to the membership for a vote.

To prepare for a ratification vote, we will provide all the relevant information about all aspects of the tentative amendments package. We will set up meetings, teleconferences and provide information on the website to answer questions. We will share comments, questions and answers with you.

The positive response of members to this year’s conversations about stewardship and integrated care reflects well on our professionalism and desire to contribute to the system on behalf of our patients. I am grateful for the emails, letters and phone calls I have received from you; you have strengthened my view that it means something very special to be a physician. In our great province, I believe we have the need and the ability to contribute to a high value, integrated and sustainable system. With a ratification vote, it will be your turn to decide if we have given you the right tools to do so.

Kind regards,

Carl W. Nohr, MDCM, PhD, FRCSC, FACS


Post a comment

  • #1

    Dennis Kendel


    2:43 PM on August 31, 2016

    Congratulations on reaching a tentative agreement. Your progressive approach to shared stewardship for health resources is a model for all of Canada.

  • #2

    Alan McPherson


    11:21 PM on August 31, 2016

    The devil is in the details, and I look forward to same. It is unlikely that I would support a fee cut, in the face of unstoppable overhead demands.

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