Update on negotiations; the care deficit hangs on

July 15, 2022

Dr. Vesta Michelle Warren, AMA President

Dear Members,

Update on negotiations

Since I last wrote to you about negotiations at the end of May, there have been continuous efforts underway. This included regular formal meetings of the negotiating teams and informal follow-up discussions to exchange additional information or to provide clarification between meetings. The minister and I have spoken frequently. I believe there is still a strong desire on both sides to reach a deal. There has been some progress, but difficulties remain.

I think we have seen improved understanding on both sides. Both parties recognize the importance of developing a strong working relationship and are making efforts to rebuild trust and collaboration. In these interest-based negotiations, the AMA has consistently upheld the physician interests that were identified through extensive member engagement.

If we succeed in reaching an agreement, there are short- and long-term objectives that can be pursued. We must ensure stable physician practices in all specialties and attract and retain physicians and learners. The foundation of an agreement, however, also creates opportunity to advance toward goals such as a Patient’s Medical Home for every Albertan, through which the patient can move seamlessly from primary to acute or specialist care and back again. In anything we will do, we are mindful that the COVID care deficit needs to be addressed.

The most challenging issues remain the economic factors (including the impact of climbing inflation on physician practices, the province’s economic situation, etc.). The AMA continues to believe there is need for a comprehensive physician compensation strategy that avoids the current siloed approach (e.g., AHS payments) and includes the principles of income equity. (Dispute resolution during or after an agreement is critical. On the topic of dispute resolution, you may already have seen the July/August issue of Alberta Doctors’ Digest. This Health Law Update column by AMA’s legal counsel addresses the topic of binding arbitration and is well worth reading.)

While we focus on what we want to achieve in negotiations, we see what is going on in the system. I thank members who have taken time to let me know what is happening in their practices. Some communities are increasingly struggling with the loss of physicians in primary and specialty care. There are concerns about erosion of continuity of care. For example, some members have pointed to stand-alone virtual care providers or new arrangements such as the pilot project pharmacy clinic recently announced in Lethbridge. These members are acutely aware that many Albertans cannot find a family physician and that more support for primary care in the community is needed. In new strategies like this, it is not innovation, technology or working with allied health professionals that concerns members, but rather the lack of integration. We know that integrated primary care is the best way to reduce emergency department visits, readmissions and costs to the system overall. I will have more to say on these topics in upcoming letters, but the worries are more about proliferation of episodic care outside of a team relationship and preventing care gaps, duplication of services or loss of information. These are things that must be monitored, and the relationships and structure created by an agreement would offer venues for discussion to occur.

All this is to say that the Board is very aware of the passage of time, the pressures on physicians and their concerns about the immediate and long-term future. There are many cogs and wheels in an agreement that your negotiators have been discussing, from terms to programs and incentives. To become familiar with the key concepts, you may wish to visit or revisit a video on the AMA website that was posted in April (member login required). The video is time and subject indexed. For today’s review please fast-forward to 31:40, "Member issues and interests that the AMA has brought forward." Please note we are also considering some additional communication, such as a webinar, to bring members more information as more discussions are held into the summer. I will let you know what will be available.

Care deficit holds on

In reviewing the results of our June member survey, I was eager to learn if the intensity of the care deficit’s impact on patient care and their health and wellness has changed. When measured against our August 2021 baseline survey, it’s apparent that the care deficit is maintaining its grip.

In 2021, we asked how apparent the care deficit was to physicians. The 2021 results showed a significant prevalence (60.7%). That prevalence has continued and even increased in some areas: physicians say the care deficit is now apparent in nearly two thirds (64%) of their patients. Unchanged from 2021, only about one lucky patient in 10 (10.8%) is not showing effects.

This experience occurs fairly consistently across specialty groups, with surgical specialists scoring the highest rate of occurrence: more than a quarter of surgical respondents say that they “almost always” observe the care deficit in their patients. When “often” is added to results, all groups report the care deficit is present in the majority of cases ranging as high as 68% for family medicine specialists.

All this confirms that patients need care, many are sicker than they would have been without pandemic disruption and there is increased incidence of more advanced disease and illness. It will take time, effort, resources and collaboration to find a way forward. With the help of the Joint Physician Advocacy Committee, we will continue to shine a light on issues and potential solutions. We are also hearing directly from patients on this through:

  • New data on the care deficit in the emergency department derived from our research community albertapatients.ca.
  • Initial reporting about Albertans waiting for care through our PatientsFirst.ca platform. Please refer any patients who are waiting for diagnosis, treatment, surgery – or care of any kind – to the website so that they can tell us their story. We will be mailing materials to help you do this later this summer. 

I will be reporting on this data in the weeks ahead. In the meantime, you can reach me any time. I appreciate the members who continue to reach out even when time to do so is so limited. You can contact me in the following ways:

  • Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org.
  • Comment publicly 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).

Sincerely,

Vesta Michelle Warren, MD, CCFP, FCFP
President, Alberta Medical Association

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