Negotiations update and AMA's key requirements for an agreement

February 7, 2020

Dear Members:
 
As reported last week, Alberta Health and the AMA have brought in a mediator to assist with negotiations. There is still a long way to go, but I believe it is positive that both parties are doing what they can to reach an agreement.  
 
I want to take this opportunity to review where we now stand and to comment on the way forward.
 
In terms of the AMA’s objectives, these remain unchanged since they were approved by the Representative Forum last September at the Fall 2019 RF. These are built on the premise that fiscal sustainability is just one piece of the puzzle. Real system improvement requires consideration and a balance of both affordability and value. The goal must be to find greater value for patients, not just to lower costs.
 
A lot has occurred since these objectives were set. With this in mind, I’m providing my comments on what will be needed to reach an agreement and improve value in the system. I will be writing to you and communicating to the public on each of these in more detail, but what follows is a high level outline. 
 
First, better information is needed. The most obvious case in point are the erroneous and misleading physician payment figures government is using. We’ve released our own assessment of the MacKinnon Report (member login required) and have now taken the step of having our analysis reviewed by an outside agency. Other information that needs to be shared are the successes that have been achieved in primary care in Alberta and the far-reaching consequences of Alberta Health’s consultation proposals.
 
Second, while there are a lot of separate ideas out there, they need to be brought into focus with a clear vision. The AMA has long championed the concept of the Patient’s Medical Home within an integrated health care system. This is essential. Without it, the changes proposed within the Alberta Health Services Review will only lead to a crisis in care and increased suffering of patients. Any new agreement will need to meet both the AMA and government’s plans for the Patient's Medical Home.
 
Third, a provincial physician compensation strategy is essential and is actually one of the key strategies required for overall system improvement. The strategy has to focus jointly on improved value for patients as well as fairness to physicians. This has been a long-standing AMA objective, but recent challenges related to the consultation proposals, on-call payments and several aspects of the AHS review, point to the critical need for a more thoughtful approach. 
 
Finally, the issue of physician supply and the control of practitioner ID numbers need to be discussed. Due to the sheer amount of government activity, this issue has largely gone under the radar, but is a crucial element in ensuring quality and access for Albertans. Government itself points to the fact that Alberta is not over-supplied, but now we find ourselves alone in the country in terms of restricting physician entry while other provinces are seeking to attract and recruit. Other provinces are worried whether or not there will be enough physician supply to meet their future demands: Alberta should be paying attention to this too. 
 
I continue to believe an agreement is possible and desirable. Government’s health platform includes many things we support and we remain at the table in hopes of achieving a fair and reasonable way forward.

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