MLR: Setting the Record Straight

April 27, 2020

Dear Members:

My April 24 President’s Letter, in response to the government’s provincial announcement about rural care, resulted in a strong and positive response about the importance of unity in our profession. Similarly, the voice for unity was eloquently proclaimed by communiques from the Section of Family Medicine, the Section of Rural Medicine and the Rural Sustainability Group.

I am deeply moved by the support declared for the unity of the profession and the Alberta Medical Association. In Twitter posts, members added “I Am AMA” to their profile names and created hashtags like #AMAisABdocs and #IbelieveAMA. These positive actions are signs to all that the profession is united and strong and that your representative voice, the AMA (which has been here for 115 years), WILL NOT FALTER. Thank you!

On Friday the Minister disparaged the AMA’s truthfulness with members regarding proposed changes to Medical Liability Reimbursement. His inflammatory message is baffling. The AMA’s messaging to both members and government has been consistent and factual. As I wrote to the Minister on March 17,

“The proposed changes will bring Alberta to the lowest level of coverage of any province. Liability protection is a practice requirement in all provinces and the cost needs to either be reflected in higher fees for those services that attract liability or through a reimbursement as has been in place in Alberta. Lowering the program reimbursement level without changing fees for high risk services creates a significant challenge.”

Subsequent letters on March 24 and April 5 conveyed an identical message.

I also provided this information directly to the Minister in several conversations. He acknowledged that work was ongoing regarding MLR in letters to me on March 30 and April 7.

MLR was discussed for members in my President’s Letter of March 30. There was also an email to members, sent April 3, about the delay in premium withdrawals that the AMA had obtained from the Canadian Medical Protective Association to provide some additional time for program details to be confirmed.

Since the onset of negotiations in November 2019, it has been the unwavering position of Alberta Health that funding for the MLR would be reduced by approximately 50%. The AMA had repeatedly warned the Minister about the consequences of reducing the reimbursement for liability premiums. In our recent member survey, 92% of over 3,000 respondents said the reduction in MLR funding would have a negative impact on their delivery of care. The MLR was an evergreen program through the AMA Agreement and, as such, was to continue fully funded this year during negotiations, unless otherwise agreed to by both parties. When the Minister tore up our agreement, programs such as MLR were thrown into limbo. The AMA expected the grant programs, including MLR, the Physician and Family Support Program and the Physician Support and Assistance Program, would be signed April 1, 2020, but this has not yet happened. (Please note: an earlier version of this letter incorrectly included the Rural Remote Northern Program and Business Costs Program in this list. They do not belong in this group.)

As anticipated, government’s decisions and the imposition of the Physician Funding Framework on March 31, resulted in swift reactions in rural communities and practices across the province. The Minister is solely responsible for the consequences of his actions.

Around all of these events, the business of the AMA has moved forward. In the aforementioned member survey, 70% of physicians said that the AMA needs to balance priorities between COVID-19 and the Physician Funding Framework. This is what we are doing. To seek guidance from our leadership, a virtual Representative Forum was held on April 15, followed by 12 breakout sessions over the following week to dig into specific issues. The AMA Board then met virtually on April 23 and 24 to review the input received from RF and the member survey. We will report to you soon on this. Other topics discussed by the Board included a proposal for income stabilization funding during COVID-19 which has gone forward to government, preparing the exit strategy for COVID-19’s first wave, and the AMA’s public positioning, including the current Share the Care campaign.

The Board is taking steps to ensure members have access to AMA representation in the absence of an AMA agreement, for example, if a physician is considering entering into an Alternative Relationship Plan.

Despite the disappointing comments from the Minister last Friday, the AMA remains committed to achieving a negotiated agreement for our profession, with third-party arbitration if necessary.

“We will not waiver, we will not tire, we will not falter and we will not fail.” - George W. Bush

In your service,

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