Hundreds of physicians are urging the Alberta government to not only put upcoming contract changes on hold but also take further steps to help prevent the novel coronavirus pandemic from overwhelming the province’s health-care system.
A letter written by Dr. Lana Myroniuk, a family doctor in Edmonton, on behalf of 558 other Alberta physicians was sent to Premier Jason Kenney, Prime Minister Justin Trudeau, provincial Health Minister Tyler Shandro and other members of the Alberta legislature on Sunday night. (Scroll down to read the entire letter below.)
“We are in the throes of a national emergency with the arrival of COVID-19 in Canada,” said Myroniuk, a maternity and family physician who also teaches at the University of Alberta.
“With the number of cases in Alberta growing by the day, it will not be long before we find ourselves in the same position as our fellow global citizens in China, Italy, Iran and Spain, amongst others.”
As of March 16, the number of cases worldwide has topped 183,000. Italy, the hardest-hit European country, on Tuesday morning recorded nearly 28,000 cases and 2,158 deaths — including 349 more in just the last 24 hours. The nation now accounts for well over a quarter of the global death toll.
Myroniuk said that if Alberta is not successful in “flattening the curve” in the next several days, the strain on the health-care system will be unprecedented.
“I shiver at the thought of Canadian doctors having to decide who will live and who will die, as is the case in Italy right now.”
She said physicians are doing what they can to stop the community spread of COVID-19 but can’t continue without government intervention.
“When the exponential rise in cases comes in the next few days, the cuts will limit our ability to continue working on the front lines. This will push patients to seek care in ERs, which will be simply unable to accommodate them,” Myroniuk wrote.
“We are literally risking our lives, and the lives of our families, to help Albertans amidst this crisis.”
The letter praised two recent initiatives but said they weren’t enough.
On March 12, the province activated a billing code known as 03.01AD, which the health minister said was used during the H1N1 response. The code allows physicians to be paid $20 per call when giving COVID-19 advice over the phone.
Then, on Friday, Shandro addressed concerns there could be nurse layoffs and other staff reductions after April 1, when the new budget year begins, as part of long-term planned changes to health spending.
[ Sign up for our Health IQ newsletter for the latest coronavirus updates ]
“There are not going to be any layoffs of (Alberta Health Services) employees during the COVID-19 response,” said Shandro, who added that he expects staffing increases to deal with the outbreak.
Myroniuk said enacting the phone call billing code and pledging not to lay off nurses was a good start, but more needs to be done. The doctors called on the province to do the following four things:
- Reverse the cuts to physician fees and table negotiations for a later date, when the province is not in crisis;
- Remove the weekly cap for 03.05JR (telephone calls to patients). This will promote social distancing and enable telephone care even if the patient and/or physician are not required to self-isolate;
- Increase the fee for 03.01AD to align with other provinces;
- Reassure Albertans that everyone who must self-isolate, physicians included, will receive financial support from the government. Otherwise, infected individuals will continue to go to work and further spread the virus.
Last month, the government ended its long-standing master agreement with the Alberta Medical Association (AMA) and said it would put new rules in place in the spring. The current master agreement with physicians ends March 31.
The association, which is the bargaining arm for doctors, sent a letter to its members on Monday with information regarding the COVID-19 pandemic.
The letter acknowledged that physicians have significant worries about what to do if they are not able to work in their normal capacity after March 31.
“Meetings were held as planned over two days last week,” AMA president Christine Molnar said. “The board of directors met subsequently to discuss the results, and some additional work is still being done at this time. I will update you as soon as I can.”
Molnar said the AMA is suggesting to Alberta Health the removal of current restrictions on weekly limits for virtual care codes and expansion of the range of services available via virtual care.
She also said clinical doctors may be asked to join the emergency response effort by working in emergency departments or other parts of the province as needed.
In her letter — which was sent before the AMA update was released — Myroniuk said the timeline to have meaningful intervention is rapidly coming to a close.
“I ask you to pause your political agenda and let us help Albertans,” she wrote to politicians. “If the proposed cuts are enacted, this will be a disaster beyond imagination.”
She said the failed negotiations between Alberta Health and the AMA are deeply regrettable but that this is not the time to discuss it any further.
“We can get back to the negotiating table later,” Myroniuk wrote.
“Now is the time for all of us to take action and be leaders during this dire circumstance.”
The press secretary for the health minister said the department is in active discussions with the AMA and Minister Shandro is open to any proposal to ensure physicians can support patients effectively, “through the pandemic and going forward.”
“The Minister recently approved reactivating the ‘pandemic’ billing code that allows physicians to bill for telephone consultations to reduce risk to patients by avoiding office visits,” Steve Buick said in a statement.
The pandemic code is not limited to COVID-19 patients, Buick said, adding there is no daily cap on calls. He said there is incorrect information circulating that confuses the new, reactivated pandemic code with the existing code for phone calls, which is capped at 14 per week.
“The pandemic code is not capped: one call per patient per day, no limit on calls per day.”
Buick claimed that the demand the province pay a higher rate per call is based on the suggestion that income from calls should be able to completely replace office visits.
He said phone calls are not intended to replace office visits entirely, except for a 14-day period when a physician may be forced to self-isolate.
“The demand to increase the rate paid per call is a separate issue. Public demands for higher rates and other pay increases are inappropriate in the context of a public health emergency and should be routed through the AMA,” he added.
COVID-19, the disease caused by the novel coronavirus, causes only mild or moderate symptoms for most people, such as fever and cough, but severe illness is more likely in the elderly and people with existing health problems. More than 79,000 people have recovered from the illness to date.
READ BELOW: The entire letter from Dr. Lana Myroniuk to the Alberta government
— With files from Dean Bennett, The Canadian Press