Updates on key areas

May 26, 2021

Dear Members:

This is to provide you with an update on several activities being undertaken by the Alberta Medical Association. These relate to our efforts regarding the compensation of physicians, the restoration of our relationship with government, the support of physicians during the pandemic and our engagement with members.

This letter provides more of a listing than a detailed description of all efforts. Over the next several weeks you will be hearing more on each of these items.

Representation on compensation issues

Alberta Health and Alberta Health Services are advancing several previously announced activities to adjust physician payments. Reaching a provincial agreement continues to be our goal and our lawsuit continues. It is still, however, very important that the AMA represents and supports physicians in these more immediate activities.

AHS compensation arrangements (stipends)

AH recently called 16 townhalls, that included 47 groups of physicians that are currently receiving AHS stipends, to present the terms and conditions for a transition to clinical Alternative Relationship Plans. Physician groups have significant and varied concerns and are accessing AMA support during this process.

In essence, physicians need to see:

• Fair and equitable treatment.
• Due process and thoughtful consideration of the issues that are important to them (e.g., ensuring sufficient full-time equivalents to recognize current service delivery).
• AMA support and representation where changes to physician compensation are being contemplated.

The AMA recently hosted an engagement session with impacted physicians across Alberta, and we have put together a stipend action committee to play a provincial role in ARP development and influence policy decisions that will be made by AHS with respect to overhead, physician on-call and stipends. The committee will also look to influence those decisions that will be made by AH on ARP rates, FTE allocation and contract template development.

Physician Compensation Advisory Committee

The Minister’s Physician Compensation Advisory Committee (PCAC) is active and will soon be bringing forward recommendations. The assessment of fees is to be based on inter-provincial comparisons with provinces of Ontario west.

We have been discussing with AH the role AMA and sections will have in this process. It is our view that the AMA and sections should be engaged in the process, be provided information in advance and have a chance to respond. Discussions are underway with AH regarding how this process could work.

Alternative Relationship Plan rates

Government has awarded a contract to a consultancy, Invictus, to review ARP rates and academic plans, including sources and accountability.

There have been preliminary meetings with Invictus to understand the scope of the project, and we will also be looking to have input into the inter-provincial review that is planned. Both the AMA Clinical ARP Working Group and the Academic Medicine Health Services Program Council will be supported in this process.

Bill 30 third-party payers

Alberta has legislated that physician fees may be paid through a commercial entity or other third party. Within these contracts, it is critical to address issues of: representation; maintaining the patient-physician relationship at the centre of medical care; and quality assurance. We are seeking assurances that these aspects will be addressed in new Bill 30 payment models going forward.

Other payment arrangements

There are numerous other payment arrangements throughout the province. The absence of an overall provincial agreement makes it a challenge to ensure physicians are represented and that the parties are aligned in their efforts to ensure timely access to quality care for Albertans.

A good example of the complexity is the situation in laboratory medicine. Laboratory physicians are faced with a variety of payers including AH, AHS, Department of Justice (for Forensic Pathologists), existing private companies, plus possible new payers through a request for proposal process currently underway. There is often no clear pathway for physician engagement. The AMA will continue to work with the Section of Laboratory Physicians to represent and support the impacted physicians, but clearly the province requires more transparent and effective mechanisms to work with key physician groups.

Restoring the relationship with government

It is critical that the relationship between Alberta’s physicians and government be restored. The Minister of Health shares this view, and I have appreciated the approach he has taken in discussions following the ratification vote on the Tentative Agreement Package. We agree that trust needs to be restored on both sides. Restoration of trust should begin with the parties agreeing on, and developing concrete steps toward an agreement.

In particular, the areas we have been discussing include:

• Immediate steps on some critical needs, including a working group with members of the AMA, AHS, AH and College of Physicians & Surgeons of Alberta to consider short- and long-term goals related to the standards; support and payment for virtual care; physician input into the PCAC process (as referenced above); the sign-off for last year and the current fiscal year on those programs that, today, are still administered by AMA (includes Maternity, Physician Health, Rural Locum, Compassionate Assistance, Accelerating Change Transformation Team and others). There has also been discussion related to a continuing medical education program.
• An information sharing agreement, so that AMA can better support physicians and engage AH and AHS in advancing proposals for system improvement.
• Outreach to the medical profession, involving the Minister and myself. Topics the AMA believes would be of value include: the survivability of community practices over the next several months and years; promoting fiscal sustainability by focusing on timely access to quality care; and other hot spots that require immediate attention.
• Physician input into health policy issues, including physician supply and the introduction of commercial entities into the public health care system.
• Terms, conditions and timelines for a return to the negotiations table.

 These are steps toward rebuilding trust and lay a path back to negotiations.
 
I hope to report progress in all these areas soon.

Responding to the pandemic

In response to the pandemic, the AMA has been active on several fronts:

• Participating in a multi-professional committee with the Chief Medical Officer of Health regarding the on-going delivery of vaccines in Alberta.
• Supported physicians and primary care networks to lead the highly successful vaccine delivery pilot in community clinic sites across Alberta. This is being extended and soon many more of the sites that expressed interest will be administering vaccines.
• Continuing to engage with PCNs and AH on maximizing availability of vaccines to Albertans, especially vulnerable populations.
• Continuing to support the profession in talking to patients about vaccines and vaccine concerns with our Be a Vaccine Positive Clinic toolkit.
• Working inter-professionally with pharmacists to share consistent, coordinated information and present a united stance on the COVID-19 vaccination effort.
• Working with AH and CPSA to clarify intent and administration of masking exemption letters and with AH to clarify compensation for this work.
• Continuing to monitor other COVID related challenges and advocate for the interests of physicians during this challenging time (e.g., personal protective equipment, public health order effects on community clinics).

Engaging members

Throughout this work, the AMA requires input and guidance from members. This follows the strong member engagement during the ratification process.
 
While much of this engagement will be through the representation and other activities identified above, the AMA will be broadly engaging members through the following mechanisms:

• A report on What We Heard during the ratification period has been developed and is based on member input provided through townhalls, online chats, discussion board postings and email. This report is being finalized over the next week.
• A follow-up report is being created to outline the themes that will underpin the activities we need to pursue in the short- and long-term. Both reports will be used to support on-going discussions within the profession.
• The Joint Task Force has continued to meet and will be recommending and assisting in implementing advocacy tools related to general system issues and in support of the AMA’s representation activities.
• The AMA will be working directly with: sections; Zone Medical Staff Associations; resident physician and medical student associations; and others to advance the above.

As always, I will keep the membership informed. Thank you for your engagement and support.
 
Your comments are welcome in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org 
• Comment publicly on this President’s Letter on the AMA website (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member).

 Sincerely,
 
Paul E. Boucher, MD, FRCPC
President, Alberta Medical Association