EDMONTON – Adding fuel to an already bitter labour dispute, Alberta’s health minister says doctors must accept a $275-million reduction in fees to leave room in the budget to pay new physicians coming into the system.
While irate physician leaders vowed a new public advocacy campaign to fight the move, Fred Horne said Monday the province’s financial struggles mean there is no choice but to find ways to make funds stretch further.
In a letter sent last week to the doctors’ bargaining unit, the Alberta Medical Association, he said the total budget for physician compensation is frozen this year at $3.4 billion. However, he said that money must be shared by more people, since an estimated 300 doctors are joining Alberta’s workforce.
“In order to accommodate volume pressures and other program increases while operating within the available budget, cost containment of an estimated $275 million is required,” Horne wrote in the letter to AMA president Dr. Michael Giuffre. “The need to make $275 million in reductions, as required by the budget, is firm.”
Such reductions could be achieved by making an across-the board cut to fees doctors receive for performing services, lowering only some of the fees, or ending specific programs and benefits, Horne said, requesting the AMA send him suggestions by Friday.
Talking to reporters Monday, Horne denied he is imposing a pay cut on doctors. He said the talks are more about ensuring the existing budget has room to pay the new doctors that the province needs, especially family physicians, geriatricians and psychiatrists.
He said some fees were undoubtedly due for a change anyway since new technology has made some services easier and cheaper to perform.
“We haven’t asked the AMA to make any cuts. What we have given them is an opportunity to be a partner at the table in making decisions about how we manage the budget,” he said.
Giuffre called Horne’s stance both confusing and punitive, saying doctors were stunned by the latest demand. The government’s decision to freeze the $3.4-billion compensation budget was already a sticking point in negotiations between the AMA and province, but news the government now wants $275 million in fee reductions is another blow to talks that are rapidly unravelling, he said.
He said the move clearly amounts to a rollback of physicians’ income, but Horne is making it worse by being “obtuse” on how the trims should be made.
“The minister is demanding a cut, but isn’t telling us whether we should be cutting our hours, cutting surgical procedures, or diagnostic procedures, or cutting access to the number of patients we see,” Giuffre said. “It’s one of those bewildering, perplexing things that lacks clarity.”
He said the government’s stance is essentially a refusal to properly accommodate the health demands of a growing and aging population.
That decision may mean the province gets fewer new doctors than it expects, since many will see Alberta as a hostile climate for physicians, he said. New graduates and specialists will flee to other jurisdictions, while doctors close to retirement will have extra incentive to close their practices, Giuffre said.
That, in turn, will result in reduced access to the system, including longer lineups in emergency rooms and longer waits to see a doctor.
“It’s a situation where (Horne) has created his own mess,” Giuffre said. “He can’t recruit anymore, he can’t retain anymore, and if new docs come here, guess what, there is no money for them. There is no other conclusion but to say Alberta is the most anti-physician province in Canada.”
Giuffre said the AMA plans to fight back through a media campaign in the coming days, and will approach patients to talk to their MLA.
The association is also examining legal action to challenge the province under unfair bargaining laws.
“We are further apart now with the province than we have ever been,” Giuffre said. “The trust capital is being quickly lost by this minister by 8,000 doctors who are really, really ticked off at what he is trying to pull.”
Both sides cannot even agree on who is to come forward with a new proposal in the negotiations. While the AMA has said it is waiting for the government to present its financial position, Horne said the budget delivered on March 7 represents the province’s plan.
Horne said there is no deadline for the talks to end, but added he needs to have a plan in place at the start of the new fiscal year on April 1.
He suggested Alberta doctors, who are on average the best paid in Canada, take lessons from the “sacrifices” teachers made in signing a deal for no pay increase in next three years.
But Giuffre called that a false comparison, since doctors are essentially small business owners who have to pay increasing staff costs, rent and utility bills with little or no change to their revenues. The AMA has said that over a five-year-period from 2010 to 2015, Alberta physicians on average will see a 22.5-per-cent decrease in their take-home pay due to government decisions.
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