Thoughts at the end of my presidential year

September 19, 2014

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Dear Member:

Last year, as I assumed the presidency, I wrote to you about ways in which the Alberta Medical Association (AMA) would work with government to improve the way health care is delivered in Alberta. I advised there would be a lot of change.

Well, we certainly got change. This year there have been three premiers, two health ministers and I’m not sure how many heads of Alberta Health Services (AHS). Unfortunately, this was not exactly the kind of change we were looking for.

Turmoil at the top resulted in paralysis in the ranks. Few of our desired changes came to pass as fully as we had hoped, not because we did not try, but because we could not get commitments from our partners in government.

Hopefully Premier Jim Prentice and Minister of Health Stephen Mandel will bring stability and constructive engagement. I have had some contact with the premier and I am optimistic that he will work with the AMA and all the other stakeholders to propel us forward through the multiple changes required to meet Albertans’s health care system needs in the second and third decades of this century.

I have said that the past year did not provide us with all the change we had hoped for, but that doesn’t mean that there was no progress at all. There have been advances on many fronts. The AMA has many good people, both in our professional and volunteer groups, working hard to advance the ideas that we believe we will need in 10, 15 or 20 years when the baby boomers move from being providers of health care to consumers of health care.

For example, the Physician Compensation Committee (PCC) has spent much of the past year working out the ground rules on how it will operate. It has made some rulings in areas where decisions absolutely had to be made, such as Allocation 2014. It is now beginning to look at 22 (fewer than 1%) of the codes in the Schedule of Medical Benefits (SOMB). Even that baby step has provided a predictable degree of anxiety among those who are affected.

The PCC will be working hard (and your representatives are an integral part of that effort) to fairly review and evaluate over 3,400 codes in the SOMB.

There will undoubtedly be some growing pains as we move along the path to a revised billing schedule that is appropriate for the evolving health care system we are working to deliver.

When the work is completed – and that will take several years – we should have a new SOMB that will fairly remunerate all physicians, regardless of where or how they work. This will undoubtedly mean that some groups see payment decreases while others see increases. Processes to make these decisions must be fair, transparent and based on good evidence and input from those most affected. While these changes will be painful for some, they must be completed so we can match physician work to the changing needs of a changing society.

Further changes will be needed for our system of primary care if we are to care for our aging population. That need is not unique to Alberta, indeed the Canadian Medical Association recently called for a national strategy to care for the seniors of the future, which includes (I hate to admit) myself.

Primary care networks (PCNs) and PCN Evolution are a start on this and will continue to evolve so that primary care moves forward to a team-based care model designed to deal with chronic diseases. This will require that we bring secondary and tertiary care into coordinated work with what has been thought of as primary care.

Alberta Health (AH) finally released is primary care strategy in May, after many years in development. This looks as if it will blend well with the AMA’s efforts in primary care evolution. The AMA vision draws heavily on the medical home model which has been endorsed by the national bodies for both family physicians and nurses.

There are dedicated physicians working on all of these – and many more – areas. The AMA is supporting them with expertise, technical skills and financial resources and we will continue to do so. When we combine our vision and ability with our willing partners in AH, AHS, nursing, pharmacy and many others, I am sure we can create the health care system that the next few decades will require.

In closing, I want express my gratitude to AMA members for your support this year. Your email messages, phone calls and face-to-face meetings have provided me with expert advice and insight. It has been greatly appreciated, as is the work each and every one of you do on the front lines every day for patients.

It has been an unforgettable experience to serve as your president. Thank you.

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