Alberta Doctors are off to Battle. Who has our Backs?

The COVID-19 pandemic is undeniably here. Most of Alberta is currently in the calm before the storm. We are doing the right things to prepare our hospitals, our medical staff and our province. Social distancing started early compared to elsewhere. If it is adequately embraced, we will hopefully be spared the worst effects other parts of the world are already experiencing. It is a stressful time for everyone, and we in healthcare are feeling it all day every day.

Yet while we prepare to be part of the front line against the coming storm, our stress is amplified by the persistent need to look over our shoulders. As we’ve been looking to the fight to come, we have little trust or confidence in our political generals, and are still bleeding from wounds they inflicted, and unsure how to deal with the bigger ones still to come. The Alberta government has not relented in their attack on physicians, despite the bluster of unity in political press conferences. You may have read otherwise in the media, and yes, as of this writing, after months of physician outcry, they have relented on one proposed change; delaying the reduction of complex modifiers (despite still claiming they should not be a problem). See this previous post for an understanding of why this will be so bad for primary care. A step in the right direction, but this is only one of many ill conceived changes that are still scheduled to come into effect on April 1, leaving many physicians unclear on how they will manage their businesses beyond that date. This coincides almost exactly with the period when we expect to see our health system beginning to strain under the load of Covid-19 pandemic patients. Physicians are far from the only ones facing significant economic uncertainty right now, but we are the ones being asked to put our own safety on the line for Albertans. Health care workers around the world have a higher infection rate than the general population due to our risk of multiple exposures (see here and here).

I’m busy with plans for how our local ER is going to cope, so I do not have time for details, but in brief these pending changes still include:

  • The loss of clinical stipends to support palliative care, trauma and other critical programs (note AHS has announced it will delay until August some of these cancellations given the pandemic. I suspect this was an AHS rather than direct government initiative and it does not include all stipend losses).
  • Daily “encounter caps” still mean many after hours walk-in clinics will need to close
  • Still undisclosed cuts to in hospital consultation fees that may make hospital work unsustainable for some specialists and rural physicians

More specific concerns as addressed in recent communications to government can be read here.

Even in the midst of pandemic planning, further stress has been put on Alberta physicians through the following developments:

On March 13, the Minister of health gave 1 year notice of termination of the contract with provincial radiologists, with the apparent intention of putting out a tender to have the province’s medical scans in the future read by the lowest bidder. This is a contract that was recently renewed in binding arbitration with a 12% fee cut. The full implications of this are not entirely clear, but one possibility is that the reading of diagnostic tests in Alberta could soon be filled by a cheaper overseas radiology “call center” of sorts. Would you rather have your MRIs, mammograms and CT scans read by Canadian trained and regulated radiologists, or the lowest worldwide bidder? As an ER doctor who relies on those reports to care for you, I know who I would rather have reading them, and who my lawyer would.

Social distancing is beginning to be achieved in health care throughout the country by the roll-out of “virtual care” fee codes. These allow your doctor to be paid when communicating with you through email, phone or video call to minimize face to face contact, and avoid clinic visits for at risk patients during the pandemic. It has been recognized throughout Canada as a key pandemic response. The fees need to be high enough to allow the doctor’s office to use them, and still pay overhead. Premier Kenney is fond of comparing Alberta physician billing to the rest of the country, so let’s do that here:

  • BC: $31 -$35 per visit
  • Manitoba: $38 – $44
  • New Brunswick: $45
  • Quebec: $49
  • Yukon: $51
  • Saskatchewan: $35
  • Ontario: $37 (> 10min), $68 per half hour of counseling

Health minister Shandro proudly re-introduced the old H1N1 pandemic virtual medicine fee, at the same old fashioned rate of $20, regardless of time spent. That’s 30-70% lower than anywhere else in the country. We have a few other pre-existing telephone fees that also pay about $20, but are limited to 14 uses per week. There are many Alberta family doctors on social media who are trying to protect their vulnerable patients during a pandemic by keeping them at home, and are right now operating at a loss to do so. Remember this money is used to pay clinic rent, utilities, staff and equipment.

This is completely unsustainable, especially in a pandemic. There are already clinics in Alberta that have announced or are planning a closure. We (speaking from the soon to be overwhelmed hospital front) need our community physicians to be able to stay in business and keep caring for Albertans! All your chronic diseases and usual day to day health problems are not going to be put on pause as easily as a Florida vacation. If family doctors, palliative care doctors and other specialists cannot provide good, comprehensive primary care – from their patient’s own homes when needed – we will further burden the acute health care system at the worst possible time in our provincial history.

[Update March 23: Today the Alberta government announced some additional temporary virtual medicine codes that are similar to regular office visits fees for both family physicians and specialists. There are a few significant restrictions including that the patient, not the physician must initiate the call, no time modifiers will be paid for longer visits, visits must last a certain minimum number of minutes to be paid, and there is no remuneration for additional administrative time including chart review, charting, prescription or consult letter preparation. They will not be subject to daily caps. This represents a definite improvement, and time will tell how clinics will adapt to survive a potentially prolonged period of “socially-distant” medicine with newly restructured rules governing their income.]

This is an unprecedented time. Everyone is suddenly either out of work or overworked, depending on what they do. Financial times are suddenly stark for many, and are going to get even harder – but is this the time to carry on with draconian and frankly completely uninformed tinkering of the health care system? By politicians who have shown no interest in listening to the experts about how that system works? Nurses have been told their layoffs will be delayed until after the pandemic. I’m sure they are grateful for the message that while they are needed to shield the province from harm they are at least temporarily of more value.

The Alberta government wants to renovate the house of health care. Instead of working with the architects who built that house, and the people who maintain it, they have come in and started unilaterally demolishing the foundation – primary care. We have spoken up loudly about it, insisting we can fix the house together, but that they are going about it the wrong way. They have persisted, and now a hurricane is coming – we are rushing to hold up the walls, leak proof the roof and make room to shelter more people. Meanwhile the government continues to dismantle the structure behind us.

It’s becoming clear that the UCP does not want this pandemic to delay their plan to reshape health care into an as yet unknown image. Have you seen the ads suddenly popping up in your social media feeds for virtual online health care in Alberta? Is that where the health care budget is going now – to these private companies? As I am writing this, Premier Kenney happily announced (on twitter) new partnerships with online health delivery companies to take care of your health needs over the phone or an app. Don’t be fooled – they are paying discount doctors a cheaper rate to do incomplete electronic medicals while a private company is pocketing the difference. Do you think that service will be an adequate replacement for your family doctor? What kind of health care relationship will you develop with this app while your GP who knows your health history and can actually physically examine you is being undercut and going out of business? This is one more thing that looks like it will save money in the short term, but will cost much more in the mid and long term because it destroys the patient’s medical home- the most health and cost effective tool in Alberta’s public health system. This government has proven itself incapable of understanding the basic principles of health care and health economics. They are dangerous.

We no longer have time to continue this asinine fight, but perhaps you are finding yourself with more time than you used to have. Perhaps you can take up the battle to defend our backs while we face the storm.

If you can,

Contact your MLA. There is growing feedback coming to physicians from some back-bench UCP MLAs that they are not happy with their own government’s approach to health care, especially once they understand the facts – that the system is going to suffer and health care is going to cost more. This is not ideological, it is math and basic health economics. We have been encouraged by some to continue our advocacy to THEIR bosses – the Minister of Health, Premier Kenney and whatever small room of yes men is setting provincial policy. Don’t accept willful ignorance or cowardice from your elected MLAs. It is their government, and its power rests in their votes. Their future jobs rest in ours. The UCP recently passed a bill limiting their own member’s ability to debate or comment on some legislation- the Premier does not want his own MLAs to speak up. Demand that they do.

Find your member of the Legislature and their contact information here.

Contact the Premier and the Minister of Health. Tell them you see through the propaganda, and insist that they acknowledge the problems that have been identified by so many physicians. Their response is always the same: “We are holding the line on health care funding.” “Alberta doctors are paid more than anyone else.” These are deflecting answers that ignore the problems in the details of their actions. Do you care what the total budget for your new house will be if the builder refuses to properly pay for the pouring of the foundation? It doesn’t matter how much you spend on the roof tiles, the house is going to collapse.

Premier Jason Kenny contact information

Minister Tyler Shandro contact information

Demand at the least that these changes be put on hold until after the worst of the pandemic is past. Invite them to then take that opportunity to collaborate with doctors and other healthcare providers who can help find the inefficiency and waste in the system, and who will continue to offer sustainable cuts  to  their own income in hard economic times – later, when there is time.

Demand our province raise virtual medicine fees to a level commensurate with other provinces, so clinics can stay open and avoid further layoffs while caring for patients in isolation.

Consider signing this petition, asking the government to see sense and delay the changes.

While you’re at it, please sign this petition, asking provincial and federal governments to please immediately implement a national plan to ramp up production of protective medical equipment. We will need it badly and the entire world is headed into an immediate severe shortage. What a great way to create some jobs in a crisis! Please consider speaking out about this.

If you want to get out of the house, please consider donating blood. It will be sorely needed for many, and is safe to go and do.

Please continue to follow the excellent advice and leadership of Dr. Deena Hinshaw, our chief medical officer of health. Thanks to her, and thanks to the blessedly wise decision of our Premier to follow her advice, Alberta has a chance to be more prepared, further in advance than much of the world. We hope it is enough, and we hope you will have our backs, while we do our best to protect the health of every Albertan.

 

9 thoughts on “Alberta Doctors are off to Battle. Who has our Backs?

  1. I am a physician in Canmore and Calgary, and I feel like things are bleak. I am calling my vulnerable patients and trying to avoid bringing anyone to clinic unless absolutely necessary. Phone visits are time consuming as I have to be extra careful that I am not missing something. I don’t know how a provider ie through Babylon, who doesn’t know my patients, can possibly provide good care virtually. Despite working a full day and caring for the same number of patients, I made about 1/4 of what I would normally make. I have no idea how my clinic will continue to pay for its lease and our staff. I am hearing of family medicine clinics laying off their staff today and closing their doors.

    The system is collapsing. I view family doctors as the first line of defense. We’re like the trenches with pikes in them, and we slow down the zombies so that the archers (ER docs) can pick them off with arrows. The critical care and ICU docs are waiting inside the fortress and they should be our last resort. I am hoping that someone will listen when I say that the front lines are collapsing.

    The last month has left me exhausted. I have spent dozens of hours organizing letter writing campaigns, trying to meet with my MLA Miranda Rosin (she no showed to our scheduled appointment), emailing Minister Shandro without reply, spearheading a town hall meeting, speaking to media, writing letters to papers, etc. I feel like I have been screaming for help for my patients at the top of my lungs, and the people who should be listening to me are busy maligning my colleagues on Twitter.

    And now. Now I will be imminently fighting for my patients’ lives in the most direct way possible and I know that I can’t count on my government to have my back, to listen to my advice, or to respect my experience. I can’t trust this government not to stab me or my colleagues in the back.

    I am utterly demoralized.

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  2. I have never been so proud of Alberta’s family physicians.

    Right now, they are running their practices at a loss, but they are staying the course to protect their patients.

    Let me put that another way: They are making no money AND they are taking money out of their life savings to continue to pay staff, rent and other expenses, so that their patients are not abandoned at this critical time.

    Many of us are also on the front lines in preparing our emergency departments for what is come. Many other physicians who currently don’t work in the ER have made contact to volunteer to help out, because they know that despite our best efforts at preparation, we are very likely going to be overwhelmed and going to need all the help we can get. Even then, it might not be enough.

    When this pandemic finally blows over, and we drag our weary bodies off the battlefield, only then will we have an opportunity to survey the wreckage of what used to be our clinics – wreckage, caused by our morally bankrupt health minister and premier.

    We can’t worry about that now. Albertans need us to shield them from the devastation that is COVID-19. COVID-19 requires our full focus and attention – and we will stay the course, because that is what we do.

    But when it’s over, thousands of doctor will leave Alberta. With our clinics decimated, there will be nothing tying us to Alberta, and little desire to continue working for a government that repeatedly stabs us in the back.

    And then Kenney and Shandro will have their balanced budget. The shortfall will be paid for by the blood of Albertans…

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  3. Expressed as I feel. Can our patients see this blog?. I/we need to get this out widely. I have no energy at the end of the day. Can we all use these posts and send them to our patients? Or let them see this so they can sign up to receive it?

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  4. I am writing as a Family Physician who qualified over 20 years ago in the UK. I have never felt so unsupported and degraded by any government that I have worked for throughout my whole career as I have done this week.

    In the face of a terrifying pandemic having been beaten into submission for months prior by the proposed billing cuts and fear of how we will continue to run our clinics we have nothing left to give and need the support of our government to know that they have Family Physicians backs and they will do everything in their power to not let clinics close and support us through these unprecedented times.

    Instead they have done the opposite and kicked us while we are down. Finally conceding albeit likely temporarily on the changes to time modifiers was little help when we are now having to help our most complex patients over the phone to keep them safe in their own homes. I have had to convert the majority of my face to face visits to phone calls this week which often take longer than my original 15 minute appointments as it is more difficult to assess safely over the phone and then requires follow up faxing of prescriptions or requisitions. For this time we get $20 per call. If I was making 4 an hour I would make $80 which does not even cover the cost of running the clinic never mind any take home pay. I am continuing to see patients in the clinic, usually the younger, less at risk of complications from Covid-19 but more likely to be carriers, therefore putting myself and my family at risk as we have yet to be given any PPE.

    As a profession we have repeatedly asked for adequate compensation during this time of crisis for virtual consults and although freeing up the 03.01AD code to be used more freely is helpful it is not adequate compensation for our time and will result in widespread clinic closure if not adjusted to be in line with other provinces.

    Today was the final kick in the teeth when it was proudly announced there is a new ARP service providing telehealth and advertised for patients to use. It appears that for $120/ hour with no clinic overheads Physicians could advise patients that they have no past medical history on regarding their current concerns and even prescribe or refer without seeing them.

    As a team in our clinic today we were staggered beyond belief at the underhand way this government is actively trying to collapse our profession during a pandemic. We have all talked about clinic closure, moving to work in another province or just leaving medicine altogether.

    In a crisis like this you would hope that professionals would come together to find the best solution to support our patients in a cost efficient safe medical home like their Family Physician. Usual medical problems continue and if underlying medical conditions are poorly controlled it increases patients vulnerability to this virus and puts them at higher risk of complications. Confusing patients by signposting to alternate providers other than the ones who know them best or not supporting Family Physicians to the point that they have to fire staff or close clinics is not providing the safe bed you need to support our most complex patients through this complex time.

    I hope you can see the error in your ways and reach out to support clinics before it is too late.

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  5. UCP AB Govt attack on our public healthcare and public schools, unions, disadvantaged, etc is not partisan politics it is darker! Their behavior is not unprecedented, it is CORRUPT. We Albertans must start using proper terminology. Words do matter! UCP ARE FIREHOSING ALBERTANS DAILY WITH DISINFORMATION. UCP Playbook: pimpin’ propaganda.
    Listen to the truth tellers: @AB_MD_WarRom @SOSAlberta

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  6. RE: Privatization of primary care via TELUS Babylon

    I am a Family Physician in Edmonton, and I have deep concern regarding the UCP’s promotion of TELUS Babylon during the COVID-19 pandemic.

    I fully agree that the time to invest in virtual care is now. However, I do not agree with divesting money from public health care to invest in private enterprises, especially during a provincial health crisis. TELUS Babylon is a free service to Albertans, so it doesn’t feel like the start of a two-tiered system. However, I want Albertans to realize that Premier Kenney is using the COVID-19 pandemic as a cloak to cover the first step in privatizing our provincial medical care.

    Alberta physicians have already begun offering virtual care visits during the pandemic. We are urging the government to align virtual care fees with face-to-face visit fees. This will enable clinics to stay open and sustain office staff employment. Patients can maintain access to their Family Doctor, who knows their history and is the optimal longitudinal care provider. Patients can also access walk-in clinic services and consult a specialist using telehealth care modalities, all while practicing social distancing or self-isolation. These measures will help “flatten the curve” of COVID-19 infections while maintaining access to quality public healthcare.

    The UCP struck a contract with TELUS Babylon in 2019. The contract allows a for-profit business to receive government funding to deliver primary care. During the pandemic, this app is being advertised as a way to relieve pressure on the primary care system. While it may be successful in doing so, it is at the cost of maintaining our public health care in the long run.

    Eventually the COVID-19 pandemic will pass, and we will return to health care delivery as usual. I am concerned that if TELUS Babylon gains a foothold in Alberta health care, the lasting effects will be detrimental. What was once a leading system built on the Patient’s Medical Home model (https://patientsmedicalhome.ca/files/uploads/PMH_ReportCard_2018-1.pdf), will become a piecemeal scheme without unified leadership. A two-tiered system will silently slip in and fracture our public healthcare system.

    Does a 10 minute virtual visit cost less than a complex care office visit? Yes. However, short-term savings will become long-term debts if longitudinal and comprehensive care are lost. With an aging population, this is a frightful proposition.

    If Premier Kenney is going to privatize Alberta health care, he should not disguise this corporate handout as an investment in primary care. We are seeing disaster capitalism at its finest, and our taxpayers deserve to know what is materializing in front of their eyes.

    Dr. Lana Myroniuk, BSc MD CCFP

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  7. I agree that this is the time to invest in virtual care. It is also the time to innovate within clinics and offer virtual visits with your own patients. Many EMRs offer virtual care add ons. (ie. Medeo by QHR/Accuro, virtual care by Input Health, etc). If the government can offer patients virtual walk-in clinics they should also offer to pay for these EMR add ons within clinics so physicians have the means to offer these services to their own patients. They should also offer other EMR vendors equal opportunities to offer these services – ie call for fair process through RFP

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  8. I am a patient and I am concerned about the things I am seeing! The present optics are misrepresenting family Dr’s ( or more so being misunderstood) and I am concerned about the potential shortage and fall out after the corona virus. It is so difficult for so many overwhelmed with fear to see what is happening behind the scenes. We need our family Dr’s and we need consistency in care…someone who knows us. WE do not need a Telus Health app sending us to one of their privately owned clinics and having them get paid more than our family Dr’s . This is not about greed as many people believe. I know when I have the time to share what I have learned since December… which is more than I want to know… People are more supportive! I have one petition started for the virtual care codes but it was only up for a day when changes were announced. Have a look if you like… I stole a couple paragraphs from wildeand random( it is titled) Please adequately fund our family Dr’s for virtual consultations during the Pandemic” . I will soon either remove it or modify it. But I believe something more… something stronger is needed to mobilize patient led support. I have been very active writing letters since December and that is not enough. I am considering a couple of ideas but if any of you have thoughts on what you would like to see your patients put out there on your behalf…. let me know!
    Stay safe all of you!

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