EDMONTON – The Alberta Medical Association is suggesting general physicians see a maximum of six patients per hour, but at least one organization says that’s not a “realistic” approach to managing appointments.
It would affect primary care offices, long-term care facilities and assisted-living patient residences. It would not apply to emergency room services, acute care facilities and urgent care centres or operating rooms.
The Capping Initiative was laid out in an email to AMA members earlier this week.
“Capping will not limit a physician’s freedom on a case-by-case basis,” the email reads. “Rather it seeks to align incentives so that physicians are not inadvertently encouraged to rush patient encounters or discouraged from serving a higher-needs population.
“This initiative aims to create more revenue equity for physicians serving patients needing a mix of longer and shorter encounters.”
The AMA said it heard some concerns about how putting a limit on the number of patients seen might limit access to a doctor.
“We do not believe anyone will be denied access to care,” the group stated in the email, adding that longer visits reduce demand and “sets the stage for improved clinical care.” The AMA also said its proposal would allow for some exceptions for clinics that have early or late hours, for under-served areas or during epidemics, for example.
However, Friends of Medicare feels the capping approach might not be the right one.
“I don’t necessarily see it as a realistic kind of approach to solving the problem,” said executive director Sandra Azocar.
“What I think needs to happen is…if they want pay equity, in terms of how doctors are being compensated for the very important work they do, perhaps they need to be looking at the fee-for-service structure as opposed to limiting how many patients they can actually see during the day.”
Azocar suggested a set service fee or even salaries. She also said there should be steps taken to make the field of family medicine more appealing, adding there are a lot of specialists in Alberta, but there is still a need for family doctors.
The AMA’s email explained the goal of the Capping Initiative is to create balance, equity and better care.
“If visits are too long, other patients don’t receive care. If visits are too short, the care needs of the presenting patient may not be met. Until now, there has been no element of the compensation model that worked to achieve this balance. Realignment of incentives is at the heart of this initiative.
“On one end of the spectrum, physicians with higher intensity patients may not be adequately compensated under the current fee-for-service model…At the other end, physicians providing high volume, low intensity services receive significantly higher remuneration for a similar number of hours worked.”
The email proposed putting the patient cap into effect Oct. 1, 2016, but asks for feedback from Alberta doctors through a survey. The association also promises to answer questions about the Capping Initiative on its website.
The health minister said the discussions between the department and the AMA on several initiatives are still in the early stages.
“Our government is really committed to providing a stable health care system…A big part of that is making sure you have stable access as well as predictable costs for the taxpayer. We’ve seen costs increase significantly in health care overall, over six per cent a year, and especially in this economic climate, that isn’t sustainable.
“We want to really bend the cost curve so we’re looking at working with partners, like physicians, who are leaders in health care and leaders in their communities to come up with ways that we can do that without impacting patient care.”
Hoffman said this is one proposal and she’s looking forward to hearing others.
“I’m not saying I’m open to this specific suggestion yet,” she added.
“We’re really thinking through some of the implications…We want to make sure that patients have access to physicians. That’s really important to us.”
The College of Physicians and Surgeons of Alberta declined to comment on the proposal Friday, saying anything associated with physician compensation is the AMA’s responsibility to comment on.
The AMA has not responded to Global News’ requests for comment on this story.
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