March 2, 2012 Dear Member: in This Letter: Government's Unilateral

Dr. Linda M. Slocombe

March 2, 2012

Dear Member:

In this letter:

 Government’s unilateral imposition of funding has created confusion  Questions answered for members  Re-emphasizing the value of an agreement

Like most unilateral actions, government’s recent imposition of funding has caused confusion for physicians, media and the public.

Many of you have written in the last few days, seeking clarification. In this letter I will comment on some of the issues that you have raised. I will also provide a perspective on the importance of an agreement that puts physicians at key tables where decisions are being made.

You asked:

1. What did government’s letter say?

Government sent its letter to physicians using its own mailing list. As ministry connections with the profession are not the best, many physicians did not receive a copy.

For your convenience, we have placed a copy of the letter on our website. The letter that the minister attempted to send to all physicians is available on our website (listed beneath the link to this letter).

2. This is not an agreement, not a contract, not a deal.

Government has acted unilaterally. We did not request it. There is no agreement, contract or deal.

… 2 The President’s Letter July 23, 2012 Page 2

I have written to the minister to ensure clarity on this so that he understands physicians are not tacitly accepting any of these possibilities. The letter states (i) that there is no agreement with Alberta’s physicians and (ii) that all issues at the negotiating table remain unresolved. The Alberta Medical Association (AMA) has not agreed to any terms or conditions, explicit or implicit.

3. When did the AMA learn of the imposition?

The minister called to advise me of his unilateral decision to impose funding at approximately the same time as he began sending letters to physicians. In fact, the AMA received media calls before a copy of the letter arrived for our information.

Over the immediately preceding days, I had several conversations with the minister about what is needed to begin rebuilding trust with the profession. I stressed to him the need for physicians to be at key decision tables (recognition), on-going continuance of programs during negotiations and the need for a fair and objective way to resolve disputes. Up until the morning of the imposition announcement, AMA senior staff and I were told that these matters were being seriously considered.

4. What government intends to do.

According to the letter, government is imposing:

An increase of 2% to insured service rates (fee-for-service [FFS] and alternate relationship plans [ARPs]) to cover the two-year period starting April 1, 2011. This fails to recover even the increase in overhead costs during that time and accordingly represents a loss to the profession. You know this, the AMA knows this and government knows this.

The primary care network (PCN) rate goes from $50 to $62. PCN funding supports family practices to hire additional staff and expand the range of services. It has not changed since 2003. As PCNs have had to use up financial reserves over the past few years, this rate change represents inflation only and at best will help to maintain services.

It’s also important to refute what some media reports have stated. This funding does not involve $12 being paid to physicians for each patient. It goes instead to the PCN to provide services and programs.

Government has said it will not discontinue several programs (Physician and Family Support Program, Medical Liability Reimbursement, etc.) until March 31, 2013. So a cliff still looms, but they want to make it more distant than June 30, 2012.

… 3 The President’s Letter July 23, 2012 Page 3

5. How does government impose these amounts?

This is an interesting question! Actually, there are two different aspects.

2% increase to rates for clinical services (FFS and ARPs): As insured services, these rates are set by regulation. Therefore, the minister can simply write an order to increase the rates. This includes the Ministerial Order now being used for ARPs with which the AMA has already expressed serious concerns.

PCN rates: These are a different story because they are part of 40 grant agreements involving physicians, Alberta Health Services and others. Unless new legislation is planned, we are unclear as to how government expects to impose this change. There is no other blanket solution.

6. What is the imposition if it is not an agreement?

Without any agreement behind it, government’s action in legal terms is really the preferment of a gift (and I am mindful of an old axiom of being wary of those bearing gifts). It can be viewed as a down-payment on a larger amount owed and yet to be agreed to. There is nothing that prevents continued public profile, lobbying, negotiation and pursuit of a fair settlement that meets physicians’ needs. The AMA will do these things.

Dealing with patients, dealing with budgets: Two solitudes

There have always been the two worlds of health care.

There is the frontline, where patients reside and are cared for by physicians, nurses, pharmacists, licensed practical nurses and many other critically important health workers and support staff. This is the world of pain and suffering, care and cure.

There is also the world of overall management, where budgets and spreadsheets reside. This is the world of sustainability, of control and political interaction.

Both worlds are necessary and deal with important questions. In a healthy system, the normal dynamic tension between the two worlds is expected, respected and dealt with through meaningful engagement.

As I have said in previous letters, in this province there have been two primary ways by which engagement has occurred: physician advocacy at an individual level and the engagement of organized medicine through the previous trilateral master agreement.

… 4 The President’s Letter July 23, 2012 Page 4

Patient advocacy by physicians and other health team members effectively brings the patient into the board room. It allows managers to engage with physicians when considering limitations of the system. It finds ways to decide where best to place limited resources when we cannot do everything for everybody.

At a provincial level, the trilateral master agreement created key programs and a decision- making/dispute resolving structure. It was a partnership, awkward at times and a bit unwieldy, but a place to build trust and a sense of joint ownership.

Both physician advocacy and the concept of partnership have suffered greatly in the past three years. The gulf between the two worlds has widened and we are all less than we could be because of it. Physicians want to close the gap or at least open up the bridges.

Government also has to step up and take responsibility for its actions and the effect they have on programs that should be designed by partnering with those most capable to improve patient care.

Please keep your comments coming. Email [email protected].

Yours truly,

Linda M. Slocombe, MDCM, CCFP President

P.S. There is still time to register for our upcoming town halls in Calgary March 6 and in Edmonton March 12.

March 6 panelists are: Heather Forsyth, Wildrose Alliance Party of Alberta; Fred Horne, Minister of Health and Wellness; Shannon Phillips, Alberta New Democratic Party; Dr. David Swann, Alberta Liberal Party; Glenn Taylor, Alberta Party.

March 12 panelists are: Fred Horne, Minister of Health and Wellness; Brian Mason, Alberta New Democratic Party; Dr. Raj Sherman, Alberta Liberal Party; Danielle Smith, Wildrose Alliance Party of Alberta; Glenn Taylor, Alberta Party.