AHS Negotiations Framework

October 2, 2015

Dr. Carl W. Nohr, AMA President

Dear Member:

In this, my first President’s Letter of the year, I am writing to you about the important issue of recent discussions with Alberta Health Services (AHS) about a negotiations framework. This subject was raised with you multiple times by my predecessor, Dr. Richard G.R. Johnston during his term. I am beginning with it today because of media reports that you may have seen regarding a lawsuit against AHS, initiated by a number of clinical assistants. There is a strong linkage between the need for a framework and the concerns of the clinical assistants and I would like to provide an Alberta Medical Association (AMA) perspective.

AHS payment for clinical services

There are two major payers for clinical services provided by physicians: Alberta Health (AH) and AHS.

In the case of AH, there is an agreement and structure to how the payment rates, terms and conditions are established and managed. Significantly, the AMA Agreement provides for recognition of the AMA, a negotiations process and binding arbitration. The Physician Compensation Committee, which manages rates of payment within the Schedule of Medical Benefits, is a significant part of that agreement.

When AHS is the payer, however, there is no such overall agreement or structure. There are at times variations in the types of arrangements and in the rates of payment for similar services. Negotiation processes are also ad hoc: sometimes the AMA is involved, sometimes not; sometimes AHS agrees to discuss issues with physician groups, sometimes not.

This can be challenging, particularly in cases where AHS is looking to bring about significant change. The kinds of challenges that can arise include:

  • Ineffective and inefficient negotiations, i.e., overly long with no conclusion.
  • Risk of being out of sync with recent court decisions, which stress freedom of association and good-faith bargaining.
  • Possible damage to relationships and taking the focus away from where it should be: patient care.

The AMA has proposed several solutions to resolve these problems, all of which have the following characteristics:

  • The freedom of association and right to representation.
  • Clearly defined and transparent negotiating processes.
  • Dispute resolution, including access to binding arbitration on the call of either party.

A step in the right direction: An AMA-AHS Negotiations Framework

As mentioned in previous President’s Letters (August 21 and September 21), there has been some progress in that AMA and AHS have agreed to develop a negotiations framework with the three characteristics outlined above. It is not completed, but significant work has been done and there are many points of agreement.

The framework under discussion is not perfect. It is a trial, for example, with an initial term to 2018 and its continuance will be subject to discussion. Also, it would only directly cover independent contractors, not employees.

Serious joint work on a framework began in May, so it has taken some time to get to where we are. AHS extended contracts to December 31, in part to allow discussions to occur.

Clinical assistants

Clinical assistants are physicians with a limited license who provide many critical services within AHS. They are an important part of the health care team. They have had a section within the AMA since September 2013.

Discussions between AHS and clinical assistants, supported by the AMA, have been ongoing for a long time. They have been characterized by many of the challenges I cited near the start of this letter. Their situation was a major driver for the AMA’s push for a negotiations framework with AHS.

The frustrations within the group have continued to grow, including about the lengthy discussions and the time it has taken to work on a negotiations framework. We can all empathize with their frustration about the lengthy process and the concern they have about their continued status and livelihoods. Earlier this month a legal action was filed by many of the clinical assistants who are independent contractors.

This week, all independent contractors received notice that their current contracts would not be renewed. At the same time, AHS announced that it was creating several new employment opportunities for clinical assistants: those who are currently independent contractors can apply for these positions.

AMA response

First, we need to get on with an AMA-AHS negotiations framework. It needs to have all the characteristics I have described. The AMA’s goal will be for all physicians to have access to fair and open processes.

Second, I am not sure that the recent steps taken by AHS are appropriate while we are still in the midst of discussing a bargaining framework which will include negotiations involving clinical assistants. This will be looked into over the next few days.

Finally, I want to emphasize the need to focus on patients. There will always be debate over who is worth what – there is no avoiding this. We can, however, set things up in such a way that we deal with these matters respectfully and with some way to bring about a conclusion, such as arbitration. This allows for important relationships to be maintained and can thereby help AHS and physicians focus on patients and their needs.

The AMA remains committed to working with the parties toward a solution and I will keep you informed. I look forward to receiving and learning from your comments and insights on this (or any issue) throughout my term. Please email president@albertadoctors.org or comment below.

It will be an honor and a privilege to work with you in the year ahead.

Kind regards,

Carl W. Nohr, MDCM, PhD, FRCSC, FACS
President

1 comment

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  • #1

    Jim

    Physician

    1:22 PM on October 05, 2015

    I totally agree with that,taking the case to the court will take physician attention away from patient safety and good care

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