Your Practice, Your Plans: Your Results

July 9, 2020

Dear Members:

Thank you to everyone who participated in our recent member survey “Your Practice, Your Plans: Tell Us How You’re Doing.” We had a very good response given the short timeline.

Your feedback is invaluable in guiding our approach with government. We will be sharing these results with the public, government and Alberta Health Services so they have a clear understanding of the profession’s challenges, concerns and perspectives on these important issues.

We received 1,472 responses from June 24 to July 3, which yielded an excellent representative sample. Taking into account the finite population correction, the results are accurate within +/- 2.4 percentage points. Meaning 19 times out of 20 the survey results are what they would be had the entire population of Alberta physicians participated.

Here are some excerpts from the survey that really jump out.

Practice Instability

What changes have occurred in recent months?

• 76% report their number of patients has decreased
• 91% report daily billings on average have decreased
• 56% report staff reductions

What are these changes due to?

• 16% say losses are due to COVID-19 alone
• 80% say losses are due to a combination of government’s funding changes and COVID-19
• 4% say losses are due to government’s funding changes alone

All Albertans are suffering during this pandemic crisis and physicians expect to experience challenges. But unlike other businesses where governments are taking extraordinary measures to assist through the pandemic, this provincial government has gone out of its way to undermine medical practices across the province. I’ll repeat that: this government is knowingly and intentionally undermining medical practices … in the middle of a public health crisis, by refusing to negotiate an agreement and pressing forward with an ill-conceived, unilaterally imposed Physician Funding Framework.

Alternative Relationship Plans

How likely are you to move from a fee-for-service model for your practice to an Alternative Relationship Plan model in the next two years?

• 71% say Very or Somewhat Unlikely
• 9% say Very or Somewhat Likely

If you are considering moving to an ARP, why? (multiple choices allowed)

• 50% say they need a payment model that fosters the type of medicine they want to practice in the future

If you are not considering a move to an ARP, why? (multiple choices allowed)

• 77% say government tore up the AMA Agreement and they don’t have enough trust to sign up for another agreement with government
• 62% say they don’t want to work under a Ministerial Order
• 57% say fee-for-service still works for their practices

Per my President’s Letter yesterday, government has introduced an omnibus Bill 30, the Health Statutes Amendment Act, with sweeping changes affecting the profession (and that was written without any consultation with the profession). I mention Bill 30 here because part of the government’s rationale for the legislation was to encourage more physicians to enter into ARPs by shifting them from Ministerial Orders to contracts with Alberta Health.

In different circumstances, this change might have created a strong encouragement for physicians interested in making the change. Government, though, seems oblivious to the biggest deterrent to ARP adoption – i.e., their own behavior toward the profession over the past several months and the absence of an overarching provincial agreement with physicians.

This should not be news to them. It has been something the Alberta Medical Association has communicated to government for some time, but perhaps it will resonate better coming from over 1,400 physicians directly. The message to the Minister is clear: If you want to make progress on developing more ARP models in the province, you will need to restore trust with the profession by negotiating a province-wide contract with doctors.

Medical Liability Reimbursement

When it comes to administering the MLR program, which of the following would be your preference?

• 89% say the program should continue to be administered by physicians through the AMA
• 10% say they don’t know/are unsure
• 1% say the program should be administered by Alberta Health

Government released their MLR plan/registration this week. Had they listened to the AMA, they would know that this approach is profoundly out-of-step with the profession. Indeed, only 1% of physicians want MLR administered by Alberta Health, while 89% would like to see it remain administered by physicians through the AMA (the most efficient and cost effective mechanism).

Representation

When it comes to contract negotiations on major issues impacting health care and physicians, which of the following is your preferred approach?

• 2% say they prefer contract negotiations to happen through individual physicians or groups government chooses
• 98% say they prefer contract negotiations to happen through AMA

For physicians considering an ARP, the AMA should:

• Provide advice, consulting and information: 96% Agree/Strongly Agree
• Act as my representative, either on my behalf or jointly with me: 93% Agree/Strongly Agree

As many of you are aware, the Minister of Health has regularly disparaged the AMA over the past year, at times even musing about seeking alternative ways of engaging with physicians.

So we put the question to you - our members – and we are very humbled and pleased to report that whether in broad negotiations, establishing ARPs or representing the physicians on major health issues, members overwhelmingly want the AMA there.

The medical profession is united and resolute – government needs to stop playing games and sit down with the AMA to negotiate a fair deal with doctors.

Thank you again to all of you who participated in the survey. I hope that by sharing some of these results (with full results to come) you will be better informed about where the profession stands on these important issues today. Your responses are invaluable to us in our discussions with government, Alberta Health Services, elected representatives and our patients.

At the end of the day, Alberta’s physicians are asking for very little. We are willing to work with government to meet their budgetary targets, but it needs to be through a reasonable, fair and good-faith negotiation process that respects our rights, as essential workers, to third-party arbitration of disputes.

In your service,

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