Negotiations update and AMA's key requirements for an agreement

February 7, 2020

Dr. Christine Molnar, AMA President

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

5 comments

Commenting on this page is closed.

  • #1

    Dr Tzvetan Parvanov

    Physician

    1:15 PM on February 07, 2020

    I as a doctor work fee for service. The amount of money I bill depends on the patient's problem, number of visits, procedures done. In other words the so called cost is attached to the behavior of the patients and their demand of service. One way of the Government to reduce costs is to involve the patients in this process. To create polices to restrict patients from abusing the system, which can be very costly, which happens ,when patients visit unnecessarily their service providers, or use ER for late night visits for petty issues, which can wait and be dealt with during day hours in the clinics. The government can look into the administrative waste of money as well as a source of saving as well as trying to find ways to increase revenue for the health budget.
    Another way to save is to reduce the taxation of the medical staff, which will allow the doctors to keep their standard of living at lower revenue and in this way save billing costs.
    Creating billing(business) medical licenses as a cost saving strategy will create division among the doctors and conflict, because this will generate income differences for doing the same job, will create the environment of exploitation of one doctor from another and this will reflect at the service provided. Many young doctors will most probably move to areas of Canada, where they will be allowed to practice freely and this in the long run will have a negative impact to the Healthcare in Alberta.
    If the government is really serious about efficiency in the health system, it will need to do a comprehensive reform, which needs to deal with issues as ownership of the system, patients' involvement and responsibility and the role of Government at all in this service.

  • #2

    James Currie

    Physician

    4:43 PM on February 07, 2020

    Firstly, I commend the AMA for its approach to a problem entirely created by the UCP government.
    I believe that cooperation with this government is inappropriate as the AMA already has an Amending Agreement. It is unethical of Kenney to break the agreement, simply because he has the power to do so.
    Let's dismiss the McKinnon report out of hand. It was a 'reverse' document in that they had a conclusion which required justification, and which made it irrelevant.
    Down to the nitty gritty. The government's proposals will have zero direct effect on me, a part time physician, at the end of his career, on an ARP. However the proposals will have a disastrous effect on Family Doctors, and their ability to provide care for their patients, most especially in relation to the length of the consultations.
    We as physicians are constantly constrained by the evidence. Kenney has reduced corporate taxes against ALL the economic evidence and now needs to cut expenditure to balance the books. We must not knuckle down.

  • #3

    Vincent Hanlon

    Physician

    10:34 PM on February 07, 2020

    Thank you Christine for your perceptive, thoughtful notes to our membership in the 2020 iteration of a government more interested in adversarial cost cutting than in patient care.

    Vincent Hanlon MD

  • #4

    Ian Laing

    Physician

    6:20 PM on February 12, 2020

    Told u so. Those who not know history are bound to repeat it.
    Your only weapon is to withdraw services except 1 E.R in major cities treating only emergencies
    and a line for prescription refills. And u do NOT go back to work until Shandro resigns.
    But , as usual , no one has any cahonnes .
    And watch the exodus ,refusal of call etc
    You have already folded. Too bad.

  • #5

    Dr. Brian Sceviour

    Physician

    11:30 PM on February 12, 2020

    Thank you Dr. Molnar for your insights and efforts.

    As a young family physician in the first 5 years of my practice, I find it is difficult to fully express the anxiety and grave concern I feel regarding the Government's actions. I moved to Alberta to complete my training and decided to stay because Alberta was the best place to practice high-quality primary care. Family doctors are (equitably or not) compensated for the time we spend managing our patients carefully and keeping them away from costly hospital services. The value of our time, training and effort is recognized. Our colleagues and health systems are making an effort to engage more deeply with the primary care setting and our patients' Medical Homes. This is the way Family Medicine is meant to be done, and every day I have at least one patient thank me for taking the time to care for them holistically.

    No amount of spin can hide the incredibly damaging effect the Consultation Proposals would have on this image of comprehensive primary care. Government is telling us that quality primary care is not worth any money. They are telling us that thousands of crucially important small businesses (i.e. family medicine clinics) - which employ tens of thousands of support staff across this province - should either dramatically reduce the quality of care we provide, or swallow an overnight revenue loss approaching 40%.

    This is, quite simply, unacceptable. It exploits the good will of caring nature of physicians, whom Government knows will be reluctant to turn patients away even at cost to ourselves. It exploits the most unwell and vulnerable members of our communities, who are too preoccupied with their health issues or desperately tight income to engage in any political activism of their own. We absolutely cannot, as a profession, accept any agreement which approaches what has been proposed. To do so would be to abandon our obligations as professionals and community leaders.

    Government MUST be made to understand that if they continue to pursue this agenda, I (and many doctors like me) will be forced to close our doors and leave the province for greener pastures. Alberta will experience an exodus of its best primary care physicians - those who are motivated to provide quality care for their patients and take the time to do so. Those who remain will be forced to practice so-called "8-minute-medicine" in order to keep the lights on in their clinics, and Albertans will be left with no options for care except the high-volume, pill-pushing walk-in clinics with which we are all familiar. Incidentally, those clinics will continue to cost the Government just as much as they did before the cuts.

    Sincerely and regretfully,
    Brian Sceviour, MD CCFP.

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