Update on first months with a new government

August 19, 2019

Dear Members: 

The Alberta Medical Association advances patient-centered, quality care by advocating for and supporting physician leadership and wellness. Most of the time, this requires collaboration with others in the system. Relationships matter – and the one between the profession and the Government of Alberta is one of the most important. As I look back over the past few months with our new government in place, I wanted to share a few thoughts with you.

My first observation is that the new government has been very active, including in health care where they have launched reviews of Alberta Health Services, laboratory services and Connect Care. I have spoken with the Minister several times already and I have offered the profession’s expertise in working through these matters. He faces numerous complex decisions in the months ahead. In all the choices to be made, physicians can provide essential insight regarding the medical needs of Albertans.

I should also note that a busy session of the Legislative Assembly was completed. Members may have heard about Bill 9, the Public Sector Wage Arbitration Deferral Act. This statute gave government the ability to delay a number of scheduled union arbitrations until October when a Blue Ribbon panel will have tabled its report on the state of the province’s finances. (The Court of Queen’s Bench, however, subsequently granted an injunction to stay the operation of the bill. Government is now appealing that ruling. We will see what develops.) For physicians, though, it’s important to note that we are not within the scope of Bill 9 because we are not covered by collective bargaining. We have our own contract with government that lays out in broad terms the relationship between the parties. From that perspective, we can understand concerns about ensuring that terms of a contract are honored.

Much of what government has done and said in its first months has been about the poor state of the province’s finances. This is not a new concern. Over the last few years, the Board has been thinking and talking about how to move forward in the best way for members and patients in a fiscally tough environment. We have developed a strong belief that physicians and our partners need to tackle dual, linked objectives of affordability and value.

Tackling either objective alone is problematic. The history of public health care tells us that focusing exclusively on budget simply drives costs to new places – while often having unintended consequences for patients. At the same time, focusing only on quality at any cost ignores budget issues that are very real. Instead, the Board has been talking about a way to balance the two, maximizing value and benefits to Albertans.

There are opportunities ahead to make this happen. We should always be open to solutions that will deliver value while maintaining fairness for physicians. As a profession, we have the knowledge, expertise and leadership to find areas where lower value resources could be redirected toward higher value uses. We have already started down the road toward value in activities such as: peer review; appropriateness; income equity; managing physician supply; and using informatics to improve accountability and evidence-based decision-making.

We must continue to strengthen and improve the Patient’s Medical Home while working to better integrate it through innovation with other services in the Health Neighborhood. With the help of primary care networks and AMA change management services, Alberta is a Canadian leader in introducing the PMH (The Patient’s Medical Home Provincial Report Card). The home is the necessary cornerstone of the system, but its full potential will only be reached when we integrate with a larger Health Neighborhood – by which the Board means a community of service providers delivering interdependent services.

I think it is increasingly important to include patients in our thinking and planning. Recent research in the AMA’s albertapatients.ca online community shows that patients are concerned about their access to health care, especially whether the system will be there for them in their senior years. 55% of Albertans expect to be healthy enough as they age, but they are worried about financial stability in their senior years. We also know from what they have told us through albertapatients that they are keen to help with the task of improving the system. They certainly deserve to add their voices to discussions that will affect them.

For our part, the AMA can bring the voice of physicians. We have a strong track record of driving real change in the health care system through the leadership of members and the excellence of our change management support services. I am excited by the possibilities.

I first raised these ideas in March of this year at the spring Representative Forum. Since then, I’ve had opportunities to discuss them with other members at various meetings that I’ve been privileged to join. I will continue to do this throughout the remainder of my term.

I’ll be writing again soon to share some of the feedback I have received. In the meantime, I am always glad to hear from you if you care to share your reaction to this letter, or to discuss anything else that may be on your mind. You can reach me as follows:

We have been offering the AMA-built Discussion Board as an option for conversation about President’s Letters, but few have taken us up on it and no one at all recently. If you are so inclined, I’d encourage you to try it out. We are seeking to offer new ways for members to engage with the AMA and with colleagues. If you’ve tried the Discussion Board but didn’t care for the experience, I’d be glad to know what you thought.

Warm regards,

Alison M. Clarke, MD, CCFP, FCFP
President

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