In late April the government of Alberta made several adjustments to the doctor compensation framework it had imposed through its 2019 budget bill. Some of these were specifically introduced to address the concerns of rural physicians.

Attracting and retaining doctors in rural Alberta has been a growing problem. When the government halted negotiations with the Alberta Medical Association (AMA) and imposed a compensation framework late last year, rural communities and their doctors raised alarms that the situation would become worse.

The government has reversed or altered some provisions in the framework. Pay rates and appointment durations, including the “complex modifier” for patients with more than one complaint, have been adjusted. 

The government has also restored its contribution to doctors’ liability insurance. Doctors’ contributions will still be capped at a $1,000 deductible on premiums, which can range from $3,420 for a family doctor to $47,352 for an obstetrician.

And the pay when a doctor is working in an Alberta Health Services-owned facility, rather than from their own clinic, has been restored to reflect that doctors still pay clinic overhead regardless of where they are working at a given time. 

Dr. Edward Aasman, president of the AMA’s Rural Medicine Section, says the revisions are welcome. But, he says, other concerns remain.

Incentives for doctors to work in rural Alberta have been reduced. Under the Rural, Remote, and Northern Program, physicians had been paid a flat fee for locating their practice in a designated area, and a “variable-premium fee”—a percentage that is added to each visit fee.

The variable-premium percentage is still in place. Doctors who live in rural areas are paid the percentage, as are “locum” doctors called in on a temporary basis. But the flat fee for locating a practice rurally has been repealed. 

“That was an important part of recruitment and retention,” Aasman said. “You have this for being there, being a part of that community. And as you know, if you’re embedded in a community and part of the community, you’re more likely to stay. If your kids grow up there and you raise your family, own houses and everything, that keeps you there.

“It is important that we actually have physicians that that live in the community because that’s what allows a patient in a rural community to have a family doctor that actually gets to know them. And that’s a very important relationship,” he said.

The AMA’s chief grievance is that negotiations on the compensation framework were halted and the government imposed a new one unilaterally. The organization is suing the government, looking to restore its right to negotiate a settlement and to seek arbitration if an agreement can’t be reached.

Aasman says it’s not just about the pay rates. “We
need the security of an agreement,” he said. “Something that we can look at that says okay, we know what’s happening. 

“I’m not sure if having something that allows the government to tear up any contracts is going to be looked at by any businesses as safe and secure, whether you’re in the oil business or you’re in forestry or anything else.”

The government’s reversal on some of its provisions has taken some of the urgency out of the rural healthcare situation. Aasman says rural doctors are largely focused on the Covid-19 pandemic and may be relieved that they don’t have the full proposed pay cuts hanging over them, for now at least.

But he says that for doctors who were considering moving elsewhere, the changes might have merely bought them some time.

“A real important point, and it was stated by the ministry itself, is that there is a shortage of rural family physicians,” he said. “We’re a different group of doctors. We have a special skill set and there’s a shortage of real family physicians across Canada.”

He said a recent Canadian Medical Association meeting in Banff for rural doctors and hospitals was attended by recruiters from several provinces and territories. 

“I think it’s dangerous at any time to really get rural physicians nervous and looking at elsewhere,” he said. “It’s important to know in rural, it’s not about the money. It’s about security and being able to have a sustainable practice.”

A negotiated agreement honoured by both parties would offer more security to Alberta’s rural doctors, Aasman said. It would also signal an atmosphere of mutual respect.

“As an employer myself, having a medical clinic,
you treat your employees
with respect so that they
want to work with you. You don’t have to devalue a
group to help them understand that there’s different situations and needs, and they’re valued as a part of those changes rather than devalued, just bullied and picked on.”

He said the AMA recognizes the need for reduced spending and more efficient healthcare delivery. The association says it offered across-the board five per cent pay cuts before negotiations were discontinued, which would have delivered the savings the government is looking for.

“They’re not trying to make government look bad or anything, but we’re just trying to make sure that the negotiations make sense within the health care system,” Aasman said.