The Government of Alberta imposed a compensation framework on the province’s doctors effective April 1, replacing the previously-existing agreement between the government and the Alberta Medical Association.
The framework includes reductions in fees, insurance reimbursements, and continuing education funding. The government has temporarily suspended changes to “complex modifiers” in the fee schedule, which would have discouraged patient visits of more than 10 minutes.
The new framework could have an impact on rural health care. Doctors will be paid less for work done in an Alberta Health Services facility (a hospital or Long Term Care facility, for example).
Because they still have to pay the costs of running their own clinics, some doctors have said the reduced pay is a disincentive for performing hospital work, especially in rural areas.
Doctors in one Sundre, Alberta clinic have already decided not to continue providing obstetric, emergency or acute care in the local hospital.
AMA president Dr. Christine Molnar said a negotiated agreement would have served Albertans better.
“We believe that it would
be important to have a negotiated contractual agreement with the government that defines not only payment models and levels, but also reform and roles and responsibilities moving forward,” she said. “In the past, AMA agreements have always provided a framework for reform and change within the system, which brings value for patients.”
Negotiations between the province and the AMA began before Christmas. Molnar said the AMA was open to cost-saving proposals.
“We offered them significant across-the-board savings right off the top, if what they want is money,” she said. “And they do want money. But the way that they’re going about taking money is destabilizing.
“And it’s not evenly applied, so it disadvantages some groups, particularly rural, which is very concerning.”
The province has said it will reduce the Medical Liability Reimbursement, a program that subsidizes the physicians’ malpractice insurance costs. Currently the doctor pays a $1,000 deductible and the province reimburses the rest.
Liability insurance can range from $3,420 per year for a family doctor who does no emergency or obstetrics, or $8,172 for a family doctor who does emergency and obstetrics work; to $47,352 for a specialist obstetrician.
“By making the [insurance] payments so high for some physicians, they will not be able to work. They will not be able to make enough revenue to actually afford the insurance,” Molnar said. “So you can understand how distressed they are that they won’t be able to afford to continue to provide services, and that will have an impact on rural in particular.”
The Rural, Remote, and Northern program is also subject to change. Currently doctors are paid a flat annual fee for working in qualifying communities. That will be changed to a percentage tacked on to the per-visit fee. Some doctors expect it will amount to less in total, and the government has not said if all of communities now qualifying for the program will qualify in the future.
Doctors’ clinics function as private businesses, and they bill the province for services in accordance with the framework. All of their expenses—rent, utilities, records, staff, etc—come out of the amount they are able to bill the province. They receive no employment benefits, overtime, or paid vacations from the province.
Lakeland-area doctors held a public meeting in March, sponsored by the M.D. of Bonnyville. They explained that if the province’s proposed changes go through, some of them will not be able to sustain their practices.
They also said that understaffing is a chronic problem that threatens to become worse. Recruiting doctors was an uphill battle even under the old fee structure.
The government has put changes to complex modifiers, which pay doctors more for longer appointments, on hold for the near term. It has also brought its payment for virtual or over-the-phone patient visits into line with what it pays Telus Health for the same service through its Babylon smartphone app. Molnar says these concessions are welcome.
But, she says, by imposing a billing framework instead of negotiating an agreement, the province has unilaterally implemented cuts that will affect doctors’ incomes and impact healthcare.
“I have not taken an antagonistic approach towards the minister or towards the government. I have taken an approach that is entreating them to collaborate and work together with the physicians of Alberta to bring high quality care at the most sustainable cost level for us all as taxpayers,” she said.
“However, I don’t believe the events would indicate that they have accepted that type of relationship.”
The government says Alberta’s doctors are among the best-paid in the country. Molnar doesn’t dispute that, but says the point has been exaggerated. “We disagree with [Premier Jason Kenney] stating that we are overpaid,” she said.
“First they started out by saying we were overpaid by 35 or 33 per cent. And then they came down to 20 and then they came down to 15. In fact, you know, we are paid more than doctors across the country. It’s more like eight per cent, which is actually less than most Albertans—most Albertans are paid around 10 to 11 per cent more than the equivalent jobs in other provinces.”
Molnar said the doctors’ recourse options are limited. They can bring their concerns to the government, and they can seek support from the public. The AMA is also looking at their legal options.
“The public must really be wondering who to believe,” she said. “If I was the public and didn’t know all the things I know, I’d be wondering. This is so complicated, what’s going on? And who do you believe? It would be very upsetting and confusing.
“I think it doesn’t do the public service, especially in this time of the pandemic, for these kind of destabilizing activities to occur. They’re disruptive, they’re damaging, and they’re destabilizing.”
Respect reached out to Bonnyville – Cold Lake – St. Paul MLA David Hanson for an interview, but he was not available.