Government rejects call for delayed implementation of framework

March 30, 2020

Dear Members:

For the past month we have continually stressed with the Minister of Health our strong objections to the imposition of his new Physician Funding Framework. Not only is it short-sighted, it is an ill-conceived scheme that will diminish the medical care of Albertans. It also threatens the viability of community medical practices across the province that form the backbone of health care for patients.

Then COVID-19 happened. And while the Minister has seen the reason of suspending provisions related to time-modifiers and delaying implementation of changes to stipends, the government did not delay other disruptive and damaging elements of their plan, which are scheduled to take effect March 31. If this new framework was a bad idea on February 21, it is a critically bad idea during a pandemic.

Over the past week, we have made several written requests to meet with the Minister. On Friday, March 27, I met with him to personally appeal for a delay in implementation of the framework. I appealed for us to work together to address outstanding issues in the framework and to facilitate a senior-level liaison between Alberta Health, Alberta Health Services, the College of Physicians & Surgeons of Alberta and the AMA in relation to community care during the COVID-19 crisis. During this meeting, the Minister committed to getting back to me prior to the March 31 implementation deadline, following a discussion with the Premier on these matters.

Today, we received his response stating that the government intends to proceed with the remaining elements of the framework on March 31. I share your extreme frustration and disappointment with this decision. Adding further disruption and uncertainty to a health care system already under unprecedented pressure from COVID-19 is simply irresponsible and not in the best interests of the health care system and our patients.

There are so many possible exemplars of this. Let’s focus on Medical Liability Reimbursement. With the current changes, the Alberta government will provide Alberta physicians with the lowest MLR support of any province in Canada. There is no recognition of the impact that devaluing this provision will have on the health care system and patients. For example, family physicians who practice obstetrics, particularly in rural areas of the province, may be forced to forego providing obstetrical care due to the increased cost of medical liability insurance. Consequently, pregnant women without a local physician to deliver their child will have to leave their communities to receive care. The need for obstetrical care cannot be put on hold. Yet the government refuses to recognize the disruption their decisions will cause, particularly with community-based care. Is this in the best interest of our patients? Clearly it is not!

The one positive statement in the Minister’s letter was his commitment to ensuring that the AMA is involved at the senior level in provincial discussion related to pandemic planning and response. The Minister’s commitment will enable a senior level linkage from the Community Support Group (CSG), through the auspices of the AMA, with the provincial COVID-19 response and recovery effort. This is essential and will be done in an expedited fashion. Clearly a united and strategic stand against the pandemic is required.

To further this notion, in recent weeks we have succeeded in establishing the CSG of AMA, AH, AHS and CPSA. This venue will be a space where the otherwise neglected concerns of the community can be discussed and escalated as needed. These concerns include adequate personal protective equipment in the community. We must also address sustainability of community practices that are currently struggling to cover costs and care for patients. These practices are essential services in the fight against COVID-19.

While we marshal the necessary resources toward the acute care needs in the face of COVID-19, we must put an equal degree of attention and support toward community-based care. This is what many consider to be the very foundation of our entire health care system. If community and rural care fail, particularly at this critical point in time, the entire system is in danger of collapse with emergency departments overflowing with non-COVID-19 patients needing care that could be delivered in the community.

The government’s actions warrant a strong response by the AMA. Our legal challenge is prepared and ready to launch. The Board will discuss the timing this week.

The impact of these changes is widespread and affects all physicians, albeit disproportionately. With the pandemic, front line physicians and community physicians are facing significant consequences, both personal and professional. As well, our fellow Albertans are immersed in enormous disruption and anxiety.

In view of this disruption for patients and physicians, the AMA remains determined to add value by supporting an ongoing focus on care for patients, not only at the coal face of crisis management, but importantly at the community level for both primary care and specialty care.

Your AMA will do all we can to support family physician and community specialist practices. When the pandemic is over, these practices still need to exist as essential elements of our health care system infrastructure. The health care needs put on hold during the pandemic will again receive the needed priority to provide quality, timely and safe care to our patients.

The AMA is focusing on supporting members as they cope with the COVID-19 pandemic. I encourage all members to familiarize yourselves with AMA’s COVID-19 webpage, where new information is being added rapidly. The most recent addition is a recording of a March 27 virtual care webinar that the AMA developed. More than 1,800 physicians participated to learn how to work with the new virtual care codes. View the webinar presentation and the subsequent Q & A sessions.

Today, Section of Family Medicine President, Dr. Craig Hodgson and Section of Rural Medicine President, Dr. Ed Aasman and I released a message to Albertans to convey that family physicians are available for patients during the pandemic and can effectively and safely assist them with ongoing or new non-COVID-19 concerns. The same can be said of specialty care in the community.

Next week we will be launching a social media and digital advertising campaign that continues this message, helping patients to stay connected with their physicians as part of staying healthy. More details will be coming to you soon.

On a personal note, I am deeply concerned by the tattered state of the current relationship between the province and its physicians. Somehow the physicians of Alberta have become the enemy of a government frustrated by its circumstance. During my 44 years of medicine, I have never seen anything like it. We have tried talking and reasoning with them. Some have tried yelling at them and shaming them. Others have just stopped trying or are on the verge of giving up.

In distressing times like these, we continue to put our heads down and soldier on for our patients. We will need to stay united as a profession and as a community and work toward our common goals – healing people, keeping them healthy and allowing our province to recover and prosper.

It would be my hope that we can engage the Minister and reengage his government to bring to bear our collective wisdom and efforts to support physicians in the difficult task that they now face with the COVID-19 pandemic. Perhaps by working together at this time of greatest need we may begin to repair the vital relationship between ourselves and government.

In your service,

Christine P. Molnar, MD, FRCPC

President, Alberta Medical Association