Master agreement terminated

February 21, 2020

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:  

• Twitter at twitter.com/Albertadoctors and 
• Facebook at facebook.com/AlbertaMedicalAssociation 

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