New Legislation – AMA Agreement and Physician Supply

October 30, 2019

Dr. Christine Molnar, AMA President

Dear Members:

Government has tabled legislation: Bill 21 Ensuring Fiscal Sustainability Act. This omnibus bill amends a number of statutes. Having received it late Monday afternoon, we have been exploring its implications. There are important provisions relating to the Alberta Health Care Insurance Act.

AMA Agreement: What's happened 

Bill 21 gives Cabinet the ability to terminate any agreement for physician compensation “between the Crown in right of Alberta and the Alberta Medical Association, or any other person.” This is not only for the existing AMA Agreement, the bill also clearly identifies that government is not required to live up to terms of future contracts. Government is cynically asking us to work toward agreements when it appears we are the only party to be bound by them.

We have urgently requested a meeting with the Minister to discuss our concerns and I will keep you informed about what happens next. We are also considering all options and getting legal assessments of the proposals to ensure value for patients and the sanctity of contracts for physicians.

Why it matters

This bill effectively gives government the power of pre-approval to cancel any physician services agreement, without recourse. This is a violation of the sanctity of contracts. The bill also moves decision-making to Cabinet, behind closed doors, apparently in the name of the public good. What is the value of an agreement when it can be revoked at any time with no public discussion?

We agree with the current government that there are many opportunities to improve our system. We understand the need for fiscal sustainability. In recent years the AMA helped government reduce planned expenditures by $500 million. We have repeatedly offered to assist the government in achieving its own health platform goals and indicated that our upcoming negotiations are a great opportunity to do so.

The AMA will continue to advance and promote access and quality in the health care system. We remain prepared to sit down at the table for appropriate and respectful discussion with due process and dispute resolution support. This is what Albertans expect and deserve.

Together physicians stand, strong and unwavering. We honor our contracts. We work diligently and with compassion to serve Albertans. Herein lies our power.

Physician Supply: What's happened

Bill 21 enables the Minister of Health to restrict billing numbers as of April 2022. All physicians with PRAC IDs on that date will be grandfathered; all others will have to apply. Regulations will be developed for the bureaucracy to support the new process.

Why it matters

By moving to billing number restrictions, government is applying a model that is 30 years out of date. There’s a reason Nova Scotia and New Brunswick recently gave up on this strategy: it doesn’t work. As the New Brunswick Minister of Health said, “The physician billing number system no longer works for the province. It is flawed because it restricts the number of physicians practising, restricts the mobility of physicians and impedes recruitment.”

We need to consider the message that PRAC ID restrictions send to learners and early-career physicians. I would like all of us to think about the environment that will be created. Will our future physicians, our young colleagues, want to practice in Alberta?

Alberta needs to be forward-thinking toward changes like virtual care and delivery models that cross provincial boundaries. We need a collaborative approach to needs-based physician supply planning if we are to succeed in ensuring physicians are where Albertans need them to be.

We cannot forget, too, that Albertans need to be engaged about changes that will affect their communities and families. We will be calling for their involvement.

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 Nuclear Medicine
FRCPC Diagnostic Radiology
President, Alberta Medical Association

7 comments

Commenting on this page is closed.

  • #1

    Alan Chu

    Physician

    3:33 PM on October 30, 2019

    Let me know where to show up for public demonstrations!

  • #2

    Dr Greg Schmaltz

    Physician

    4:17 PM on October 30, 2019

    This just adds to the reasons I am happy I left Alberta and Canada twenty years ago! Young doctors need to get out to find a better place to practice before they end up miserable civil servants on underpaid salaries.

  • #3

    Dr.Viliam Makis MD, FRCPC

    Physician

    3:33 AM on October 31, 2019

    Alberta Medical Association has no leg to stand on, given it's own NDP-era corruption scandals.
    Christine Molnar knows this well.

    Firstly, AMA Officials [redacted] and [redacted] were caught covering up (at CPSA) staff abuses committed by [redacted] Appointed AHS Executives [redacted] and [redacted]. This is the subject of lawsuit [redacted] currently at Alberta's Highest Court.

    Secondly, AMA just gave an award to CPSA [redacted], who is under Criminal Investigation for sabotaging the careers of a number of Alberta physicians including Radiologist [redacted] and Nuclear Medicine Physician [redacted].

    AMA President Dr. Christine Molnar needs to get AMA scandals under control and needs to co-operate with UCP's Bill 21, especially since it will be the vehicle by which hundreds of Alberta NDP appointed AHS Executives like AHS [redacted] and his entire AHS network will be eliminated from AHS.

  • #4

    James Dickinson

    Physician

    4:03 AM on October 31, 2019

    This is indeed a foolish policy. Forcing doctors to go where they do not wish to go or to stay only ever worked short-term - in UK, in Australia, and other provinces in Canada. Even the rural people are not happy if they have disgruntled doctors who do not want to be there, without the right training for the community needs, nor the proper backup. The work of many rural doctors is more stressful than that of many of the highly rewarded city specialists, specially without the backup that colleagues provide in the city hospitals. But the province rewards rural doctors with poorer conditions than city specialists get. What they should support is: more appropriate training for future rural doctors to obtain the extra skills they need, then the right remuneration structure to encourage them to go and stay, and maintain their skills, with enough others that the on-call rosters are sustainable.

  • #5

    Cam Westhead

    Other health care professional

    6:27 AM on October 31, 2019

    In response to Alan Chu [comment #1]

    There is a demonstration at South Health Campus on Tuesday, Nov. 5 from 11:30 to 13:00 along Seton Blvd, and another demonstration at Calgary City Hall Wednesday, Nov. 6 starting at 12:00.

  • #6

    Dr. J. Malmberg

    Physician

    11:05 AM on October 31, 2019

    In response to Dr.Viliam Makis MD, FRCPC [comment #3]

    This post is off topic. The issues are restriction of freedom to practice and the willingness of this authoritarian government to renege on agreements without discussion.

  • #7

    Kapil Sareen-Khanna

    Physician

    4:38 PM on October 31, 2019

    In response to James Dickinson [comment #4]

    I agree with you Dr. Dickinson. Rural doctors are a class of their own, and the answer is training more rural doctors, perhaps as a specialty, not forcing non-rurally trained physicians into work where they are not trained or do not want to do. This may lead to poor care, burnout and ultimately leaving said practice.

    Also, Quebec has been doing this with the PREM system, which has not worked, and the overall result is an exodus of Family Medicine trained physicians who move to brighter pastures.

    I hope the proposed Bill 21 changes face legal challenges and get dropped, for both the benefit of Albertan patient's and their healthcare providers.

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