Needs-based physician resource planning
November 29, 2016
Dear Member:
- The AMA (Alberta Medical Association) commends government for its commitment to fund any new physicians that Alberta needs while working with the AMA toward a needs-based physician resource plan.
- Principles will guide the Board of Directors.
- The timing is good to develop an evidence-based plan without being driven by a crisis in physician supply.
The recently ratified Amending Agreement strikes a balance between providing quality of care for patients and respecting the fiscal prudence that the province’s financial situation requires. The issue of physician supply is an excellent example.
I applaud the minister and Alberta Health (AH) for agreeing that government will continue to fund any new physicians that Alberta requires. At the same time, they have committed to working together to complete a detailed, needs-based resource plan that will identify the optimal supply, mix and distribution of physicians. This is the kind of quality-focused and measured approach that will contribute to long-term sustainability.
The AMA, AH, Alberta Health Services and other key stakeholders will come together at the newly formed Physician Resource Planning Committee (PRPC). The AMA will have one representative, as will the Professional Association of Resident Physicians of Alberta and the Medical Students’ Associations. For more information on the mechanics of the PRPC, please see page 16 of the Amending Agreement for the terms of reference.
The AMA is eager to approach the task of building a needs-based physician resource plan, and to working with our partners to achieve this end. When there are many complexities and variables designed to support overarching goals, a principles-based approach is most effective as a starting point. At our December meeting, the Board of Directors will be discussing the principles and policies that the AMA will apply for our work at the table.
Can we succeed in this initiative? I strongly believe that we can.
One of the greatest benefits of the Amending Agreement is that it creates an 18-month window of opportunity for coming to terms with some big issues. By doing so, we are then positioned to address long-term solutions through our discussions for Negotiations 2018 and beyond. I am confident that the unprecedented gathering of partners at PRPC – and a mutual commitment to delivering what patients need – will be a successful venture and create a strong foundation for a sustainable future.
The timing is fortuitous. We are working to meet an identified need, but we are not under pressure of a crisis. Today for the most part, the natural attrition of physicians in the province is being resupplied by the output of our medical schools. We have the time and the ability to do things right. We have the knowledge and expertise to develop a highly refined and effective needs-based physician resource plan.
I will have more to say on this topic in the months ahead. I would like to know what you think about issues of physician supply and the principles that might guide us. Please email president@albertadoctors.org or leave a comment below.
Yours truly,
Padraic E. Carr, BMedSc, MD, FRCPC, DABPN
President
2 comments
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Frank R Friesen
1:18 PM on November 29, 2016
Thank you for all the work that you do.
Please ensure that physician burn-out is included in your physician requirements. The introduction of the EMR notes has increased by 30% the time a physician takes to see the patient and write appropriate consult note or daily progress note. This occurs without an increase in fee stipend. Two of my colleagues have quit the SHC post-natal service over this time imposition. Another is ready to quit the PLC service. Fewer young paediatricians are signing up for inpatient hospital work because of the long hours, night call and week-end call. More income can be made in the office without the sacrifice of time and toll on the family.
How are you counting millenials in the physician number requirements? They do not have the same work ethic that physicians graduating prior to ~1990 [probably with good reason].
Sincerely,
Frank R Friesen
Nathan J Brown
9:10 PM on November 30, 2016
I have sent this letter to the AMA president as well:
I would humbly propose the AMA work with AHS and AHW to to explore other cost saving options.
Examples:
1) needless blood work ordered again and again on surgical patients. Routinely I see stat CBC, lytes, Cr, ECG, and chest X-ray ordered for day of surgery. This is often a complete waste of money and goes against most guidelines (Eg. the CAS guidelines) regarding peri-operatiev investigation. Most patients have had blood work drawn recently, or the investigations are not necessary given the nature of the surgery. The Choosing Wisely campaign is a good initiative to draw attention to this wasteful practice, but it is currently a suggestion, or voluntary. AHS could audit surgeon's office (the main culprit for ordering all these investigations) and give feedback about wasteful practices. This is similar to the feedback the Physician Learning Program gives to us about various aspects of our practices (whether it's cost-related or not).
2) Every saved fluoroscopy shot during an ortho surgical procedure gets read by a radiologist after the fact, at least by my understanding. Since this bears no impact on the point-of-care surgical decision made in the operating room, I would suggest that intra-operative fluoro shots no longer be read by radiologists. The exception to this is x-rays taken specifically to look for surgical equipment left inside the patient when the equipment count is discordant.
3) AHS should increase transparency of contracts and equipment costs. My understanding is that non-disclosure of equipment costs is normally a part of the contract with equipment suppliers. When public funds are involved in these contracts and purchases, the public really should be able to access this cost information. This step would also discourage conflicts of interest when contracts are made.
4) AHS should make departments accountable for decisions and rules that needlessly increase cost. Examples are from Infection Prevention and Control (IPC). A few years ago they made a blanket statement that all anesthesia circuits are to be changed after every patient encounter. This was not evidence based, it was purely conjecture. A highly irresponsible conjecture when you consider the increased cost (and patient safety issues - another matter altogether). We provided evidence that there is no increased infection risk when the standard viral/bacterial filters are used with the circuit and IPC backed down on their mandate. However, the cycle repeats itself as IPC continues to have the power to hand down sweeping mandates to AHS employees. They have now mandated (with no evidence to back their claim) that we cannot have bronchoscopes prepped and ready in their sleeves, primed for emergency situations. We have to keep the bronchoscopes packaged in the sterilized boxes in which they come up from processing. The safety issue of not having a bronchoscope at the ready is obvious. So we now have to have disposable bronchoscopes at the ready, which are replaced every 24 h. At a time where the province and the health budget are looking to cut costs, it makes no sense that IPC is allowed to make sweeping mandates that drive up costs, based on their own conjecture. The AMA should work with AHS and AHW to take these people to task and revoke their deleterious, irresponsible decisions. Departments like IPC should not have absolute power to impose measures without supporting evidence, especially when these drive up costs.
5) The AMA should work with AHS to minimize use of single use disposable equipment. Unless there is a clear advantage to the disposable equipment, reusable and cheaperitems should be sought. Examples are reusable vs disposable LMAs in the OR. The reusable ones over the life of the equipment are much cheaper than the disposable. Another example is disposable video laryngoscopes vs the reusable options - the latter are cheaper, especially when we already have surgical sterilization facilities in place (mandatory - so you might as well get equipment that's reusable). Another example is disposable laparoscopic instruments. Some of these are several hundred dollars - more than the surgeon's fee for the operation. SIngle use and disposable. If an alternative is not available, AHS should negotiate a much reduced price - compensation for the company winning the contract and having essentially a monopoly on that equipment for all of Alberta, for the duration of the equipment. For instance, AHS should mandate to the company that instead of spending several hundred dollars on the laparoscopic disposable instrument, AHS will only pay at most $100). The AMA could work with AHS to move toward these cost saving measures.
I would support these cost saving measures over penalizing physicians through the SOMB. I do agree the SOMB needs adjustment so that payment for work more fairly reflects the value and difficulty of the work. As long as it's done in a fair manner. However, the above suggestions are examples of ways the province can cut healthcare costs without arbitrary and/or unfair pay cuts to physicians.
I would also suggest the AMA speak directly to the premier's office and the minister of health with the suggestion that, if they want physicians to take a percentage pay cut from our income, the government MLAs should lead by example and take an identical percentage cut before mandating this to us.