Value for Patients, Fairness for Physicians

September 25, 2019

Dear Members:

This week we will hold the 114^th Annual General Meeting of the Alberta Medical Association, in conjunction with our Fall Representative Forum. We will have many discussions at both events about the challenges and opportunities facing physicians in caring for our patients. There will be updates on topics such as healthy work environments, informatics, physician compensation and income equity. The RF had previously requested that meetings should also include content on topical public health issues. This time, we will host a panel session on supervised consumption services.

One of the major themes will be our relationship with government, which affects so much of what the AMA does for members. In the immediate future, this includes the upcoming financial reopener under the AMA Agreement. The parties have exchanged letters of notification so these negotiations will commence soon and the RF will hear about how we have been preparing.

Concerns over what course these negotiations may take have been raised among physicians, largely due to release of the Blue Ribbon Panel report, which I wrote about in my September 4 President’s Letter.

I will return to these concerns later in this letter, but before doing so I’d like to comment on the context in which the report was written. We should keep in mind the larger picture. Specifically with respect to the terms of the government’s health platform that contains provisions that physicians should support.

I am referring to a number of objectives government has set toward system improvements. Committing to such detailed strategies is a good beginning. For example, government has:

• Recognized that every Albertan needs a medical home and the need to expand on the successful foundation that already exists here.
• Highlighted the need to decrease waiting times to no more than four months, avoiding increased pain and burden for patients and their families and additional costs to the system.
• Pointed out that seniors need more support, along with their families and caregivers – the most cost-effective health care providers who have been overlooked for too long.
• Undertaken to provide early and increased access to mental health services at the primary care level, for those in crisis and for vulnerable populations.
• Offered assistance for issues of opioid addiction by expanding treatment and behaving compassionately toward those afflicted.

In all these things the patient perspective is paramount. We need to listen to the issues that mean the most to them and build around their needs. We can also give patients increased responsibility in their care by giving them access to their own medical information, while improving access and timeliness through strategies such as e-visits. We need patients’ empowered involvement to ensure we are building a system that works for them in the long run.

Having noted opportunities in government’s health platform, I also want to mention some of the Blue Ribbon Panel report’s more challenging aspects (and I have heard from many of you recently on some of these points). The report:

• Lacks context and ignores the significant financial contributions that physicians have made in recent years including fees, program dollars and savings initiatives.
• Is selective in some of the information chosen to present. For example, the Canadian Institute of Health Information itself (cited in the report) has pointed out that presenting only fee-for-service data is problematic and the inter-provincial picture is different when FFS and alternative relationship plans are included.
• Fails to recognize the many areas in which Alberta leads the country. While it is important to look for improvement, in doing so we want to recognize and build on our strengths. These should be the starting point, including: the outstanding quality and commitment of our health care providers; successful innovation in informatics; and our national status as the front-runner in medical home implementation.

Where does all this leave us?

The AMA Agreement provides a fair and balanced structure in which the parties can consider all available information related to physician payment (e.g., gross payment, overheads, hours of work, etc.) and a means to resolve disagreements. This is important, because it allows the parties to reach a fair conclusion in a timely way – something I think Albertans expect us to do.

This is only right, because good, fair processes for working through payment matters allow patients, physicians and government to keep moving forward with what matters most: Building a high-value health care system for Albertans.

I will write to you again one more time with my thoughts at the end of my term as president. In the meantime, if you have any comments to share, I will be glad to receive them.

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 below.

Warm regards,

Alison M. Clarke, MD, CCFP, FCFP
President, Alberta Medical Association