In your service: a new president’s thoughts

October 7, 2019

Dr. Christine Molnar, AMA President

Dear Members:

It is a great honor to represent our profession as AMA president.

I have been a physician for 43 years. I have practiced my dual specialty in Calgary at the Foothills Medical Centre and in EFW Radiology’s community clinics for 34 years. I now come before you simply as a physician devoted to our profession.

Over the course of my career, through the ups and the downs, I have been driven with passion and integrity by my vision of compassion and quality-based health care. I now commit that energy and dedication to you and this organization.

The health care system, created with Medicare in the 1970s, existed in a very different world than the one we live in today. In my own practice, PET CT – only a dream then – has revolutionized the way we evaluate cancer.

The digital revolution has changed our world and is radically transforming the way we practice medicine. We are beginning to see a transition away from a scarcity-based system to one of abundance.

In the past, physicians were repositories of knowledge. We read the texts. We owned the knowledge. We used our expertise to help our fellow humans. Now, the workplace is different with both physicians and patients using applications such as Google to find the information they need. Medical knowledge has been democratized.

We see the impact of shared knowledge and communication in many spheres. I recently read a research article that looked at improving math performance of challenged school children. The assumption was that more intense, costly intervention such as tutors would be the most effective. To the surprise of researchers, results actually showed simple text messaging to parents was a low-cost, but effective, solution to providing students with support to succeed. If simple solutions can impact education, we can expect similar unanticipated successes in medicine.

As physicians, we understand that the health care system as we know it is not sustainable. This is a critical time for our profession. We are facing challenges but there is also enormous opportunity for positive change.

Physicians are both leaders in science and within our communities. We are passionate about helping patients and consider it our duty to collaborate to improve our health care system.

The Government of Alberta must consider us as valued partners and seek our medical knowledge and expertise when they contemplate changes that will affect patients. The AMA is trusted and qualified. Our track record demonstrates we are willing and able to be part of solutions for our patients.

Many of us had the chance to review the Report and Recommendations of the Blue Ribbon Panel on Alberta’s Finances, released last month. We know this report will have the most positive impact if the AMA is involved in moving the recommendations into action.

The government’s health platform included commitments that physicians support:

  • Enabling the medical home, which will improve Albertans’ health tremendously. We celebrate that Alberta already leads other provinces in operationalizing the medical home. The literature shows its potential to reduce costs in the system at large.
  • We agree with the need to address wait times, which only serve to prolong needed diagnosis and intervention. Long wait times add to overall health care costs while Albertans suffer. Together we can improve patient care by supplementing surgical resources within our communities.
  • We stand behind the commitment to supporting seniors and the elderly at home in the community; it is the right thing to do. It is not only compassionate, it yields significant cost savings.
  • We agree that new directions are needed to support those challenged by mental illness and those who struggle with addiction.

Change is coming and as a profession we must be organized and actively involved. I invite you to partner with our fellow Albertans across this province to find novel solutions to the challenges we face.

The renowned anthropologist Margaret Meade wrote: “Never doubt that a small group of thoughtful committed citizens can change the world; indeed it’s the only thing that ever has.”

The AMA is exactly the kind of organization that is capable of driving this change. Through your dedication and the unity of our profession, we can move our health care system toward a sustainable, effective future.

I will write frequently about a variety of issues; the next topic will be changes to the Physician On-Call Program within Alberta Health Services. Please let me know what you think on any topic, today and throughout my term. You can reach me by email at president@albertadoctors.org if you would like a direct response. You can also comment publicly on this letter below; please note those comments are public even if you are logged in as a member.

I am humbled by the opportunity I have been given and look forward to working with you.

In your service,

Christine P. Molnar, MD, FRCPC Nuclear Medicine
FRCPC Diagnostic Radiology
President, Alberta Medical Association

6 comments

Commenting on this page is closed.

  • #1

    Noel Corser

    Physician

    5:30 PM on October 07, 2019

    Hoping this is an appropriate venue for a comment, and a suggestion.

    What a time to start your term as AMA president, Dr. Molnar! :) Wishing you all the very best as you navigate all the challenges ahead.

    Since you mentioned that the Physician On-Call Program changes will be next up for your letters to membership, thought I'd put a suggestion out there. Assuming that the POCP is designed to provide a stipend to docs who have to give up their personal time to be on-call, in contexts where their billing doesn't cover their time, why not tie POCP stipends to billings-while-on-call? AH has all those numbers, and would just have to set up a link. The result would be that docs who bill lots while on-call don't get (or need) a stipend, docs who don't bill much (but still have to be available) get a better stipend, and we don't fight amongst ourselves over what category we should be in (and the time-frames we're expected to see pts within)? Just a thought...

  • #2

    Liana Hwang

    Physician

    9:31 AM on October 08, 2019

    Welcome, Dr Molnar! We appreciate your advocacy and support.

    I like Dr Corser's suggestion.

    I don't necessarily object to a call stipend based on response time. However, I think the categories we are assigned to need to reflect the level of service we actually provide. As a rural GP surgeon, one of the things that concerns my rural family doc colleagues apart from ER is that we have all been classified as B2, requiring a 1-4 hour response time. This is clearly incorrect for family docs with special skills like surgery and anesthesia who are supporting an obstetrics program where as you know, obstetrical emergencies can evolve unexpectedly within minutes.

    I also have some concerns about how this change was implemented. Apart from a vaguely worded email from the PCC on September 30, we received no advance notification and I feel blindsided by the change. There was no opportunity for us to participate in decision-making, and in fact, I received an email on October 2 advising of the change "effective October 1". Respectful two-way communication is needed.

  • #3

    Natalie Yanchar

    Physician

    10:30 AM on October 08, 2019

    There are challenging times ahead, indeed. As stewards of the financial health of our health care system and accountable to the public, I wholeheartedly agree with the AMA's stance in bringing patient care into the community and addressing mental health and addiction. However, I was disappointed to not see any mention of a commitment to consider other recommendations of the panel in your letter - namely moving more physicians to alternate payment plans as many of our colleagues across the country have embraced. What is the AMA's stance on this?

  • #4

    Dr. Christine Molnar

    Physician

    7:55 AM on October 15, 2019

    In response to Natalie Yanchar [comment #3]

    Hi Dr. Yanchar,

    You are correct that the Blue Ribbon Panel addressed the importance of moving to alternative relationship plans. This is an area where Alberta has lagged behind the country somewhat. The AMA, however, has supported ARPs for decades. We continue to do so today, whether through a range of clinical arrangements, the Academic Medicine Health Services Program or new models such as the Blended Capitation Model for primary care. You can find more information about the AMA's recent work on ARPs here: https://www.albertadoctors.org/services/physicians/compensation-billing/arps

    ARPs are part of the overall Physician Compensation Strategy. You can read a 2017 President's Letter and even watch a video from one of my predecessors, Dr. Neil Cooper, here: https://www.albertadoctors.org/services/media-publications/presidents-letter/pl-archive/physician-compensation-strategy-video

    The overall goals of the compensation strategy seek to align how physicians are paid with the needs of our patients. While there will never be one perfect model for everyone, you can bet that ARPs have big possibilities in Alberta.

    Thanks for your post

  • #5

    Dr. Christine Molnar

    Physician

    10:30 AM on October 15, 2019

    In response to Noel Corser [comment #1]

    Hi Dr. Corser,

    You raised some good points that I thought might interest others. We will share your note with our representatives involved in these discussions.

    When the programs were created, we often heard competing perspectives around payment, e.g.:

    • That on call payments should be structured to compensate those who remain available but who are not called in very frequently; or
    • That on call payments should be structured to better compensate those who are significantly disrupted by call (who either have to travel to attend to the patient or take telephone calls after hours).

    As with many of the other call programs across the country, rates of payment in Alberta were ultimately structured around disruption (specifically, the expected response time to attend to the patient).

    The points you raise are a good example of why the programs need to be reviewed with the medical community to determine if the underlying principles around payment are still relevant and desirable, and to ensure they provide an appropriate level of compensation for the services rendered.

  • #6

    Dr. Christine Molnar

    Physician

    10:34 AM on October 15, 2019

    In response to Liana Hwang [comment #2]

    Hello Dr. Hwang,

    Thanks for your posting your comments.

    The AMA did not support these reductions to the on-call stipends, nor did we support the $10M reduction to the annual budget for this program. Our recommended approach was (and is) to review and rationalize the funded rotations/programs. While this might not save the government $10M, it would be a more appropriate way to address the government’s budgetary pressures. I should also point out that the Physician On-Call Program is a grant agreement that exists between Alberta Health and Alberta Health Services and the AMA does not have a signatory role in that agreement.

    I agree with you that respectful, two-way communication is needed. Programs need to be reviewed with the medical community to determine if the underlying principles around payment are still relevant and desirable, and to ensure they provide an appropriate level of compensation for the services rendered.

    I also share your concerns about how these changes were implemented and we will be taking these issues and points to the PCC table.

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