What the AMA offered: Real savings, real solutions

June 4, 2020

Dear Members:

Government claims that during negotiations, the Alberta Medical Association did not offer concrete proposals to deal with the province’s fiscal challenges. I thought members would be interested to learn more about what the AMA put forward.

The parties sat down at the negotiating table in November 2019 and each tabled an opening position. Clearly there was a gap to close, but that is expected in the initial phase. Typically, the two sides meet repeatedly, trying to find a common negotiating zone that represents movement of some sort on both sides. When parties reach an impasse, third-party binding arbitration is used to resolve disputes (as provided for by the AMA Agreement that was torn up on February 20).

In this case, government brought to the table a single budget figure of $5.4 billion and this remained their first priority throughout all the months of discussion. As we know, the tool they used to reach their target was the set of 11 consultation proposals, which became a significant part of their Physician Funding Framework. In this way, government chose to impose a budget requiring cuts to physicians’ practices that ultimately would destabilize the health care system and diminish patient care.

The AMA brought what we believed to be a fair approach to negotiations with government. Developed with guidance from the Representative Forum, member surveys and Board oversight, the AMA’s approach offered to deal with the government’s fiscal situation, but without the damage that would result from unilateral and inequitable imposition of the Physician Funding Framework.

The AMA made numerous proposals to seek a collaborative solution. The essence of what the AMA proposed was:

• An across-the-board fee reduction for all physicians to provide government with its immediate up-front savings requirements
• A commitment to meeting government’s $5.4 billion target, with any under-expenditures applied to physician services, benefits and programs
• Maintaining existing physician support programs and benefits with only minor changes
• Working together in year one to define the roles, responsibilities, accountabilities and authority of the parties with respect to the budget
• Commitment to work with government to enhance the uptake of community primary care Alternative Relationship Plans to achieve the national average over the next five years. This would be done by reviewing and improving present models and developing change management support to accomplish this goal.
• Improving appropriate billing of the Schedule of Medical Benefits through implementation of an enhanced Peer Review program
• Developing a coherent set of policies for services within Alberta Health Services, e.g., stipends, on-call and overhead

Today we are without a Master Agreement and continue to call on government to return to the table for negotiations. Albertans expect government to honor the contracts it holds. The structure is important to the system, but there is more. AMA agreements define the relationship, responsibilities and accountabilities between physicians and government. Quite simply, government will not achieve any meaningful health transformation without the support of physicians through the AMA. As for the financial terms of the agreement, if government believes their position is fair, then they should be unafraid to access third-party arbitration. Arbitration can find a way forward before working relationships are damaged beyond repair.

These AMA proposals were serious, practical yet innovative attempts to meet government’s fiscal imperative. Collaboration is essential to provide value for patients and fairness for physicians. The AMA offered immediate and sustained savings for government. We committed to work with government and AHS to move toward a more integrated, quality and efficient health care system.

Let me state once again: Physicians understand the financial challenges of the province, made more extreme by the pandemic. We know Albertans are struggling. We are willing to do our part. Government must do more than simply say: “We listen when we want and then we decide.” That is neither a negotiation, nor a workable foundation for a health care system that will be there for patients now and in the future.

In your service,

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

P.S. If you thought I’d forgotten to mention our campaign, you were wrong! Response is going well, but we still would like to ensure that every physician, resident and medical student has a chance to participate. Between AMA members and the public, over 9,500 emails have gone to MLAs asking simply for a return to negotiations. If you have not already done so, please lend your support through the campaign website.