Thoughts at the end of the year

September 23, 2016

Dear Member:

In closing my term as president, I have selected a couple of topics that have had particular relevance this year.

Professionalism and the social contract

Most dear to me are matters of professionalism, stewardship, integrated high value care and the social contract we have with the public: on our side of the contract, we provide compassion; availability; accountability; working for the public good; and altruistic service. On the other side, we receive trust, autonomy, self-regulation, status and rewards.

Varying the terms of the contract by either party will result in changes on the other side. We are seeing some consequences to changes in the fulfillment of the social contract across the country. Professionalism, stewardship and high value integrated care are on the national agenda, and we are participating in these discussions. Like other provincial medical associations, we too must decide what our vision is.

Productive relationships

A year ago, I talked about preparing for negotiations with government. Many members of the Alberta Medical Association (AMA) and staff have worked diligently with our government counterparts to get us to this point. Like you, I have had to work through many concerns; I am satisfied we have come to a place that is good for the patients of Alberta and for the profession. I hope that you will share this opinion when it’s time to cast your own vote on the tentative Amending Agreement.

Relationships are the key to advancing in any area. We share with government the goal of an effective system. This common goal has allowed us to develop the positive, respectful working relationship we currently have.

Aligning incentives with system needs and patient values

In physician compensation, there are two issues. Equity is one. We need clarification of what our guiding principles are for relative payments. What should make a difference in the payment rates for different kinds of medical work? It is our collective responsibility to ensure that all physicians receive a reasonable portion of the available dollars.

The second major issue in compensation is design. In my view, we should place value-for-patients first as a design principle, rather than expect it as a byproduct of behavior. Preserving intrinsic motivation will be more successful at producing value than modifying behavior by financial incentives.

Relationships with patients remain the touchstone of our profession. I have said before that every time we meet a patient, we have an opportunity to increase or diminish the standing of our profession. We must continue to show we care about them as we care for them. We plan system level changes, but it is the individual encounter with providers that the public sees as the system. Compassion is the prevailing principle behind our historical success. The information monopoly model of medical care must change to a patient-value-based model, incorporating, or re-incorporating, compassion.

Hopes for the future

I have a vision of a high-value, integrated system that is so obviously centered around the patient that we don’t even need to use that term anymore. We will be working with patients under the terms of the social contract to co-create care that they value, in ways that they find convenient and acceptable. Health care is something we used to do to patients. Now it is something we do for patients. The next step is to make health care something we do with patients. When this is done, we will have achieved integration around the patient. 

I have a vision of our profession as leaders in a system that supports our work, where precision self-regulation is a welcome and significant part of our professional lives, and where internal motivation and professionalism are driving principles.

We can do this. It will take work in health legislation, regulatory functions and in our association to get there. While policy development is needed, it alone will not create the culture we need. A principled vision of who we are will show us the way.

As you know from my President’s Letters, I’d like to conclude by asking something of you.

Be compassionate with your patients, with your colleagues, with those dear to you, and with our lovely planet. Remember why you became a doctor, and let the highest principles of our great profession permeate every aspect of your lives. 

Insofar as we can do that, we will be happy in our work, and we will show to ourselves and to our patients that it means something very, very special to be a doctor. 

With thanks and appreciation

I am grateful for the many relationships inside and outside our profession that have sustained and taught me. While there are different perspectives on health care, there are no enemies. Compassion dictates that I wish for others the same things I wish for myself. Adversarial positions express neither strength nor hope, and accomplish little of lasting value. Like produces like; trust and mutual respect produce more of their own kind. 

In that context, I appreciate the relationship that has developed between the AMA and the Minister of Health and her team. While the perspectives of government and the medical profession differ on some matters, we have much in common in terms of goals for the health care system.

I have learned much from other medical leaders across the country, and from so many of you, my colleagues in our great profession. I also continue to learn from my patients, and I am grateful for the trust they give me in allowing me to care for them.

I cannot adequately describe how valuable the support and direction from the Board members – and from many members – has been. I am also very appreciative for the support of my surgical colleagues and medical community in Medicine Hat, and my long-suffering medical office assistant. Finally, I gratefully acknowledge my dear wife for continuing to believe I am useful, despite occasional evidence to the contrary.

My goal during this year was to live and serve with integrity and compassion so as to add value to the office of the president of the Alberta Medical Association. You may judge whether I have been successful or not.

Kind regards,

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