Many Alberta doctors have reacted with shock and outrage to the provincial government’s decision to unilaterally impose changes to how physicians are paid.
On Thursday, Health Minister Tyler Shandro said the UCP government would rip up the existing contract and impose changes to billing and compensation after talks with the Alberta Medical Association broke down.
Christine Molnar, the president of the AMA, calls the move an attack on physicians and says she’s “outraged.”
“It defies logic,” she said. “It’s an unprecedented move. This has never happened in Canada during the whole duration of medicare.”
Learned about changes through media
Molnar says she found out the agreement between doctors and the province would be torn up when she read about it in the media. She says her organization had prepared a new offer for the province that was going to be delivered on Friday.
She also says she hasn’t heard anything about a proposed new funding arrangement, in the form of three-year contracts, that doctors could enter into with the government.
“Most Albertans, you know, if you think about democracy, the sanctity of contract law is pretty fundamental to a democratic environment. When you make a contract with someone and you sign it, it’s a legal agreement,” she said.
“And to just legislate the power of a contract away, it fundamentally disables the democratic process.”
Molnar says her organization had already presented offers that would have amounted to a three per cent reduction in pay for physicians.
Removal of additional fees
The province made several changes to the way doctors will be paid, including the removal of an additional fee — known as a complex care modifier — that doctors could charge for visits that went over 15 minutes.
The new rules mean doctors will be able to charge only 50 per cent of the fee starting on April 1 — down to $9 from $18 — before it is eliminated altogether the next year. Doctors will still be able to bill more for visits that stretch beyond 25 minutes.
That has caused concern among some practitioners, especially for specialists like Fiona Mattatall, who won’t have the year-long phase-out.
Mattatall is an obstetrician in Calgary who says she is often dealing with complex medical issues and other concerns including post-partum depression or anxiety during pregnancy.
“The way that the modifiers are changing allows me to either spend that time and not get paid — which affects my ability to pay my front staff and keep the clinic running — or to not spend that time with patients and ask them to come back on a separate occasion for that visit, which I think is a disservice to patients,” she said.
‘I feel completely deflated’
Mattatall, who shares space in a clinic with five other physicians, says they run a tight ship. The obstetrician says she will have to sit down with her accountant to see how to manage the financial changes — which could include losing staff.
“I’m trying to sort out how can I change because I can’t practise the same way I am. It is unsustainable from a financial standpoint,” she said.
Mattatall says a reduction in payments for liability insurance will also have an impact on her practice as obstetricians carry some of the highest coverage.
“I feel completely deflated as a physician working in Alberta,” she said.
Shandro said on Thursday that his government is focused on the bottom line and that holding total physician compensation steady would prevent a $2-billion overrun on the province’s budget.
He argued that Alberta doctors are paid significantly more than their counterparts in other provinces — something the AMA contends isn’t entirely accurate.
“You know that we have different opinions about the data that’s being used,” said Molnar.
“We have a third party independent analysis of the data that we had provided to the government at the negotiation table and it shows a very different picture than the picture that they’re painting to the public. And I believe that when we asked for arbitration that perhaps they realized that if this came to arbitration and the data was viewed by an independent arbiter that it might not go in their favour.”
Shandro also said changes to the modifiers were needed because they were being misused, with 50 per cent of visits incurring the added fee.
Molnar says she’s not surprised by that figure but disagrees that it indicates a problem. She says only five per cent of the population uses 65 per cent of the province’s health care resources, because they are the ones who require the most care.
Fozia Alvi, a family physician based in Airdrie, says she doesn’t understand why the government is excluding front-line workers like herself in the decision-making process and that these changes could end up costing the government more money.
“I think that more people are going to end up in the emergency, more people are going to end up with mental health crises and they will be admitted in the hospital,” she said. “So I think it’s going to be a disaster.”
Alvi says she thinks more family physicians will decide to leave the province.
That’s also a concern for Franco Rizzuti, president of the Professional Association of Resident Physicians of Alberta, which represents doctors fresh out of medical school and training in their field.
“There are a lot of fears, talking to my colleagues,” he said. “A lot of them have fears about the viability of being able to work in Alberta.”
He says the changes, and the way they were imposed, could have a significant impact on recruitment and retention of talent in the province.