The Alberta Medical Association says proposed cuts by the provincial government are “troubling,” would impact primary care physicians and could be “devastating to rural family practice.”
The AMA shared with its members that the government tabled several proposals on Nov. 14 that it believed were outside negotiations.
“Given the severity of many of the proposals it was thought best to bring matters into the light of day for all members,” the letter from AMA president Christine Molnar said.
The AMA said the proposed changes would target comprehensive primary care and specifically, patients who are elderly, with chronic or complex conditions or those living in rural or remote areas.
“For one of the items — payments from Alberta Health Services — the impact is unclear and could affect many physicians,” the AMA notice reads.
“If these proposals go through, the effects on our healthcare system will be devastating,” Dr. Lauren Eastman said.
“Patients without good, comprehensive primary care will ultimately be forced to higher cost areas of our healthcare system such as emergency departments and admissions to hospital.”
“Changes this government is making to doctor compensation is leaving me feeling scared, disillusioned, angry and very undervalued,” said Dr. Bailey Adams from St. Albert.
Both Eastman and Adams joined NDP MLA David Shepherd at a news conference to oppose the UCP’s plans for health care funding.
“Alberta Health has come to the Alberta Medical Association with a set of proposals that, frankly, are looking to cut in a number of areas that would directly impact the ability of particularly family physicians to provide care, particularly for complex patients and particularly in rural areas,” Shepherd said.
“That includes things like cutting the amount they would be paid for the amount of time they spend — basically incentivizing doctors to spend less time with their patients.”
Health Minister Tyler Shandro this is a process with the AMA and the government is negotiating with Alberta doctors.
“We’ve been clear that we need to bring our spending in alignment with other provinces. We spend more on our physicians than our comparative provinces do throughout the rest of the country. We’ve tabled our proposal to the physicians now we’re waiting for them to provide us with a counter proposal.”
Dr. Adams said Alberta doctors don’t get paid if a patient doesn’t physically come to the office for an appointment.
“When they do show up, I get paid based off a set amount of time I spend with them. One of the most amazing things about Alberta is that there is slight — they’re not massive — but there is slight compensation. Many of us will choose to earn slightly less so we can spend more time with them.
“That has been proposed to be set back to a much longer time and therefore that’s a significant cut to what we earn in a day — roughly, honestly, probably about 15-30 per cent daily income cut, which is a lot… when we pay 30 per cent often in overheard just to cover everything else.”
Dr. Adams said the proposed cuts also include rural stipends to physicians, and capping the number of patients doctors see in a day.
“If you see more than 50 patients in a day, you will get paid 50 per cent less than what you would have otherwise for any patient up to 65 and none after that.
Shepherd said the UCP is also proposing eliminating good faith claims.
“Here in my constituency, I have a significant number of people who live on the streets, who do not regularly carry ID. If they go to see a doctor right now, if that doctor reasonably believes them to be an Alberta resident, they can receive care. Under this government’s proposal, these physicians would not be paid for providing care to that individual.”
The minister was asked about removing good faith claims. Shandro said he was caught off guard if that was part of the proposal.
A spokesperson for the minister’s office said, in a statement, that proposals were tabled last week to control government spending on physicians.
“Alberta is a great place for doctors to work and nothing in our proposals will change that,” Steve Buick, spokesperson for the health minister, said. “Our spending on physicians is out of line with other provinces – 15 per cent higher than national average per capita.
“Our proposals are common-sense things like paying doctors for overhead costs only if they have to pay those costs, not if they work in a publicly funded facility. We’re committed to comprehensive primary care, including the Medical Home model. Nothing in these proposals changes that.
“I’ve heard a suggestion that our proposals that could reduce a physician’s income by 85 per cent, limit patient visits to five minutes, etc. There is nothing in our proposals remotely like that.
“I would urge you to bear in mind that we’re just beginning negotiations and there are going to be a variety of claims made. We’ll work through them at the bargaining table.”
This news comes after Alberta Health Services announced that it would be forced to cut hundreds of nursing positions.
“These cuts are completely contrary to what Mr. Kenney and the UCP campaigned on,” Dr. Jillian Ratti, a family physician in Calgary and member of Canadian Doctors for Medicare’s board of directors said.
“A lot of my patients have problem lists that are 10 to 20 deep and they can be on 10 or 15 medications and the idea that I’m supposed to through all of that In 10 minutes is completely unfeasible,” Dr. Ratti said.
The board also said UCP delegates voted against a resolution to uphold the Canada Health Act and access to hospital and physician care based on need, not ability to pay.
“Per capita health care costs in Alberta are indeed high, but they are far lower than what is seen in the United States,” said Dr. Ratti. “Our service levels, particularly to vulnerable patients, reflect our investment. The solution for decreasing costs is not to cut public sector jobs and health services. Albertans would be better served by an honest and in-depth assessment of the public sector innovations that have enabled other provinces to reduce their costs in a way that improves health and ensures equitable access to care for all.”