No consultation with AMA on Bill 30 development

July 8, 2020

Dear Members:

I have received a number of emails regarding Bill 30 and my President’s Letter from yesterday. Thank you for that feedback.

Bill 30, the Health Statutes Amendment Act, as many of you aware, is an omnibus bill covering several matters: increased public representation on health profession regulatory bodies; revised reporting and mandate for the Health Quality Council of Alberta; an amendment to the process for chartered surgical facilities; change processes around Alternative Relationship Plans; and the ability for the Minister to contract with a range of organizations to handle the administrative work of operating medical clinics.

It is unacceptable that the Alberta Medical Association was not consulted on the development of these significant reforms to our health care system. These impending legislative changes will have consequences for the profession and how we practice, as well as our freedom to advocate for our patient’s needs. The patient-physician relationship is at risk.

In addition to Bill 30, the Minister announced a review of the medical staff bylaws, connecting this to an incident that occurred four years ago in a Grande Prairie hospital. As yet, we have no information on the extent or scope of the review. Bylaws are important as they define the relationship and expectations of physicians in the Alberta Health Services system. Bylaws need to reflect the balance of the responsibility for medical practices in the AHS system with the need for physician advocacy with respect to access and quality for patients. There must be accountability between the parties in this relationship.

These events are deeply concerning and especially in light of Bill 21 and the cancellation of the AMA Agreement. (See the October 30, 2019 President’s Letter regarding Bill 21.)

Our preliminary review of Bill 30 indicates, ironically, that the “range of organizations to handle administrative work” that are outlined in the Bill are excluded from the easy-out clause government provided itself last fall (Bill 21). So while physicians must suffer with lack of stability, these new companies will be guaranteed contractual certainty.

The initial feedback I have received about yesterday’s President’s Letter indicates that I was not strong enough in objection to Bill 30. I take this as your support and direction to me. The issues being raised by members include:

• The process for appointment to regulatory bodies. How will members to these bodies be appointed? What are the steps that will ensure that these members are truly reflective of all Albertans? What skill sets will they bring to the organization?
• The commercialization of medical services. What are the implications for our public system? How do we ensure that the ownership of the practice of medicine stays with physicians and that their primary relationship with patients is maintained? How do we prevent the erosion of advocacy within these American-style, for-profit corporations? What is the impact on publicly funded health care in Alberta?
• The sense that the provisions around contracting and alternative payment plans are an attempt to diminish the role of physicians in general, and the AMA in particular.

The Board shares all of the concerns expressed above. The lack of any meaningful consultation with the public and physicians on legislation that will have a significant impact on health care in Alberta, raises questions about good governance.

With government’s majority in the Legislature, Bill 30 will likely pass quickly. We will therefore focus our efforts on identifying the potential impact of these new measures on the system, both short-term and long-term.

In some cases the concern is not so much with what Bill 30 is, but how it could be used. The movement of ARPs from Ministerial Orders to contracts is a good idea in and of itself. What is contained in the contracts is important, though. We have to ask; will the process for establishing and maintaining these contracts ultimately result in better value for patients and fairness to physicians?

There are many uncertainties right now. Our reaction to Bill 30 is reflective of a number of things going on in our system. Over the past while, all of the following elements have come into question: physician contracts (elimination of the AMA Agreement); access to practitioner IDs, and hence access to practice; lack of adequate support for community practices during a global pandemic; aspects of self-regulation and the right of individual physicians to take effective steps to express concerns; and AHS privileging. These are the basic underpinnings of the relationship of physicians to the system and, combined with a lack of consultation and collaboration, we must ask: What are the true intentions of government? What road are we on? Where are they taking the system?

We are preparing a more detailed response to Bill 30 and that will be shared with all of you.

A detailed member survey will be forthcoming to allow you to provide us with feedback on possible action strategies.

In your service,

Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association