No decisions made on physician supply mechanisms
January 13, 2017
- A needs-based physician resource plan will be developed by a multi-stakeholder Physician Resource Planning Committee (PRPC).
- Any decisions about how to manage physician supply must consider the evolving plan.
- No decisions regarding billing number conditions have been made.
As noted in my last President’s Letter, the AMA Amending Agreement commits the parties to establishing a needs-based physician resource plan. Using best evidence, the plan will be developed by a multi-stakeholder Physician Resource Planning Committee (PRPC). I am pleased to announce that Dr. Ruth Collins-Nakai, past AMA and CMA President, will be our representative to this important committee. (Thank you to all the individuals who applied to serve on this committee. We are fortunate to have an abundance of talented physician leaders to help us with the work of the association.)
I have heard from a number of physicians about the future direction of this initiative. Specifically, there is a concern that restrictions to billing numbers are imminent. Before saying anything else in this letter, let me emphasize that no decisions have been made with respect to application of billing number conditions.
The plan must inform decisions and actions
The increase in the net new number of physicians entering Alberta is significant and unsustainable. The number of physicians in Alberta has been increasing at a rate of around 5% per year on average since 2010. The overall trend is an important consideration, particularly when coupled with Alberta’s difficult financial state.
It makes sense for the parties to consider management of entry, exit and physician distribution as a contributor to sustainability. However, for sustainability as we have defined it, the all-important aspects of patient access and quality of care must be addressed. Additionally, the AMA, AH and AHS believe that we must continually renew the profession by incorporating new graduates into Alberta as practicing physicians.
This is why any decisions about how to manage physician supply must consider the evolving needs-based plan to be developed by PRPC. The committee stakeholders, including future PRPC members, first met in October to receive information on physician resources in Alberta, including trends in physician supply, distribution of physicians in Alberta, and the costs of physician services. For purposes of gaining insight and feedback, AH and AHS also presented a draft proposed regulatory approach, giving AH the authority to issue new billing numbers only to new physicians who practice in positions identified in the needs-based plan.
Since that first meeting, AH has held several individual and small group meetings with stakeholders to further discuss the draft proposal. Any eventually proposed changes must be approved through the regulatory process, which includes consultation with stakeholders. AH is consulting and listening to feedback. This engagement will continue; AH has indicated they are very open to further input. This includes the PRPC, which involves community-based physicians, primary care networks, resident physicians, medical students and international medical graduates. The necessary representation and channels are built into the design of the PRPC. (See page 16 of the Amending Agreement.)
No decisions on future actions have been made
Again, no decisions regarding billing number conditions have been made. There are a number of existing tools that could be applied as needed. Government is naturally looking at all options as part of its own diligence. They are clear, however, that the PRPC owns the task of developing a needs-based plan, based on the best current evidence and involving all the appropriate groups. This evolving plan must be – and will be – considered as we move forward.
As I have said before: The timing is fortuitous. We are working to meet an identified need, but we are not under pressure of a crisis. Today, for the most part, the natural attrition of physicians in the province is being resupplied by the output of our medical schools. We have the time and the ability to do things right. We have the knowledge and expertise to develop a highly refined and effective needs-based physician resource plan.
Let’s also think about this: We have a significant opportunity with this new Amending Agreement, because we have a real voice and influence in all aspects from the fee schedule to clinical appropriateness to physician supply to informatics and beyond. That kind of influence, though, comes with a price: we must take on some risk, some responsibility, and willingness to lead by doing things differently. We need a plan, and that is what the agreement calls for.
There is a great deal of work ahead for the PRPC. All the necessary parties will be there, and our Agreement ensures this. We have an unprecedented commitment for everyone to be guided by the outcome of the committee’s work – based on best evidence and consultation with those most affected. This is a unique collaborative effort, and will set the stage for our future endeavours with government.
I will keep the profession informed as we move forward, including principles set forward by the Board which will guide our deliberations. As always, please let me know what you think. Email firstname.lastname@example.org.
I look forward to working with you in 2017.
Padraic E. Carr, BMedSc, MD, FRCPC, DABPN
P.S. Physician supply and related issues are topics of interest across the country. The CMA launches a new workforce study today. Click here to access it. I encourage you to participate to assist with data collection at the national level.