Alberta doctors working in some rural and remote areas say they could lose thousands of dollars a year from government changes to their pay.

One of several tweaks the provincial government announced last week removes an incentive for doctors to put down roots in small communities, some rural physicians said Tuesday.

Health Minister Tyler Shandro unveiled a laundry list of modifications to the Rural Remote Northern Program last week. Among them was the elimination of a flat fee paid to doctors that rewarded them for living in the communities they served for at least nine months of the year.

Encouraging doctors to settle where they practise is key for continuity of care and ensuring doctors are available for patients, said Dr. Edward Aasman. He's a family doctor in Rocky Mountain House, and head of the rural section of the Alberta Medical Association.

"Having a physician actually live and work in a community more or less is going to help you retain the physician in that community," Aasman said Tuesday.

The flat fee paid doctors was between around $4,000 and $40,000 a year. The more isolated the community, the higher the fee was.

An updated government bulletin issued Monday removed that extra pay for doctors in about 450 Alberta communities. Doctors in about 140 other communities keep a fee of about $4,300 to $8,600.

Aasman said doctors are still calculating the net effect of multiple changes unveiled last week.

Modifications meant to help keep rural doctors

Doctors who qualify for the Rural Remote Northern Program (RRNP) could make up some of the lost cash by seeing more patients after the government lifted a $60,000 cap on rural premiums. However, a new agreement imposed on doctors last month by the provincial government caps the number of paid patient visits at 65 per day.

Rural doctors will also receive higher on-call rates than before. The government will cover most of the cost of rural doctors' medical liability insurance. Shandro also cancelled a change that would have prevented rural doctors for claiming overhead pay for the hours they work in hospitals.

Health Minister Tyler Shandro announced changes on Friday he said were supposed to lure and keep more doctors working in rural Alberta. (Colin Hall/CBC)

Although Shandro's office did not respond by publication time, his issues manager, Tara Jago, tweeted Tuesday that government is increasing funding for the program by 20 per cent.

Minister <a href="https://twitter.com/shandro?ref_src=twsrc%5Etfw">@Shandro</a> has increased funding for RRNP by over 20%, making it the most generous incentive program for rural physicians in the country. You’d think <a href="https://twitter.com/abndpcaucus?ref_src=twsrc%5Etfw">@abndpcaucus</a> would support it, instead they’re running smear campaigns during a pandemic. 1/6 <a href="https://t.co/m39FW9t26M">https://t.co/m39FW9t26M</a> —@tarajago

"Lifting the cap means more money for physicians in more-isolated communities," Jago wrote.

A doctor in High Level who bills for $350,000-worth of services would make an extra $115,000, she said.

Shandro announced these new incentives and exemptions after physicians from Pincher Creek, Sundre, Rocky Mountain House and beyond threatened to withdraw their services from rural hospitals.

Under the terms of the new provincial agreement, they said they couldn't afford to work both in their clinics and in hospitals.

The Alberta Medical Association is suing the province for denying their right to arbitration and passing a law that allows the government to impose a contract without negotiation.

Doctors say there's too much uncertainty

Dr. Danielle Diaz , a Sundre-based physician, said she stands to lose about $13,000 a year now that the flat fee is being eliminated.

She said the benefits of removing the cap on premiums are almost irrelevant.

She said the health minister touting changes to rural doctor pay as increases when many doctors will experience a significant pay cut is "underhanded."

"I'm frustrated on behalf of the future of rural medicine," she said in a Tuesday interview. "Because that is one of the ways we recruit and keep physicians working rurally. And it was cut with no fanfare."

She and her husband — also a family doctor — have a toddler and a preschooler and had planned to stay in Sundre for the long term. The changes are so unsettling, and their communication so unclear, she doesn't know what their future plans are now.

"Ultimately, it's patients that are going to suffer with these changes," she said.

Doctors' concerns about the announcement's fine print come after a weekend snafu, where the government had initially removed 141 communities from the list of places where doctors are eligible for the Rural Remote Northern Program.

Alberta Health said employees had posted the wrong list, and that removing the communities' rural designations was an administrative error. The government posted a new list Monday.

However, a Friday news release said the government was reviewing which communities were eligible for the program.

Rural doctor burnout possible

NDP health critic David Shepherd said Tuesday these are more blunders in a series of mistakes that should prompt Shandro to resign.

"He's botched this file entirely," Shepherd said. "He's been dishonest. He's failed to communicate properly."

NDP health critic David Shepherd said the health minister has mishandled relations with Alberta's doctors and should resign. (CBC News)

Shepherd said doctors have told him the rural changes amount to pay cuts and were introduced without consultation.

He said the government should repeal legislation that allows them to impose an agreement on doctors and head to arbitration with the medical association.

Aasman, meanwhile, is concerned about the potential for rural doctor burnout if people leave small communities.

"I think in the end the uncertainty might [lead to] a physician loss, particularly rural," he said. "We're seeing that physicians are saying they're fed up. They're going to move to different provinces, or they're just going to retire."