MAPS final report released, AMA and Alberta government to strike an MOU
October 18, 2023
Dear Members,
Earlier today, the Minister of Health released Modernizing Alberta’s Primary Health Care System (MAPS): Strategic Advisory Panel Final Report.
Many of you were involved in extensive consultations that formed the basis of this report, and we have been waiting anxiously for its release as family medicine and primary care have continued to erode in Alberta. Each week we hear of more physicians retiring or relocating their practice, including to British Columbia where recent significant changes have substantially improved the foundation for family practice. Changes in BC, as well as Manitoba and Nova Scotia, have brought new urgency to addressing family medicine in Alberta and changed many of the assumptions that informed the MAPS report.
An important part of the minister’s announcement today was the release of Honouring our roots: growing together towards a culturally safe, wholistic primary health care system for Indigenous peoples - Indigenous Primary Health Care Advisory Panel final report, along with the implementation of some of its recommendations. At its very outset, that report acknowledges, “health outcomes for Indigenous peoples are moving in the wrong direction.” We all share an accountability for addressing that shameful legacy and we are committed to continuing to work closely with Indigenous leaders and government.
As I wrote to you last week, government has been closely analyzing the proposal on longitudinal family practice (LFP) submitted by the AMA and its family medicine leaders. The proposal will address significant gaps in government support for family physicians and incentivize longitudinal or comprehensive family practice. As part of that proposal, we have also advocated for substantial stabilization funding necessary to help retain our family physicians.
We know the announcement was not what members expected. Even the minister said this, and she acknowledged the need for a new funding model and adequate stabilization. While these comments are promising, physicians whose practices are on the brink will be particularly disappointed. We need rapid and substantial measures, and while it is unfortunate they were not announced today, we will not rest.
The minister’s announcement included a commitment to a Memorandum of Understanding with the AMA that promises to include an LFP proposal in Budget 2024. The minister’s announcement also includes funding to support panel growth which, while modest, is expected to be supplemented by further stabilization funding per the commitment in the MOU.
Government has said that MAPS recommendations will be implemented through a phased approach, with several moving forward immediately, followed by medium- and longer-term improvements. MAPS speaks to potential new governance structures for primary care in Alberta. New governance, along with potential new accountabilities, have been cause for debate amongst our membership. Members have also told us they want to preserve elements of our system that work well now. Alberta has some of the best approaches to team-based care in the country, even while the overall structure and supports for primary care have been ignored by government for too long.
We will work with government to ensure the MOU includes provisions to work on all of these elements in a cooperative manner – including a specific provision about engaging with the AMA on modernized governance structures. In this context and elsewhere, we will reinforce the importance of a medical home. Nothing can replace the comprehensive, high-value care provided by family medicine specialists who have years of training in understanding the needs of patients through the whole life journey. The best approach is an integrated team that includes allied health professionals and physicians working together to address a patient’s medical concerns.
I have heard from many members that you are burned out; your practices lack financial viability and the departure of doctors from your communities has created unreasonable expectations and workload. Now we face several weeks of intense work and I ask you to be patient. We will work with family physician leaders to support the work with government, to finalize details for the LFP model, inform appropriate stabilization and discuss governance. We cannot guarantee the outcomes, but we must do all we can to influence and guide policy so that all Albertans can benefit from an appropriately resourced medical home.
Family medicine is the foundation and heart of primary care. Without it, effective primary care is impossible. I am committed to keeping members up to date and will ensure our work is transparent and that we engage widely to capture the views of members whose practices are diverse. We will be particularly focused on ensuring that government’s next budget addresses urgent needs in the health care system.
You can reach me anytime at president@albertadoctors.org. You can also comment on this letter on the AMA website.
Regards,
Paul Parks
President, Alberta Medical Association
5 comments
Commenting on this page is closed.
Paul Marner
11:06 PM on October 18, 2023
I listened to politicians in the UK extol a "Physicians Charrer" in the 1960s. Then, as now, it was rhetoric and promises by people with self interest at heart.
After 5 years I left. Saskatchewan, and since 1974, Alberta was a lot better.
However,particularly in the past 5 years, a similar. poison has developed here. I retired after 60 plus years of enjoying the family practice rewards, but not the politics.
Andrew Swinton
9:19 AM on October 19, 2023
It is a significant misstep that Health Minister LaGrange chose this as the starting point to initiate MAPS. Providing funding so that primary care doctors are incentivized to add more patients--COMPLETELY misses the mark. All of us are working flat-out, most of us have added hundreds of patients to our panels that we miss providing adequate access, keeping those already panelled barely happy that we are able to address both acute and comprehensive needs, when booking so far in advance. The after hours administrative and paperwork generated keeps us busy until the lights go off for the night. Incentivizing us to do 'more' speaks to an out-of-touch govt, and says should be interpreted as advancing payment to provide for divorce and palimony. We CANNOT work any harder without sacrificing an even bigger piece of our personal lives. This does nothing to retain and support the existing PCP's in this province trying to provide comprehensive care. We need support not only for virtual visits, but immediate $ incentives to provide comprehensive care, and a panel or forum JUST to address the problems with administrative paperwork!
Jane Doe
2:20 PM on October 19, 2023
I am very grateful for the great work the AMA is doing advocating for the viability of family medicine practices in Alberta.
One point in the report I wish to have clarified is the action the government is taking to implement "a payment system that will support nurse practitioners to open their own clinics". Does this mean nurse practitioners will be practicing independently from family doctors? This point seems to go against Dr. Janet Reynolds quote about the MAPS recommendations "recognizing the importance of integrated team-based care".
Last month, I heard the former president of the CMA speak at the University of Alberta and he discussed the problem of our health care system creating silos which make it increasingly difficult for patients to navigate our healthcare system. Dr. Alika Lafontaine said, "we're continuing to expand those silos in the ways that we always have. We're continuing to add new folks so now, instead of fixing primary care health teams, we're expanding scopes of practice so people can work even more independently from each other, which is the opposite of what our actual solution to our problems are."
I have great respect for nurse practitioners as part of the health care team, but I also agree with the statement from BC Doctors last year: "Nurse practitioners cannot replace doctors". At a time when the CFMC is raising the residency duration from 2 years to 3 years, it would be discouraging as a trainee to see our province allow providers with significantly less training practice autonomously, and I worry about the inefficiencies and poor health outcomes this would create.
Greater communication from the AMA in this area to understand exactly what is going on would be greatly appreciated. Thank you for your excellent work!
Walter Mair
12:58 AM on October 20, 2023
I am retired from my office of 40 years but continue to practice geriatrics. It is quite incredible how underfunded our office family docs have been in the present system. Improved funding will be a huge mainstay in the future of family medicine. BC has definitely developed a better system for rumuneration for the family docs and that's what the Alberta docs need most. The comprehensive care clinics are wonderful but don't cover every patient so the office docs are left with trying to fill the gap. Bottom line.... govt has to pay the family docs a whole lot better if they are going to stay and not retire early.
Regards, Walter Mair, with almost 44 years of experience.
Alan Richard Egan
9:04 PM on October 22, 2023
I am a family physician who worked in the UK for 14 years and the last 8 years as a salaried GP working in their version of a blended capitation model (QOF). I would describe that system as hell and soul destroying. We, as GP's should refuse anything to do with it.
All autonomy was slowly stripped away and pay stagnated. Your were provided with more and more criteria to meet around access and regulation. Hours increased, patient demands increased and respect from the public was stripped away,
I worked with increasing numbers of NP's which the government saw as a cheap solution to paying more doctors. However NP's very quickly realized - why should they accept that level of responsibility for a fraction of the compensation? so virtually all clinical decisions were referred back to the GP doubling our workload. Patient's very quickly became frustrated and unhappy that they can no longer see their doctor (currently this is one of the biggest complaints in the NHS set-up).
It was also very apparent doctors being paid a fixed salary only do what they are forced to do - many do the bare minimum and avoid any extra work - the system becomes incredibly inefficient.
If you want doctors to provide more services and access compare FFS to salaried physicians. I can instantly tell who is which when I call to make a referral as I am sure other GP's also experience. FFS doctors are happy and will bend over backwards to help you, salaried doctors are outright obstructive most of the time trying to reduce there workload, after all they get paid if they see 10 or 30 patients a day.
The government and the AMA are focused on alternative payment plans - I can see why the government is because they just want to pay less for healthcare and blame us for the outcome, but why is the AMA accepting this. It is being held up as the holy grail of healthcare, why?
I work in a FFS clinic with an excellent multidisciplinary team, with PCN support and the support of many fantastic colleges, we do not need nor want NP's and I believe neither will our patients just as things have turned out in the NHS.
Has the AMA ever actually polled its family doctors to see who wants FFS or alternative payment plans. My impression is the majority do not want alternative payment plans.
As for the advisors pushing this agender many work in a false alternative payment model where negation is not being applied and millions of extra dollars have been poured in to make the project a "success".
Nothing I can see will encourage more doctors to Alberta but then why bother doing that if you can do it all with cheap NP's I guess?