Priority Activities
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Year-end update
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Negotiate an agreement for the provision of insured services with government that is fair to physicians and provides value for patients; and restores physicians, through the AMA as an active partner in the health system.
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- The parties reached a tentative agreement in late-August after many months of discussions. Following board discussions and a special RF the tentative agreement was sent out for ratification on September 13. On September 28, the AMA membership ratified the AMA agreement with just over 70% of responding physicians voting “Yes” (voter turnout was 45.8%).
- Implementation activities have continued over the last few months. At a staff level, the Joint AH/AMA Agreement Implementation Working Group have been meeting once per week to discuss the status of the implementation activities underway related to the AMA Agreement. The AMA Board receives an update on the activities as an agenda item at each of their meetings. As well as updates on the agreement activities in the President’s Letters, the parties have agreed to joint communications as appropriate to keep either party’s stakeholders informed.
- Representatives to the Management Committee and Rates Committee under the agreement have been finalized. After a membership-wide callout process, the board selected its representatives for both committees.
- Management Committee: Dr. Paul Boucher, Dr. Alison Clarke was chosen as the AMA physician representatives for Management Committee. As well, by virtue of position, Mr. Michael Gormley, AMA Executive Director will sit on the Management Committee. Meetings of the Management Committee were put on hold pending the provincial election. To date, Management Committee met on November 23, 2022, and March 3, 2023. The next meeting is scheduled for September 25.
- Rates Committee: Dr. Heidi Fell, Dr. Jeff Way and Dr. Brian Wirzba were selected as the three physician representatives for the Rates Committee. Meetings of the Rates Committee were put on hold pending the provincial election. AH has indicated that the next (second) meeting of the committee will be scheduled for September 11. In the interim, staff-level discussions are occurring around year 2 allocation items which will be brought forward for approval at a Fall RC meeting.
- Government tabled legislation on December 5 to repeal Section 40.2 of the Alberta Health Care Insurance Act. This regulation enabled termination of the AMA agreement. Government committed to eliminating that provision as part of its commitments under the AMA agreement. AMA legal counsel has advised us that Bill 4 received Royal Assent meaning it is now a law in full effect. As Section 40.2 was released, the AMA filed its discontinuance of claim through the courts on January 9, 2023. This matter is now officially concluded.
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Support members in local and provincial compensation discussions on rates, viability of practice, due process and working conditions, including:
- Laboratory grid agreement
- Cancer care agreement implementation
- Stipends, on-call, z-codes
- ARPs
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- Lab Grid Agreement: Negotiations between AMA-ASLP and AHS-APL have come to an impasse. Mediation/arbitration is scheduled for November.
- Cancer Care: Collaborative Advisory Committee (CAC) meetings between AMA-CCA physicians and AHS have commenced. Discussion included a high-level summary of activities undertaken by the previous Joint Workforce Planning Committee, identification of challenges in workforce planning and workload management and next steps. The goal is to address retention and recruitment issues for CCA physicians and AHS. A Workload Standards Working Group was struck under the CAC to engage in this work.
- Stipends: The newly ratified AMA Agreement extends stipends to March 31, 2025. Schedule 6 provides for a Stipend Working Group to develop a process to review current stipends paid by AHS to physicians and allows for an independent chair to make a decision should the parties fail to reach consensus. A recommendation is made by the working group to the Management Committee and subsequently to the Minister. AMA is of the firm belief that:
- The due process afforded to stipend-paid physicians must also apply to any consideration of physician stipends going forward (e.g., non-stipend groups experiencing difficulties with physician retention and recruitment)
- There must be alignment of all AHS payments (stipends, overhead, on-call).
- Transparent processes must be developed; AMA has created a draft and Terms of Reference to include objectives, principles, terms and conditions, roles and responsibilities for AHS, impacted physicians and AMA for presentation to Management Committee for use by the Stipend Working Group.
- AHS has asked the AMA to think about a side process, outside of Schedule 6, for physician groups already in the process of exploring a clinical ARP. The stated intent of the side process is to allow for willing physicians to transition towards new arrangements without having to wait 6-12 months for the working group process.
- An MOU between AMA and AHS outlines an AHS-AMA Engagement Framework on Physician Compensation Related Matters within AHS Facilities to address issues through a process of engagement (negotiating, renewing, extending) within the best interests of patients and the health system. The parties may, through mutual agreement, appoint mediation and/or arbitration to help resolve the issue.
- AMA staff and the Stipend Action Committee continue to exchange information with physicians that are receiving stipends, often regarding the AMA Agreement, the Engagement Framework and the due process that is available to them.
- ARPs - Clinical ARP rates and associated FTE definitions will be reviewed by the Rates Committee as per the new AMA Agreement. AMA staff and the Clinical ARP Working Group continue to review, identify and prioritize key ARP issues to raise with Alberta Health. A joint AH-AMA ARP Working Group has been struck to inform on clinical ARP policy and ARP models.
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Support academic physicians in the negotiation of the Academic Medicine Health Services Program and the supporting Individual Services Agreement.
- Comparison between FFS, cARP and AMHSP rates
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- In late fall, following an election process, the AMHSP Council elected its North and South co-chairs. Dr. Walter Hader as the South co-chair and Dr. Steven Katz as the North co-chair were elected.
- The release of the draft AMHSP Master Agreement by Alberta Health has been delayed and the current Master Agreement will be extended for up to one year to allow for further review and consultation. We are hopeful that this will allow time for successful discussions with Alberta Health regarding AMA representation and recognition as a signatory to the Agreement.
- AHS sent a formal letter in early May 2023 acknowledging the AMA’s representation of AMHSP physicians and confirming they will honor the 2019 opt-in process.
- In December, communication was shared with the AMHSP participating physicians on the recent initiatives and activities Council has been focusing on over the past year and the status of that work.
- The AMHSP Council last met on June 21. Consideration at that meeting included expected changes and impact to AMHSP physicians related to the clinical rates funded through the Physician Services Budget, ongoing communications with participating physicians, engagement with AMHSP Participating Physicians, and a discussion for Council direction to the AMHSP Negotiating Committee as it prepares for further engagement with AH once the AMHSP Master Agreement is released.
- An expansion total of 72 FTEs to the existing AMHSP is in process. Three new programs will see a total of 12 FTEs each (anesthesia, obstetrics and gynecology and general surgery); 12 new FTEs will be added in psychiatry focusing on pediatric and adolescent care and 24 FTEs will be added in family medicine. These positions focus on increasing the number of Alberta-trained physicians, as well as supporting generalist care in rural and regional centers. Grid rates for the new expansion groups are being discussed at a provincial subcommittee, and with discussions focused on existing provincial payment rate methodologies.
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Advance AMA third party contracting principles and support physicians involved in these new models.
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- While supportive of physicians who wish to be involved in these types of alternate compensation models, the AMA must consider and evaluate how the physician portion of the Physician Services Budget would be managed as well as the effect of giving third parties’ control over the physicians. AMA’s role is two-fold: to ensure there is clarity on the impact to the PSB, as well as to support physicians through representation and provide guidance as requested by physicians considering alternate compensation models.
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