Master agreement terminated

February 21, 2020

Dr. Christine Molnar, AMA President

Dear Members:

The termination of our master agreement is an outrageous action that must be challenged. Government is putting physicians and patients at risk. 

The AMA Board met last night and will meet again Sunday. We are reaching out to all sections and zone medical staff associations to discuss: 

  • Legal options;
  • Plans for engaging the public;
  • The results of our surveys (“Yes” patients overwhelmingly value their time with their doctor and feel that sometimes more is needed; “No” patients don’t agree with the tearing up of contracts); and
  • Next steps needed to get government’s attention.

Full strike options are not available to us, however, job action that does not put the immediate health of patients at significant risk does not violate the CPSA standard. We will need your help. 

The intent of our actions is two fold:
 
First, we will relentlessly seek to remove the harm to patients that is being put in place by this government.
 
Second, we will reinforce a point made several times to the Minister: the consultation proposals do not fairly balance the economic burden being put on physicians and there will be significant unintended consequences. 

For example, family physicians are disproportionately impacted through many of the consultation proposals, particularly rural physicians.  

The reduction in support for CMPA reimbursement will have a significantly adverse effect on physicians providing higher risk services. An example that comes immediately to mind is obstetrical care provided by family physician specialists. 

AHS physicians are not spared. Consultation proposal 8 will eliminate stipend payments. Consultation proposal 7 will reduce fees for physician services in public facilities, to acknowledge reduced overhead. 

Physicians have clearly stated their concerns to the Minister about many aspects of the proposals. This was discussed when I presented to him on December 19. AMA agreed that there were opportunities for improvements and we proposed a process whereby we would review all proposals and provide analysis and recommendations so that wise decisions could be made. 

The termination of the agreement and implementation of the consultation proposals as they are, leaves us with consequences that are far-reaching, some of which include: 

  • A reduction in time modifiers that disincents longer visits, even when patients and physicians feel a longer visit is necessary. The evidence is clear that supporting patients in the medical home pays off through better health outcomes and decreased costs to the acute care sector (i.e., reduced emergency visits and hospital stays).
  • Inadequate coverage for medical liability insurance, which is a requirement for physicians to practice in the public system. This puts a disproportionate financial burden on physicians in high risk practices. This may result in elimination of these services in certain environments, which is not in the best interest of patients and physicians. 
  • Removal of stipends that were historically put in place to ensure availability/coverage for necessary low volume service programs. This may result in decreased access to care and create gaps in patient care coverage. 

Let’s not forget our younger colleagues, who will soon be severely restricted as to where and how they practice. That’s if they even choose to stay in Alberta at all.  

The approach taken by government to terminate an existing agreement and replace it with a unilateral framework is unacceptable. The tearing up our contract has eroded the trust physicians have in this government. Government’s refusal to bring their information to an arbitrator shows disrespect to physicians and a lack of faith in their own information. We need a reasonable and fair approach to resolve disputes in order to maintain relationships and work together in the interest of Albertans. 
 
These are challenging times. This government has introduced an unprecedented level of uncertainty for physicians. We must remain steadfast on the path we have taken, which is focused on quality care for our patients and fairness for physicians. To be effective, we must stand together and maintain our strong, united voice. 
 
Governments come and go, but the AMA has represented physicians and patients in this province for 114 years. Make no mistake, we aren’t going anywhere.  
 
I will be in touch with further updates. Please stay tuned. In the meantime, I would ask all members who are on social media to help us amplify our voice. Let’s stand up and be heard on social platforms, like Twitter and Facebook, where we know this government interacts. 

Please follow the AMA on:  

Please tag/share/retweet our posts as much as possible and feel free to use the hashtag #ABdocs4patients.

Please let me know what you think in the following ways:

  • Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org 
  • Comment publicly below on this President’s Letter (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member).

In your service, 

Christine P. Molnar, MD, FRCPC 
President, Alberta Medical Association

26 comments

Commenting on this page is closed.

  • #1

    David Lardner

    Physician

    6:27 PM on February 21, 2020

    For the UCP government to legislate termination of an existing contract is an abuse of process. Would they dare to legislate to unilaterally alter an existing contract for road services with a roading contractor. Without doubt this would lead to litigation which would be prolonged and the government would ultimately lose. They would incur all legal costs, reinstatement of the contract as well as punitive charges likely. This is in essence what they have done to physicians. We should litigate for this illegal act that the UCP government. This would keep this illegal process front and center for a prolonged time leading to them having to come to settlement with the AMA.
    Additionally this has usurped the fee equity process that the AMA had been helping to spearhead

  • #2

    Johan A Viljoen

    Physician

    6:42 PM on February 21, 2020

    Why in hell would I want to practice in a province where the government demeans my worth as a Physician .
    Why would I encourage any other physician to come work here.
    Why would I encourage my children to study medicine at great personal sacrifice to come work in Alberta.???
    Dream on AHS
    Dream on politicians.
    You suck as a government.

  • #3

    Robert Pearcey

    Physician

    6:46 PM on February 21, 2020

    It is the ultimate in bully boy tactics to break a contract with a group whose College does not allow for a measured response. I hope young doctors and medical students are seeing the writing on the wall for future careers in Alberta.

  • #4

    Alan Chu

    Physician

    12:18 AM on February 22, 2020

    Can somebody think of a creative way to give the government what it is essentially asking for: minimal non-AFP family medicine (ie all family medicine outside of academic sites, reserves, and certain agencies) and nobody spending time on complex patients; a preponderance of non-hospital surgical facilities which would help many people get their anterior eye surgeries, podiatry, and plastic surgery; minimal staff on call at hospitals.

  • #5

    Terry A Wiens

    Member of the public

    12:48 PM on February 22, 2020

    As a polio survivor I have been immersed in healthcare most of my life. I grew up in the Alberta Children's Hospital and then later worked at the Holy Cross in Calgary for almost 12 years. That was the beginning of the erosion and I made a career change where I worked as a policy analyst. I have spend my life collecting broken promises from governments that want out of earlier commitments to a wide variety of chronic disabilities. Now that I have reached retirement I am discovering all of those programs and attitudes I fought to improve.

    Now the governments, in what I can only see as a way to alienate healthcare professionals, is putting forth regulations and policies that require doctors to ignore their own commitments to the ethics and moral of public wellness. This government appears to prefer doctors who will walk away from their ethical responsibilities while adopting UCP's "healthcare through policy" rather than actual healthcare by patient need. Governments are there for the people not the other way around. Past SCOC Charter challenges have already ruled in favour of organizations like the AMA. Governments cannot pass legislation or introduce policies that inadvertently or purposefully require those actions could impair protected rights under the Charter.

    Right now there are approximately 900 polio survivors (there are all kinds of other issues) that put us in that "complex care" area through no fault of our own. The Alberta government has now created the first healthcare agreement that is actually a bigger systemic barrier than we currently face. The Kenney government s now asking Alberta doctors to ignore human rights legislation and manage their practice based on spread sheets and "bottom lines" to the detriment of quality patient care.

  • #6

    Judith chaffee

    Other health care professional

    2:41 PM on February 22, 2020

    Fully support physicians !

  • #7

    Noel Corser

    Physician

    5:14 PM on February 22, 2020

    I remain concerned about the AMA's approach to this government. Legal action is ridiculous (you can't sue the government who makes the laws, unless they violate the rules they operate under - i.e. Constitution/Charter). Engaging the public is going to have mixed results at best - doctors are in the top 1% income earners, and the more we say "patients will be forced to have shorter visits", the more patients will ask "who's doing the forcing?" And getting the government's attention is not the problem. This government simply does not care about the AMA's opinion, as is quite obvious.

    The issue here is that (in the absence of any better proposals by the AMA) the government is instituting massive funding cuts to physicians in the best way they see fit. Which means anything they can rationalize somehow (higher-cost than other provinces, higher cost than privately-provided, "perks" like CME and CMPA reimbursements, etc), without much apparent regard for knock-on effects or total system costs. It's highly probable that further cuts are coming, as they discover other things that can be trimmed. The AMA is not able to stop this, because the government holds all the cards here.

    The AMA has a few options. It can keep on its current path, acting like it has for 114 years, which will result in government-led cuts all over the map and major, unequal, impacts to physician incomes. The inequality of the cuts' effects may well trigger a breakup of the AMA, if family physicians realize the AMA's not doing anything much on their behalf. I suppose adding "wait for the next election" joins the list, but the next election won't be swayed by this issue. The government's got us over a barrel here - if patient care suffers, the blame goes squarely on the docs' shoulders for adjusting their practices to maintain their profits. Another option is to go back to government and say "you've made your point - now please can we show you how to re-assign your cuts to minimize patient-care impacts and spread the pain more equitably among Alberta doctors" - there's always a chance the government would listen to that. However, that sounds very similar to "income equity", which the AMA hasn't made a dent in for 114 years. Here's hoping though...

    One thing is certain - if there was ever any time to suggest major changes to the healthcare system, it's now. This government is a bull in a china shop, and has no problem deconstructing things no one has touched for decades. We might well end up with highly privatized medicine, given this government's proclivities, but we could also end up with the best healthcare system in the world (why not dream?). I would implore the AMA to consider being more than a union (especially since that's not working), but instead take a leading role in crafting Alberta's future medical system - otherwise this government will continue doing that without us.

  • #8

    Ralph Wohlgemuth

    Member of the public

    5:55 PM on February 22, 2020

    Our doctors, especially family doctors, should be encouraged spend time with their patients to learn about their lifestyle and help them develop, or maintain a healthy lifestyle that reduces their use of the health care system long term.

    I had a doctor a number of years ago who believed in and practiced this approach. It helped me then and continues to help me now. A policy change that doesn’t recognize this is counter active to reducing health care costs.

  • #9

    Alana

    Physician

    7:46 PM on February 22, 2020

    Family Medicine. As I sit here, on my day off (i.e. non-billable time), catching up on labs and charting because I love my job and care about my patients, I'm feeling quite demoralized and undervalued. How much is my time worth? I thought I knew, but perhaps not. In our clinic, we care about the system and do our best to steward resources judiciously but with patient safety as priority. We are proactive with screening, and have caught significant pathology early. Doctors and staff in our clinic form authentic relationships with our patients, who have come to trust us. All these things, I believe, contribute to a healthier community. Primary care in Alberta has grown into something we can be proud of. It breaks my heart to know that our so-called leaders don't see it that way. It also breaks my heart that at this moment, I am cynical enough to feel that this is what voters wanted, so I suppose we should give it to them.

  • #10

    Cindy Cook

    Member of the public

    6:57 AM on February 23, 2020

    What the government did, by tearing up the contract and dictating the future is completely unacceptable - that is not democracy. The government does not and should not have that power. Both sides need to come back to the table and work out a reasonable contract.

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.