MAPS Innovation Forum update

January 24, 2023

Dr. Fredrykka Rinaldi, AMA President

Dear Members:
 
The Modernizing Alberta's Primary Health Care System (MAPS) initiative has been set up to recommend short- and long-term actions to strengthen primary health care in Alberta.
 
On January 16-17, primary care stakeholders came together at the MAPS Innovation Forum to discuss potential innovations for modernizing Alberta’s primary health care system. Key topics included:

  • How to fully realize team-based care.
  • Meeting the needs of Albertans living in rural and remote parts of the province.
  • Ways to better meet the needs of vulnerable and underserved populations.
  • How to enhance partnerships between Indigenous communities/organizations and other parts of the health care system.

Our members at the forum advocated for:

  • Resources for team-based care at the clinic level and beyond, e.g., other allied health providers.
  • Alternative funding models that are capitation based, improvements to the BCM.
  • Sustainable funding for PCNs and community supports.
  • Leveraging and building from the good work that’s already been done, such as PCNs.
  • Informational continuity while growing teams, e.g., accessible, affordable internet access for all Albertans.
  • Unique solutions for rural Alberta.
  • Partnering with communities to better address local population needs.
  • Consideration of social determinants of health.
  • Avoiding quick access solutions that further fragment care.

Outcomes from the Innovation Forum will be fed back into the MAPS panels to support their work of developing a strategic roadmap for primary health care in Alberta.
 
What is clear is that there is no quick fix for all that ails primary care and the government cannot solve this by themselves. It’s up to all health system partners to contribute and seek tangible ways to better sustain community practices while improving access for Albertans.
 
I will continue to keep you informed as things progress.
 
You are always welcome to share your thoughts with me. You can email me via president@albertadoctors.org. You can also comment on this letter on the AMA website.
 
Regards,

fred Rinaldi, MD, CCFP, FCFP, LLB, MBA, MPA(HSA), BCom
President, Alberta Medical Association
 
"Fate whispers to the warrior, 'You can not withstand the storm.' The warrior whispers back, 'I am the storm.'"

4 comments

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  • #1

    Clay Hammett

    Physician

    9:00 PM on January 24, 2023

    What ails healthcare is 4 decades of ever increasing 3rd party control of healthcare in order to keep expense in check. What has happened in this socialist paradigm is that bureaucratic control by government, insurance companies, large corporations and regulators have begun to choke themselves as the system they try to control disappears like a field of canola with seed but no water and no will to live.

    Things will only turn around when Doctors are allowed to run their businesses more or less as they please again. And part of that is being able to charge what they need to hire the team members they need — not be fed a team with more hoops and regulation.

    Government needs to enable docs to run their businesses again, so that doctors enjoy what they do and build good operations. It will take time but this is the only way forward.

  • #2

    David Smyth

    Physician

    2:13 AM on January 25, 2023

    Team based care is not effective when you don’t get to choose your team. The only useful parts of the PCN have been referral co-ordination. I need nurse practitioners to help me and my colleagues see more patients. They need to be hired by me and paid be me but then I need to be able to let them bill under me.

    Our clinic has sixteen doctors and two LPNs. There is a reason our clinic has sixteen doctors and it has nothing to do with anything the AMA of AHS has done.

    I’m my opinion the medical home model based on PCNs has failed and nothing will get better and we will spin our wheels. PCNs have money to advertise and look like they are effective, PCNs tend to be in very expensive real estate.

    Too many people are making too much money doing very little in health care including Primary Care. These central referral collection points are insulting and put patients at risk.

    In my 27 years, much of what has been implemented has made health care more expensive while delivering less continuity of care, more useless expensive investigations,and less quality care. Walk in clinics in our area generate horrendous quality and quantity of referrals to our ER and can turn a sprained ankle in to an expensive ordeal. A meaningless ST elevation done on an asymptomatic patient ends up as an ER visit or a cardiology consult. Then there is the obligatory useless RX as many are owned by the Pharmacy.

    Why are there pharmacies on every corner and why are some ordering tests and prescribing drugs under homeopaths?

    Radiology groups are being bought out by Venture Capital because they have been so profitable. Venture capital will now put downward pressure on the Radiologists fees and working conditions along with their staff and equipment.

    I am glad I am coming to the end of my career because almost every year we are revamping health care. There is enough money in the system but the waste is sickening. Why are we still doing sick notes, massage and chiropractic and physiotherapy prescriptions. Insurance companies guilt us into not charging ill patients. We have to deal with so many AISH, CPP disability and Disability tax credit forms, useless Blue Cross special authorizations, and a host of others that I get why doctors are running to fragmented, “skim the cream”areas of primary care.

    The AMA has failed us in implementing FFS reform and is little more than a rebate centre for CMPA and CME. It has accomplished very little and was bullied by Ophthalmologists that cut their own deal in the end. Why doesn’t the AMA at least help us get good cheaper accountants and Divorce lawyers. That would be at least more useful than deals on a rent a car that are higher than Costco.

    Another useless panel chosen by people who are clueless. But remember after all the money is paid to these useless consultants, and patients are leaving the ER, Walk-in centre, specialist appointment, accountants office, injury lawyer, mental health clinic etc, “ Don’t forget to follow up with your family doctor.”

  • #3

    len wade

    Physician

    9:05 AM on January 25, 2023

    As a family Dr who practiced in rural Alberta, I am well aware of the shortage of rural GPs. I am concerned that the move to increase family medicine residency to 3 yrs will aggravate the shortage of family Drs both rural and urban. Rural communities have always had difficulty attracting Drs and this increase in training time will have a greater negative effect on rural communities than urban.
    There is a need for both a provincial and national manpower plans to show us what types of Drs are needed and where they are needed. We also need to do a better job at matching the manpower needs of specific specialties to the identified shortages and provide more incentives to encourage Drs to work rural and accept residency positions where there is a need rather than aggravate an oversupply of a specific specialty.
    I understand that these are very difficult problems to address, and I am appreciative of the work that is done by the AMA to improve healthcare.

  • #4

    David Smyth

    Physician

    9:37 PM on January 26, 2023

    In medical school one of the senior Hematologists came to talk to us and he ended up detailing a story about his wife and their experience having a child at the hospital he worked in. There were some complications and because people were aware of who she was married to, some of the OBGYNs that were in administrative roles were going to dust of their lab coats and come to provide expertise.
    He declined all their help and wanted an experienced practicing doctor with messy hair and coffee and blood on his lab coat to look after his wife. In other words he wanted someone from the trenches that has dealt with his wife's issues day in and day out.
    Very few of the people on the Advisory committee seem to be content to provide continuity of care for any length of time. Many seem to like the limelight and there certainly is a PCN bent. It also appears that many have moved from places to place and job to job. I guess just providing solid long term Primary care in one spot is not important, but hey if you can get a consultant gig why not.

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