Support for OMA

April 29, 2016

Dr. Carl W. Nohr, AMA President

Dear Member:

Discussions continue between the Alberta Medical Association (AMA) and the Alberta government, seeking to find ways in which the parties can reduce the rate of growth for health care expenditures while maintaining access and quality of care.

As I wrote in a President’s Letter following the provincial budget, government has made a commitment that there will not be cuts to services. At the same time, the budget’s amount for physician services appears low when considering the impact of service levels, population growth and aging.

My impression is that Alberta Health’s (AH) strong preference is for cooperation and collaboration between the parties – an approach that the Board of Directors supports. We all recognize the financial difficulties facing the province and want to find real solutions to promote financial sustainability, and better care for patients. I will keep the profession up to date on progress as we move forward.

Many provinces are facing similar challenges. As you are likely aware, the Ontario Medical Association (OMA) is embroiled in a long dispute with their provincial government, where fee cuts have been imposed upon physicians as a budget control measure and the government has been unwilling to grant the profession binding arbitration to resolve the dispute. The OMA has launched a constitutional challenge on the concept that without fair dispute resolution processes, physicians lose the right to the effective and meaningful bargaining mechanisms that are part of the right to freedom of association.

At the spring 2016 meeting of the AMA Representative Forum, the following motion was passed unanimously:

“That the AMA consider both fiscal and human resource contributions to the Ontario Medical Association in support of the current court challenge protecting physician rights.”

We have talked with and written to the OMA asking what the AMA can do to assist them.

Late last week, the Ontario government released anonymized data about the highest-billing physicians in Ontario. The Ontario minister of health has argued that the figures illustrate inequities in the fee schedule that justify the cuts he has imposed.

No one disputes that fee schedules across Canada require re-alignment with the way that modern health care is delivered. In Alberta, the ongoing 2011-18 AMA Agreement acknowledges that both sides have to be open to finding ways of managing physician payments. We have created a mechanism for that, the Physician Compensation Committee (PCC), which essentially serves as a rate-setting body where AH and AMA each have one vote and an independent third party (the chair), casts the deciding vote as necessary.

The PCC has just completed its first significant challenge. A process that is summarized in the April 19 PCC Update was used to select a list of 22 fees for review that eventually became a list of six. As a result of the review – which is a precursor to a larger schedule-wide fee equity review in the future – two fees remain unchanged and four will be reduced. The savings from these reductions must be retained within the Physician Services Budget and further work is required to determine how this will be done.

With this unprecedented process, Alberta has demonstrated that there are ways to work together to align the fee schedule and payment mechanisms with modern practice. I sincerely thank the involved sections for their efforts to work with the PCC by providing information and insight to assist the committee, and for their ongoing willingness to continue to work with the PCC. This process showed the importance of appropriately engaging the physicians most involved as PCC works to further modernize the fee schedule.

Let me know what you think. Please email or leave a comment below.

Kind regards,

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


Post a comment

  • #1

    Noel Corser


    8:09 AM on April 30, 2016

    Dear Carl & AMA board,

    I'm sure you're already well aware of what I'm going to say, but perhaps it's still useful to hear it from the rank-and-file. I think it's fair to say that the amount of money being spent on healthcare by every province in Canada is unsustainable, given the trend to perpetual increases over the years, ageing population with more chronic health problems, and more highly-expensive treatments/procedures coming down the pipe all the time. I believe Alberta spent about 20% of its total budget on healthcare in 1980; last year it's at 40%, and increasing. Our current system mostly pays doctors and hospitals, which is out-dated given the need for more preventative care (doctors and hospitals are good for treatment, but not for prevention) and, in health-care, a dollar of prevention probably is worth many dollars of cure. So I'm guessing that no-one argues we need readjust healthcare spending, in a downward direction.

    The AMA (and the OMA) clearly want doctors to be involved in deciding where and how to cut costs. This makes sense, as doctors do have a good sense of what patients' need. However, doctors are NOT good at moving away from the perspective of the individual patient in front of them, to the good of the system as a whole. We shout very loudly when the government tries to enforce cuts to the system, yet after what appears to have been a huge amount of work, the Physician Compensation Committee has managed to reduce 4 billing codes, with the insistence that those funds go back to physicians somewhere else! Four codes!! I wonder what fraction of the total number of billing codes that works out to? And I've yet to see any meaningful suggestions from the AMA to move away from the current physician/hospital model to something that might actually succeed in creating a healthier population and reducing overall healthcare costs. I'm naturally optimistic, but looking at the results of this "pilot study", I think we can conclude that if it's the best we can do with the "low-hanging fruit", there's really no point in using this process to make effect meaningful systemic change.

    My opinion is that if doctors (as represented by our "unions") are unable to make a significant dent in the amount we drain from the public purse, the government SHOULD step in to save us from ourselves. I have kids, and they're going to live with the debt that results from our choices today (we're talking a deficit of $10 billion, yearly!, in Alberta right now), as well as a health-care system that finally does fall apart because it's unsustainable. If we don't stop dragging our feet, as a group, about dealing with physician costs, we'll soon lose our chance. I'm sorry, but 4 fee codes adjusted simply doesn't cut it, and we shouldn't be patting ourselves on the back.


    Dr. Noel Corser

  • #2

    arthur dawrant


    12:21 PM on May 01, 2016

    I have reviewed your comments relating to ways in which parties can reduce the rate of growth of health care expenditures while maintaining access to good health care. It is baffling that you fail to mention or recommend the one obvious means of reducing the rate of growth of health care expenditures while, at the same time, maintaining access. What, I hear you asking, could this be? It is for the user -- the patient -- to be involved in the enterprise whenever he or she seeks medical or hospital care. After all in just about all aspects of daily life such as the preparing of food, arranging housing accommodation for self or family. learning work skills, etc, society does expect the ordinary citizen to look after these matters. And most people do so quite successfully! So why are Canadians denied choice in this one area of their lives? I look forward to hearing your views on my observations. Best wishes -- A. G. Dawrant

  • #3

    John saber


    7:41 PM on May 03, 2016

    In response to arthur dawrant [comment #2]

    Arthur, it is not clear from your message whether you are talking about user fees for patients to access the system, patient selection flood their doctors, or something else. Given all the patients going to ER for non emergency issues, user fees would seemingly cut costs. The concern though is that patients would come at late stages of disease and cost more to manage. I do suspect that there could be a way to systematically target some issues individually ro avoid this issue.

    If you are talking about patients being about to choose among doctors and that competition driving price down that would not work. Waiting lists are ever growing - nobody would have to worry. Not to mention that patient assessments are not reflective of actual outcomes so this would not a useful way to distinguish. Being in Ontario, I am very happy to read what Dr Nohr has written and I only wish the same were happening here.

  • #4

    Diana Walker

    Member of the public

    8:29 PM on May 03, 2016

    I live in Ontario and I really like your letter. I am sharing this on my FB Page and asking people to share. I have signed our doctors' petition and have called our Premier, our Health Minister, and my MPP. We have a terrible problem here. In the last few years I have lost 2 family physicians who left Ontario. I'm hoping that our provincial govt will open it's eyes and see that they have to negotiate with our doctors.

    Thank you.

    Diana Walker

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