The head of the Alberta Medical Association says a provincial budget that holds the line on physician compensation at $5.4 billion will actually be a 20 per cent cut as costs go up and billing fee changes kick in.

Dr. Christine Molnar says the reduction is compounded by the fact the province has cancelled the master agreement with the association and can now raise or lower billing fees with no consultation.

"It creates a level of incredible uncertainty for a business to operate," Molnar said in an interview Friday.

The 2020-21 budget, introduced Thursday, leaves the total health operating budget at $20.6 billion, including $5.4 billion for doctors.

However, Health Minister Tyler Shandro is making changes on multiple fronts to reduce costs and redistribute those savings to improve patient care.

That includes new fees for physician visits beginning April 1 that the AMA says could be devastating to doctors in rural and family practices.

The United Conservative government had said the changes are manageable because Alberta doctors make more than physicians in other provinces, taking in almost $390,000 in gross clinical earnings in 2018-19 — $90,000 more than doctors in Ontario.

"Alberta's budget for physicians has gone up by 289 per cent since 2002," Shandro said in an email. "Without any changes, taxpayers would have been on the hook for an additional $2 billion in just three years — that's not sustainable."

At a June presentation to orthopedic surgeons, the group's lobbyists said Health Minister Tyler Shandro had directed the group to his principal advisor, who they said was personally overseeing the file. (Colin Hall/CBC)

The AMA disputes those numbers, saying they are based on faulty comparisons. Its figures show Alberta doctors get $386,000 a year on average, more than the national average of $346,000, but reflective of higher wages across Alberta's job spectrum.

"This whole vilification of physicians is based on data that we fundamentally disagree with," said Molnar.

She said in the weeks to come, doctors and the AMA will do townhalls and use social media to fight back against the government's messaging on their salaries.

Opposition NDP health critic David Shepherd said he is particularly concerned about reductions that will impact front-line care — particularly the cut to diagnostic imaging despite long wait lists for care, and cuts to public health care as the coronavirus outbreak continues.

"We don't have any [coronavirus] cases in Alberta yet and I sincerely hope it stays that way," said Shepherd. "But there are cases in Canada and in the U.S., and this is the time to strengthen our public health system, not to weaken it."

Shandro said the public health budget includes measures to cut costs, but they have nothing to do with the work that is being done to monitor, prepare and guard against the coronavirus outbreak.

"It is deeply irresponsible and extremely inappropriate for the NDP to try and play politics with the serious, evolving global coronavirus situation," he said.

Heather Smith, head of the United Nurses of Alberta, said the budget is another step down a regressive and very unfair path.

"What I heard [in the budget speech] is a belief that the heydays [of high oil prices] are going to return and, until they do, public sector workers are going to carry the brunt of paying for the economic woes here in the province," said Smith.

The United Nurses are currently bargaining a new contract with Alberta Health Services, which is asking for wage freezes, cuts to overtime and holiday pay, and reductions to benefits.

Smith said the union has offered solutions to those demands, but she is not optimistic.

"It's not negotiations. It's not constructive dialogue," she said.

"Alberta Health Services has been given marching orders by this government and that's what they are doing."