Income equity and the Special RF

July 6, 2017

Dr. Padraic Carr, AMA President

Dear Member:

I am sending this letter to update you regarding the results of the Special Representative Forum (RF) regarding income equity. I am pleased to say this was a very productive meeting for the Alberta Medical Association (AMA) that provided greater clarity on a very complex initiative. The direction given to the Board of Directors going forward is crucial to the success of this endeavor.

Background of the Special RF

Inequitable distribution of physician compensation weakens the unity of the profession. It can also skew the delivery of services; negatively affecting patient access to certain necessary services and resources.

Calls to address income equity come from specialists and family doctors alike. In fact, in our polling at Spring RF, over 90% of the entire assembly felt income equity needed to be addressed. Over 80% supported using reallocation as a tool toward it. Let me emphasize, though, that equity does not mean equal. Income equity is a fair or just difference in the daily income earning capacity of a full-time physician between sections. At a time when fiscal concerns dominate provincial and national agendas, ensuring relativity and value for services has never been more important.

That’s why the Fall RF asked us to come back with concepts and methods to address income equity. The Spring RF then provided direction to move forward and develop a comprehensive strategy that includes Adjusted Net Daily Income (ANDI) and reallocation as tools in a five-year timeline. Versions of ANDI are being used in other provinces, but obviously every province is unique and our model needs to be developed here in Alberta.

The special meeting offered opportunity to discuss and debate equity-related motions not addressed due to lack of time at the spring meeting – as well as other new concepts that arose. Once again, the overwhelming atmosphere was one of courtesy and respect for the opinions of others. It is so very important that the profession remain united in this work and what I have seen so far gives me confidence that we can do so.

What was discussed at the meeting

After the Sprint RF, the Board gave direction to the AMA Compensation Committee (AMA CC) to lead income equity work. (The AMA CC reports to the Board of Directors and provides advice regarding compensation strategy.) The RF received an update on work to date from our AMA CC co-chairs: Dr. Steve Chambers and Dr. Jeff Way. We sought the RF’s insight about what the Board and AMA CC should focus on and where more work will be needed.

The RF provided thoughtful and considered input into many of the factors that AMA CC will consider and apply in ANDI calculations, including various forms of compensation, overhead, hours of work, training, modifiers and other adjustments. General direction, provided via motions, was that the AMA should:

  • Consider carefully the anticipated impact of changes on the profession and patient care
  • Consult closely with the sections
  • Be transparent and objective in use of data
  • Give members a chance to vote on what is eventually developed

This session was held in camera. The actual motions are available on the website (member log in required).

Looking forward

The Board will consider all the motions that were passed and referred, including how we will address the member voting process that will occur. It will provide the AMA CC with direction in order to complete a plan for this Fall RF meeting.

The movement toward income equity will be measured and careful. Assuming our general membership vote echoes the will of the representatives at RF, we intend to do the groundwork to get the job done. We must rely on collecting the best information we can at any point in time. We will plan, we will act, we will review, and we will remain adaptable. There will never be perfect or permanent information. We certainly don’t have that now with our current payment models. We can, though, develop the best information we have, and then be prepared to monitor and adjust in the future.

Engagement and consultation began with sections following the Spring RF to discuss factors for income equity data when applying ANDI. Engagement will continue through the summer, the Fall RF and beyond. Please see the below timeline, updated since the Special RF (Click image to view full-size).

As we engage sections, individual members will also have the opportunity to contribute (whether through your sections or directly to the AMA).

Why the AMA?

Some members may still ask: Why are we taking on this challenge ourselves? I think the answer to that is quite simple: the health care system needs help. Physicians are uniquely positioned to inform policy and funding decisions – and particularly in improving the delivery of care when resources are limited. We are at the forefront of a national movement and are well positioned to lead the country with the issue of income equity. Our health care system, our profession and the patients we serve are sure to benefit. 

The way we treat each other regarding compensation speaks to who we are as doctors. AMA members are intelligent, thoughtful and compassionate. Working together we can accomplish whatever we set out to do.

I will leave you today by reiterating the Board’s commitment to appropriate communication, consultation, and engagement between now and the Fall RF (and afterwards), as well as transparency in our use of data and our decision making. This will be a two-way conversation; we expect to adjust in response to what we hear and there are no pre-determined outcomes. Finally, you will have the opportunity to vote in a timely fashion.

As always, please let me know what you think. Email or leave a comment below. If you have meetings coming up with sections or other groups of colleagues over the summer months or fall and would like a chance to discuss AMA activities and direction directly, please let me know and I will do my best to participate.

Yours truly,

Padraic E. Carr, BMedSc, MD, FRCPC, DABPN

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