An Update on Income Equity Initiative and Overhead Study

April 25, 2019

Dr. Alison Clarke, AMA President

Dear Members:

In the March 25 President’s Letter, I wrote to you about the overhead (office expenses) study under the Income Equity Initiative. Concerns have been raised by the Representative Forum and sections about the results provided by Deloitte. In response, the Board has formed a small working group with delegates from the Specialty Care Alliance and sections of General Practice and Rural Medicine. The working group will review what has been provided and then recommend (i) what, if any, elements of the study are usable and (ii) next steps for ensuring usable overhead information for use in the IEI.

I want to thank all the sections and individual members for their continued participation and informed input into the overhead study. Many participated, as challenging as the survey was. The Board truly regrets that what resulted fell short of the mark. We can, though, learn from this experience to ensure we avoid similar challenges in future work such as the hours-of-work and years-of-training studies. While the Board can’t guarantee that there will be no further setbacks, we promise to respond to such challenges to the best of our ability toward the overall objectives of the Physician Compensation Strategy: equity for physicians; access for patients; quality of service; promotion of productivity. (If you are interested, I made these and other comments April 24 in an email to sections, which I’ve provided below.)

The timelines for IEI will be stretched by the overhead study results review. We will make every effort to move as expeditiously as possible, balancing the need for quality information that is broadly acceptable as we move forward with the initiative.

As I write this letter, the provincial election has just concluded, a federal election is on the horizon and the province faces ongoing significant fiscal challenges. Members may wonder what these things mean. In March the RF heard and discussed the Board’s thoughts about ways to pursue value and affordability in an integrated health system. We know that collaboration with government in the past has achieved many good things for the health care system. We see more promise ahead, building on the well-recognized leadership and accomplishments of Alberta physicians.

I will keep you updated on the Board’s work, the IEI and other important matters through President’s Letters. I also expect to be out talking directly with members this spring and summer in meetings of various kinds across the province. Please keep feedback coming. You can reach me directly or comment as follows:

  • Communicate with me privately and directly by email if you would like a reply:
  • Share your perspectives with colleagues on our member-only Discussion Board (member login required).
  • Comment publicly below on this President’s Letter.

Warm regards,

Alison M. Clarke, MD, CCFP, FCFP

From: Alison M. Clarke
Sent: April 24, 2019 7:17 PM
Subject: Income Equity Initiative and the Survey of Physician Office Expense

Dear Section Presidents and Fees Representatives:

Further to my e-mails on March 19th and April 1st, I am passing along the results of a discussion held at the April meeting of the Board of Directors regarding the Physician Compensation Strategy and more specifically, the Deloitte office expense (overhead) study.

The Overhead Working Group has been formed with representatives identified by the Specialist Care Alliance and the Sections of General Practice and Rural Medicine. This group will assess and review the preliminary results provided by Deloitte and has already scheduled meetings beginning this afternoon.

Please find a consensus statement below from the Board’s discussion. Please also note that in follow-up to the March 25th President’s Letter, I will be sending the Board’s statement via another President’s Letter in the next few days.

Thank you.

Warm regards,

Alison M. Clarke, MD, CCFP, FCFP

Board Consensus Statement:
Income Equity Initiative and the Survey of Physician Office Expense

The AMA Board remains committed to the principles and aims of the Income Equity Initiative (IEI). Fundamentally, the IEI aims to contribute to the fair distribution of physician payments with due regard to office expenses, hours of work, years of training and the need to ensure that Alberta remains competitive in the market for physician services.

Moving forward with the IEI requires the collection and analysis of data on the major components referenced above. With the cooperation of AMA sections, considerable effort has been put into this over the past two years as well as the designing of the overall IEI parameters and processes. This included carrying out an overhead survey, done in conjunction with Alberta Health through the AMA-AH Physician Compensation Committee. Preliminary results of that survey were just recently shared with sections.

The early review from sections has indicated concerns with the survey results which may limit the use of some, and possibly all, of the data collected. Working with the SCA and the primary care sections (SGP and ASRM), the AMA has established a Overhead Study Working Group that is tasked with recommending: 1) what, if any, elements of the Deloitte study are usable; 2) next steps for collecting usable overhead information for use in the IEI.

Alberta Health has been informed of the AMA’s concerns and the Working Groups assessment will be shared with them. The Working Group Report will also be shared with all AMA members.

In making this statement, the AMA Board recognizes the following:

  • Many hundreds of members participated in the survey, challenging as it was. These efforts are greatly appreciated and the Board regrets that the resulting product may fall well short of the mark. Every effort will be made to ensure that future efforts at information collection avoid the challenges of this past survey. This includes the hours of work and years of training studies which are underway and will continue.
  • The IEI timelines will be stretched by the overhead study review and what arises from it. While every effort will be made to do this in as expeditious a manner as possible, this needs to be balanced with the need to use information that is broadly acceptable to the community of physicians.
  • As noted above, efforts will continue to collect the other IEI data elements. These studies will also have their challenges. The Board cannot promise that there will not be future setbacks, but does promise to respond to these challenges to the best of its ability and to continue working towards the overall objectives of the AMA’s Physician Compensation Strategy: Equity for Physicians; Access for Patients; Quality of Service; Promote Productivity.
  • It will be important to remain open to all activities that support the Physician Compensation Strategy goals. Current activities that support Equity and other objectives include:
    • The development of more streamlined process for alternative relationship plans (ARPs) for those physicians who wish to take up this alternative
    • Support for academic physicians under the AMHSP
    • Support for payment discussions with AHS
    • The Peer Review process
    • Advocacy for new methods of service delivery, such as expanded e-care
    • Advocacy and development of a medical home for every Albertan within an integrated system of care
  • The Board believes that the best approach is to remain open to these and other possibilities, taking advantage of and putting our energy towards opportunities that arise.

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