We Asked, You Answered

May 19, 2020

Dear Members:

Thank you for the fantastic response to our member’s survey April 14-24! Almost 4,500 members (32%) responded, giving a clear picture of what is important to you and providing a foundation for our advocacy and planning. Your thoughtful responses are greatly appreciated. There were over 550 pages of verbatim comments. Clearly, there is much that the membership wants to share. We will continue to seek out ways to actively hear from you.

The insight gained from the survey has already influenced the Board’s decision-making, activities and resources of the AMA in a significant way. The survey contained quantitative and qualitative questions and while results reinforced the directions the Board has been taking, they were a poignant reminder of the challenges we face together. The key findings were:

• The emotional/personal response: The government’s actions these past months – tearing up our agreement, denying arbitration, imposing the Physician Funding Framework, walking back parts of it inequitably – have been wearing and confusing to members. What comes through in the survey, particularly in the qualitative results, is a sense that physicians feel devalued and disrespected. For many years, the profession has taken pride in our role as stewards of the system and partners with government. Now, members say they are being treated differently and they feel that their input is not valued. We cannot continue in this climate of uncertainty and unilateral government decision-making. These results have further strengthened the Board’s determination to seek a negotiated agreement with access to third-party arbitration.
• Physician Funding Framework: The survey closed on the day that government announced the walk-back on many components of the framework for rural physicians (April 24 President’s Letter). As we all know, there has been extreme concern about the negative effects of the imposed framework. The survey found that at the time, 75% of respondents anticipated a personal net income loss of 20% or more due to implementation of the Physician Funding Framework. The areas of greatest concern were reductions in Medical Liability Reimbursement coverage, reduced fees (z-codes) associated with hospital-based activity, loss of the Continuing Medical Education program, caps on the number of claimable v-codes per day and ending good-faith claims. Rural physicians have been granted a reprieve by government on MLR and other framework provisions as of April 24, while other changes impacting urban medicine are on hold for several months. Uncertainty remains with respect to the ultimate detriment to the system and the profession. We need an end to unilateral decision-making by reaching a negotiated agreement. This will allow us to make decisions, maintain productive relationships and keep building value and affordability for patients. In a recent letter to members, Section of Rural Medicine President, Dr. Ed Aasman, expressed what needs to occur on this topic: “Leadership brings people together to find solutions, it does not impose solutions.”
• COVID-19: Not surprisingly, top concerns for physicians regarding COVID-19 were about practice viability as a result of lost income. Safety of families followed, with a range of issues around personal safety, availability of personal protective equipment and the issue of psychological wellness and emotional stress. The areas of least concern were potential for practicing out of a usual scope of practice and balancing outpatient clinical needs with COVID-19 coverage. While physicians have clearly expected the AMA to support them in opposing the Physician Funding Framework, 71% of respondents said the AMA must also address pandemic-related priorities at this critical time. In response to this information, the AMA has invested heavily in providing support through webinars and our COVID-19 resource page, that includes information about business supports and virtual care tools and resources. We have also advanced a proposal to government for income stabilization related to COVID-19.
• Communication effectiveness: Members told us that they overwhelmingly prefer email as a means of communication during the pandemic, with webinars and website information also deemed useful, but to a lesser degree. Members also gave the AMA strong marks for timely, clear and trustworthy communication and indicated that the amount of information received has been “just about right.”

In concluding the final survey report, our pollster noted that members are facing: unprecedented uncertainty; threats to their autonomy and reputation; and a lack of fairness. The report went on to say that members will need to know that their voices are being heard as they unite to defend quality health care for patients and physicians.

In addition to our outward advocacy, it is crucial that we support each other as we work through our shared and complex mix of emotions, including the palpable sense of loss. Our Physician and Family Support Program is working with Well Doc Alberta to design a webinar around the emotional impacts of these changes. Objectives will include further building a sense of community, enhancing literacy and providing tools, allowing for self-reflection and finding meaning in these difficult experiences while creating hope and opportunities for empowerment. We expect this webinar to be scheduled in June – look for further details coming soon.

Thank you to everyone who gave us their robust feedback via this survey. Thank you also to the 2,500 physicians and counting who have already engaged in our campaign to tell government to return to negotiations. If you haven’t lent your support through our easy-to-use campaign website yet, please do so now. We are now beginning to engage the public as well, and thousands have already responded. Every voice matters and if you haven't already, I hope you will add yours.

“It is during our darkest moments that we must focus to see the light.”

- Aristotle Onassis

In your service,

Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association