AMA President's Letter

General surgery needs attention and intervention from government.

The bottom line: wait times for oncologist care are unsafe and worsening.

The Board is excited to announce Karina Guy will assume the role of AMA’s CEO as of July 18, 2024.

I appreciated that about 280 members joined the June 26 Inside Scoop virtual town hall on June 25.

June is National Indigenous History Month in Canada, an annual event intended to celebrate and learn about the rich history and contributions of First Nations, Inuit and Métis peoples. 

We know that physicians are eager to learn the details of the Physician Comprehensive Care Model (PCCM), a novel and game-changing funding option that will provide family physicians and rural generalists with the stability and incentive to provide life-long, comprehensive patient care.

Your Board of Directors is not slowing our pace heading into summer; in fact, we are increasing our efforts. That was a key takeaway from last week’s Board meeting and two days of business and strategic planning for 2024-25 to deliver what you need from the AMA. 

The number of oncology spaces funded in Alberta has failed to keep pace.

The acute care system is in desperate trouble. That was the subject of our latest Inside Scoop virtual town hall on May 22 with over 250 acute care, hospital and community-based specialists.

Cancer care provided in Alberta is second to none, when you can access it. Unfortunately, this expert care is no longer being delivered in a timely fashion because we do not have enough oncologists to provide the care that patients need.

The acute care system in Alberta is like an expanding aneurysm that could rupture at any time.

I have written to Premier Danielle Smith and requested that she ask the federal government to reconsider proposed changes to capital gains taxation included in the recently announced federal budget 2024.

This morning I participated in a joint news conference with the Minister to announce that government is committing to the Physician Comprehensive Care Model with a target implementation date of fall 2024.

The second Inside Scoop Town Hall was Thursday, April 11 and the recording is available (member login required). Here are some comments on the discussion at the session.

Many members are extremely concerned that they are ineligible for the Transitional Funding Program funds that began flowing to physicians yesterday. Unfortunately, the TFP is not available to family or rural generalist practices with panels of under 500 patients.

As I wrote to you last week, today we will begin distributing transitional funding support payments to eligible family and rural generalist physician practices. The AMA has received the funds from Alberta Health.

On April 4, transitional funding support will begin flowing to eligible family and rural generalist physician practices. This milestone follows months of relentless advocacy through the AMA and heroic efforts by the Strike Team.

Alberta Health issued a Bulletin yesterday indicating that retroactive payments will be distributed this Friday, March 22 to physicians who are eligible for Rural Remote Northern Program (RRNP) benefits.

The first round of Canadian Resident Matching Service (CaRMS) numbers was released earlier today, and Alberta has fewer unmatched family medicine residency positions this year than last year. This is good news. I was pleased to see that across the country, the numbers are looking more positive. Visit our website for additional context and an at-a-glance breakdown of the match numbers.

About 350 members joined our post-budget virtual town hall on Wednesday for an update on where things stand with government and a look ahead at advocacy plans. A recording of the presentation is available on the AMA website (member login required).

The Alberta Budget 2024 was released yesterday. 

To the Minister, in media interviews and to the public, I have one message in the next two weeks: Family and rural practices are no longer sustainable and they need urgent support in Budget 2024.

You may have heard that government has released $12 million to the AMA to provide family physicians and rural generalists with support for costs related to panel management and practice improvement activities. This is part of the October 2023 release of the MAPS final reports, which included an announcement of $57 million in funding over three years for physicians participating in panel management. We did not negotiate these funds.

Yesterday, Alberta Health issued a Bulletin announcing that their billing system has been updated and physicians can now submit eligible ‘good faith’ claims – retroactive to April 1, 2022.

I am pleased to inform you that last week, after being without a contract since 2018, our colleagues in laboratory medicine voted yes to a new agreement with Alberta Precision Laboratories, effective April 1, 2022. 

Yesterday the government announced plans to restrict access to gender-affirming treatments for pediatric trans patients. I immediately consulted with the Section of Pediatrics for the expertise these colleagues can bring regarding these vulnerable patients.

Last week we released disturbing survey results including that 61% of family and rural generalist physicians are contemplating early retirement or relocation, while one in five fear they can’t maintain their clinics more than six months.

Our news conference on Tuesday about the crisis in family medicine received excellent media coverage. You can review the news conference recording (or watch the Q&A session) as we highlighted new data measuring the extreme financial instability and threat to viability facing family and rural generalist physician practices. 

We were pleased to see the Alberta Health Bulletin issued earlier today announcing that enhanced virtual care codes for mental health services provided are now live. 

The situation in family and rural medicine isn’t just bad – it's dire. That’s what I told reporters earlier today at a news conference we held to share the results of last week’s survey of family and rural generalist physicians regarding the state of their practices and finances.

Through the holiday season and into this early new year, we have advocated ceaselessly for your needs with government, in the media and through social media. 

As you know, we’ve been advocating intensely and continuously to stabilize family and rural generalist practices in Alberta. I also promised you that there would be more information coming about AMA proposals to government to address the parallel crisis in acute care. 

The AMA has been advocating ceaselessly for virtual code changes to be implemented as promised under our agreement. Our mental health system is in deep and increasing distress. Making it possible for physicians to provide a broader scope of virtual care to these patients is not only logical, it’s essential.

There are two things I wanted you to see before 2023 comes to an end.

• Campaign materials – Save Family and Rural Generalist Practices
• First action to address the crisis in acute care: Finding flexibility and solutions in Alternative relationship plans

This afternoon I joined Minister of Health Adriana LaGrange and Premier Danielle Smith at a news conference to announce that government will apply $100 million to immediate stabilization of family and rural generalist physician practices.

The calendar year may be running down but our advocacy to urgently stabilize family physician and rural generalist practices is still at full throttle. As you know, intense discussions have been underway for weeks.

Our AMA agreement includes a letter of commitment for restoration of Good Faith claims, but the terms were not something that physicians could live with. Between the burdensome manual process and gaps in coverage for patients, it just wasn’t going to fly. 

AMA members are fully behind our fierce advocacy for primary care and our efforts to save and support family physician and rural generalist clinics. Everyone agrees the system has no future without this foundation.

There is a lot going on! It can be challenging to keep members well informed about all that we are doing, so we’ve created a page on the website with a list of the key activities currently underway and what’s happening in each, including primary and acute care, agreement implementation and the health system reorganization.

Earlier this month, the Minister of Health announced a plan for what is being referred to as the Health System Refocus. I provided some information on this development in an earlier President’s Letter, and I have been actively engaged with government, AMA members and the media discussing some of the pros – and a lot of the potential cons – of this approach.

In the time frame of Budget 2024, Minister LaGrange has committed to stabilization and restoration of family medicine and rural generalist care.

Yesterday we cut through the fog created by government about who provides primary care in Alberta. Our colleagues across the health care spectrum deserve respect and support.

In February the government will introduce its budget for the 2024-25 fiscal year, and we are working to ensure that commitments made to support family medicine and rural generalists form part of the priorities that are included in that plan.

The Local Doctors, Local Issues tour has allowed me to engage with hundreds of physicians across the province and I continue to be impressed by your passion and insight. Wednesday night nearly 400 members joined our virtual town hall.

You are likely already aware the government has now unveiled plans to “disaggregate” health care services in our province. This restructuring will ultimately see the establishment of four separate crown corporations responsible for various aspects of health care

Yesterday afternoon, mid-way through my provincial Local Doctors, Local Issues tour, I held a news conference to broadcast what members have told me about changes needed in our health care system.

On October 16, I launched the province-wide Local Doctors, Local Issues tour to re-connect with members and raise awareness changes needed in the health care system.

I have signed a Memorandum of Understanding with Minister of Health Adriana LaGrange that was referenced in last week’s release of the Modernizing Alberta’s Primary Health Care System (MAPS): Strategic Advisory Panel Final Report.

Earlier today, the Minister of Health released Modernizing Alberta’s Primary Health Care System (MAPS): Strategic Advisory Panel Final Report. Many of you were involved in extensive consultations that formed the basis of this report, and we have been waiting anxiously for its release as family medicine and primary care have continued to erode in Alberta.

Last week I met with Minister of Health Adriana LaGrange to discuss the ongoing crisis in family medicine and the proposal the Alberta Medical Association has submitted to address it.

As I begin my AMA presidency, I have been thinking a lot about where things stand and the year ahead of us.

This is my last President’s Letter. Tuesday evening, at the AMA’s 118th Annual General Meeting, I delivered my valedictory address with thoughts at the end of my term.

The Fall Representative Forum marked a major milestone in terms of the AMA’s Income Equity Initiative. Delegates expressed strong support for IEI and use of the Income Equity Measure to guide AMA decision making.

The Representative Forum meeting last weekend included a candid session with Minister of Health Adriana LaGrange. The minister addressed the RF and then took questions from the delegates.

Progress continues toward implementing the agreement. Top-ups to the one-time recognition payments that were issued in December of 2022 will be made this week.

I wrote to you May 31 regarding the fact that our laboratory medicine colleagues have been without a contract for five years despite our continued efforts to advance one. Alberta Health Services agreed last May to the AMA’s proposal for arbitration and this is now scheduled to take place in November.

The Board meets next week in final preparations for the September 22-23 Representative Forum. The RF’s guidance will be more important than ever at this time and in this environment.

The 2023-24 annual membership renewal statements will be sent to all members next week. After five years of frozen AMA membership dues, the Board has decided to increase dues for some membership categories. This will help the AMA to continue providing support to members in these increasingly challenging times.

Last week, Minister LaGrange announced that Alberta Health Services has signed a memorandum of understanding with the ownership of Dynalife, which will see the private provider (Dynalife) transfer all of its staff, operations and physical locations in the province to the government-owned Alberta Precision Labs by the end of 2023.

This is another brief update on activity. There has been daily contact with government and AMA senior staff. There have been meetings between primary care physician leaders (Section of Family Medicine, Section of Rural Medicine, Primary Care Networks Physician Leads Executive) and the minister. 

Alberta Health has released a bulletin regarding fee-for-service retroactive payments under the agreement. This is the second retroactive payment for the 2022-23 year. It covers the period December 1, 2022 to March 31, 2023. Payments will be made Friday, August 18. Read the bulletin here.

You will have received an Income Equity Initiative Update from our AMA Compensation Committee Co-Chairs yesterday. I am writing to encourage members to review this update including the linked videos.

I promised to keep you apprised about discussions with government. There have been numerous government meetings in recent weeks including with the Board of Directors, primary care physician leaders and senior staff. We have communicated at every opportunity that there is a deepening crisis in primary care and that action is needed now to stabilize community family medicine clinics. The minister has listened to our concerns.

After more than 30 years of service to the Alberta Medical Association, our Executive Director Mike Gormley is retiring October 1. There will be more to say about his departure, but I am writing today to let you know that the Board of Directors has conducted an exhaustive search and appointed his successor.

An AMA-Alberta Health Alternative Relationship Plan Working Group will begin meeting in September, as provided for under our agreement. This is essential work to remove many barriers that have existed in developing and implementing ARPs.

Community practices across the province are imploding and must be stabilized. We have been meeting with Minister of Health Adriana LaGrange and her team. The crisis in family medicine is the first priority at every table and it appears we are being heard.

The Board and I have provided briefing materials and have had numerous interactions with Minister of Health Adriana LaGrange in recent days. AMA senior staff are also in contact with their counterparts at Alberta Health and Alberta Health Services.

There have been multiple media reports regarding the resignation of Dr. Esther Tailfeathers from the AHS Indigenous Wellness Core. The AMA immediately commented on this with the essential voice of our Indigenous Health Committee. I also made a statement to commend a group of AHS physicians who courageously penned an open letter to media.

Connect Care is one of the topics about which members contact me frequently. The Specialty Care Alliance recently conducted a survey to assess the impact on members.

With the election behind us and the new government in place, there are many things to get done. Minister Adriana LaGrange and I had a brief conversation this morning. I appreciated receiving her call.

All specialties in our profession deserve due process for contractual discussions, with access to dispute resolution when required. I am writing you today to let you know that there’s one community in particular that is still waiting to see due process: laboratory medicine.

The United Conservative Party has won the provincial election and will form the government until 2027. I have written today to Premier Smith to congratulate her on the outcome of the vote.

The final component of our election information program is hearing from the two major parties in response to the questions we posed in our seven-topic Handle With Care series. You can find their answers here.

Last night the AMA hosted a virtual patient town hall about health care with Ms. Danielle Smith and Ms. Rachel Notley. The video is now available for viewing. More than 2,200 patients joined the virtual event on a long weekend Monday evening.

Every day, angry and frustrated members write to me about their financial challenges. I understand. I have the same issues. But we are the AMA. We don’t approach challenges as an organized labor group would. Negotiating fair and competitive compensation is a most important Key Result Area, but we seek to do this in a way that benefits patient care. 

Today we release the final issue of our election information program Handle With Care. The primary care profile addresses: the state of family medicine; the need to sustainably support clinics and family physicians that are in crisis; and the value of providing every Albertan with a medical home.

Recent years have caused at-risk individuals in cities and towns to become homeless or lose access to support for substance use disorders or mental illness. While they have struggled to get the help they need, increasingly toxic street drugs have taken a horrible toll. We lost 1,498 vulnerable Albertans in 2022 to unintentional drug poisoning. In 2019 that number was 626. 

Today is National Physicians’ Day. A day to celebrate the contributions of the extraordinary people who choose to serve in the medical profession. 

The most recent issue in our Handle with Care election information program explores Indigenous health. By almost every measure, First Nations, Inuit and Métis Peoples in Alberta experience poorer health outcomes as a result of ongoing health inequities and barriers to care. This is evident in higher rates of chronic illness, mental health challenges and addiction. It’s unacceptable that this reality persists in 2023.

The Canadian Resident Matching Service (CaRMS) reported an unprecedented number of unfilled family medicine spaces in Alberta in their round one match this year. 

The Community Information Integration and Central Patient Attachment Registry (CII/CPAR) enables physicians and their teams to share patient information to Alberta Netcare directly from their electronic medical record (EMR).

The latest issue in our Handle with Care election information program is Rural Health Care. Pick almost any topic in health care and you will find the environment is more complicated or resources more scarce in rural settings. It’s the nature of rural medicine but it’s more difficult than ever right now.

The Joint Physician Advocacy Committee seeks to understand member issues in practice and advises the AMA on our advocacy activities. JPAC has found that while there are many things that physicians need as professionals, we also have needs as individuals.

The third issue of the AMA’s election information campaign is Pediatric Mental Health. This care deficit issue deserves a lot of attention.

The AMA Agreement package includes an AMA-Alberta Health Services Memorandum of Understanding with an Engagement Framework for physician compensation in AHS facilities. The AMA has been advocating for this approach, including: consistent, transparent principles; structure that guides policy according to system objectives; clear roles and responsibilities; physician engagement; and dispute resolution.

Alberta Health sent a bulletin today letting physicians know that the year one allocation has been completed and a new Schedule of Medical Benefits has been issued. These changes are already reflected in the AMA’s Fee Navigator® and we’ve put together background information (member login required), including a short video, about the allocation process.

Last week we launched our pre-election information program to help keep health care front and center during the election. There are seven main issues that are important to physicians and their patients. Today we release the second issue: Health Human Resources. We conclude with three key questions for candidates and political parties to answer.

I’ve received many emails from members regarding the first round CaRMS results. 

An overview of unfilled positions in the 2023 R-1 main residency match and information on international medical graduate eligibility.

I am writing to share with you information about the 2022 Medical Liability Reimbursement top-up payments that will be issued shortly by Alberta Health.

The first round CaRMS numbers from last week are alarming. We have 42 unmatched family medicine residency positions in Alberta. In BC there are two; in Saskatchewan, none.

Today we launch a public information program to help ensure that health care remains front and center for Albertans in the coming provincial election. 

The 2022-23 Continuing Medical Education Program provides a benefit of $2,200 per physician and is administered by the AMA.

Government is moving forward with the Modernizing Alberta’s Primary Health Care System (MAPS) initiative. 

The Representative Forum held a productive two-day meeting March 10 and 11 in Calgary. 

Following media reports on a study that identified explicit anti-Indigenous bias among some Alberta physicians, I have released a statement.

Media reports over the weekend highlighted a 2020 study by colleagues at the University of Calgary that found significant presence of explicit anti-Indigenous bias among some physicians who participated in the survey.

Members have commented about a recent media event with the Premier, Minister of Health and Alberta Health Services Official Administrator. At this public relations event the OA outlined progress on his mandated tasks relating to reduced surgical wait times, emergency room wait times and emergency medical services response times.

Yesterday’s budget includes new funds for a health care system under stress, but it is difficult to determine how much. For example, health spending grew significantly in the past year, but that growth is measured against a period of fewer services for many patients due to the global pandemic. 

The two major parties have both released statements about primary health care. Polling suggests that health care will dominate the general election (May 29 or earlier) and the provincial budget (Tuesday, February 28).

There is a new Alberta Health Bulletin regarding 2022-23 retroactive payments for physicians in clinical alternative relationship plans, Academic Medicine Health Services Program, sessional clinical alternative relationship plans and Blended Capitation Model. Each category has a payment schedule that is explained in the bulletin.

Government has announced short-term recommendations from the Modernizing Alberta’s Primary Health Care System (MAPS) initiative and funding for primary care in the provincial budget. We see generally good news, if somewhat short on details, to ensure we support sustainable family practice and move primary care in the right direction.

The MAPS initiative, an Alberta Health initiative involving numerous professions and organizations, is progressing. I thank the expert physician leaders who have worked for months to develop AMA proposals to improve the primary care system. 

The Joint Physician Advocacy Committee advises the Alberta Medical Association about our public advocacy. They have suggested that the AMA should tell the public more about how the system works, what’s happening and how physicians contribute. There are two streams: (i) Family Medicine and (ii) Acute and Hospital Care.

Yesterday the federal government announced a proposed new health funding framework with the provinces and territories, prioritizing primary care, health workforce wellness, health human resources and innovation toward sustainability.

There are always many things going on in the AMA and I like to keep you informed about our current priorities even if the next steps or outcomes are still unknown. The Board of Directors is meeting today and Friday in Calgary to be briefed and provide direction on many issues for the profession.

The Modernizing Alberta's Primary Health Care System (MAPS) initiative has been set up to recommend short- and long-term actions to strengthen primary health care in Alberta.

Today I am releasing our latest tracking data on the care deficit and the impact on patient care disrupted by the pandemic. This survey took place in November 2022 and we have been tracking the care deficit since summer 2021. You can read the albertapatients.ca full report, but here are the highlights compared to March 2022. 

Knowing how highly regarded she is by physicians, I wanted to let you know that our Immediate Past President Dr. Vesta Michelle Warren, is being recognized with a Queen Elizabeth II Platinum Jubilee Medal.

The first of two fee-for-service retroactive payments for the 2022-23 fiscal year will be deposited January 13, 2023. Alberta Health has released a bulletin with details on this retroactive payment, including timing.

I have heard from many of you with concerns about the increasing number of independent pharmacist clinics in the province. This is an important issue. I wrote a letter to the editor on this topic that appeared in the Edmonton Journal on December 31. You can read it here.

Letters to the Editor, Edmonton Journal: We understand that the ongoing shortage of family physicians causes patients to consider other providers to assist with their primary care needs. We are working with government, under our agreement in the Modernizing Alberta’s Primary Health Care System (MAPS) initiative, to seek short- and long-term solutions to support patients.

In these last days of 2022, the Board of Directors has one message for the membership of the Alberta Medical Association: You are all heroes.

Government tabled legislation 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.

I want to share with you a letter of thanks that was sent to the Canadian Medical Association on behalf of all members of the AMA last week.

The agreement provides for an increase of the Business Costs Program rate from $2.95 to $3.59. This change goes into effect tomorrow, December 16. Current BCP program assessment rules remain the same.

The one-time payment will be issued by end of December. Most physicians will be eligible for the full payment. 

Currently there are two separate Continuing Medical Education (CME) benefit programs to consider.

Today government has tabled legislation to repeal Section 40.2 of the Alberta Health Care Insurance Act. 

In case you missed it, Alberta Health published a bulletin announcing that effective December 1 (today), the daily cap on the number of services a physician can fully bill for will be officially lifted. 

I wrote to you briefly on November 2 and more details are now available. I have noted below things that you need to know or do at this time. For those who want to read more, links are provided for each item.

Since our agreement with government was ratified, we have been making progress on various pieces of implementation.

Today the government announced that the Board of Directors of Alberta Health Services has been replaced by an administrator. We thank the AHS board for their service. 

As school settles in and respiratory viruses surge, the AMA has been advocating on social media platforms to encourage Albertans to take preventive precautions, including masking in crowded venues and vaccination for COVID and seasonal influenza.

View important details about one-time payment, Medical Liability Reimbursement and Continuing Medical Education.

In December we presented government with our Acute Care Stabilization Proposal, a comprehensive framework that will align payment models and incentives and help to stabilize acute care so that Alberta can once again be competitive in terms of physician retention and recruitment.

Two fall 2023 stabilization proposals – and months of advocacy – were an SOS call to the Government of Alberta from Alberta’s physicians. I’m sorry to say that there has been no answer. 

The urgency is real and compounding. We need the Physician Comprehensive Care Model approved, formally announced and implemented before fall.

After many months of intense work and consultation with member stakeholders and web experts, I am thrilled to let you know that the AMA has launched a new and improved website. 

This letter is for those who prefer very brief updates. Read on for information on items that members have inquired about.

The Board of Directors met Thursday and Friday, September 27-28. This was our first meeting since the new agreement was ratified and an opportunity for assessing where we are and why as we move into implementation.

As we adjust to the welcome realities of a post-negotiation environment and having an agreement with government, I want to assure you that our advocacy work will continue. Our health care system is still under immense pressure. As physicians, we have a responsibility to help Albertans understand what is happening and what is at stake. Our Care Deficit Assessment Series (CDAS) has explored some of those system-wide issues, including the crisis in emergency departments, children’s mental health and care of the elderly.

As I begin my term as president, I would like to thank the membership of the AMA for your vote of confidence. This is an honour that I certainly wouldn’t have expected myself. Hopefully, I will prove worthy.

At Monday’s Annual General Meeting, I began my term as AMA president. It is a privilege to face this year with you as we begin a new agreement with government in the midst of an ongoing health care storm. There are many priorities, but I believe there are three key things that will be essential, and I will write to you again in the next few days to comment further on these.

When I became president of the AMA in September 2021, I was told that the year would go by fast, yet I am still astonished at how quickly it has gone. Serving as AMA president has been altogether the most challenging, humbling experience of my life.

Voting closed today at 4 p.m. for the 2022-26 agreement package just negotiated with government. I am pleased to report that members ratified it with a “Yes” vote from 70.2% of responding physicians. (Voter turnout was 45.8%. While turnout was higher for the package that members rejected in 2021, today’s result is significantly higher than recent ratifications.)

You may recall that I have been engaging with the seven candidates for the leadership of the United Conservative Party in recent weeks. I have met now with five and meetings are booked for the remaining two.

Members tell the AMA that one of the most important things we do is help the public better understand the health care system from the front lines. As promised in my letter last week, advocacy will continue as members consider the potential agreement package and beyond the vote, regardless of the outcome. This advocacy work helps focus attention on critical health issues so we can work together to ensure Albertans receive the care they need, when and where they need it.

In the March 25 President’s Letter, I wrote to you about the overhead (office expenses) study under the Income Equity Initiative. Concerns have been raised by the Representative Forum and sections about the results provided by Deloitte. In response, the Board has formed a small working group with delegates from the Specialty Care Alliance and sections of General Practice and Rural Medicine. The working group will review what has been provided and then recommend (i) what, if any, elements of the study are usable and (ii) next steps for ensuring usable overhead information for use in the IEI.

Like me, perhaps you have lately observed a surge of headlines, reports and journal articles like these: "Why focusing on professional burnout is not enough", "Task force launched to tackle sexual harassment", "Addressing gender equity and diversity in Canada’s medical profession", "Understanding how patients perceive physician wellness and its links to patient care", "Most doctors have little or no management training, and that’s a problem."

At our annual planning retreat in a few weeks, the Board will be bringing together months of environmental scanning, analysis and discussion around the Board table. We will be planning for the year ahead in the interests of members and with a new government. Today I wanted to give you a sense of what that has involved.

You may have seen an update bulletin from the Physician Compensation Committee today, including reference to the recent Deloitte overhead study and the committee’s discussion. As I wrote to you April 25 in a President’s Letter, the Board of Directors formed a small working group in response to concerns raised by the Representative Forum and sections about the results provided by Deloitte. The working group was asked to review what has been provided and then recommend (i) what, if any, elements of the study are usable and (ii) the next steps for ensuring usable overhead information in the Income Equity Initiative.

In June, the government cancelled construction of the Edmonton laboratory hub lab project and is currently exploring the needs of the province for laboratory services. Yesterday, the Canadian Society for Medical Laboratory Science added its voice to support appropriate investment in this area. We wanted to update members with our own assessment of the situation and to let you know what the AMA and Section of Laboratory Physicians have been doing.

I’m writing as promised in my July 9 President’s Letter to provide all members with a copy of the Overhead Working Group Assessment and Review Report regarding the overhead study commissioned by AMA and Alberta Health for the Income Equity Initiative. It is available here: https://www.albertadoctors.org/leaders-partners/income-equity/related-documents (member login required).

The Alberta Medical Association advances patient-centered, quality care by advocating for and supporting physician leadership and wellness. Most of the time, this requires collaboration with others in the system. Relationships matter – and the one between the profession and the Government of Alberta is one of the most important. As I look back over the past few months with our new government in place, I wanted to share a few thoughts with you.

Yesterday you will have heard about the release of the Report and Recommendations of the Blue Ribbon Panel on Alberta’s Finances. The report details government’s concerns over the growth and level of health expenditures, i.e., the issue of affordability. It conveys many of the same messages contained in the government’s election platform, although the focus there was more on value for patients and included creating a medical home for each Albertan, as well as issues related to seniors’ care, mental health and addiction.

AMA/CMA renewal notices will be sent out later this week. AMA and CMA dues remain unchanged from last year and we want to remind members that, starting this year, membership in the CMA will be optional for Alberta physicians. Through our renewed partnership, the AMA and CMA are working together to advance our shared priorities and to advocate for physicians at the national and provincial levels, and that is why we want to encourage all AMA members to continue to support the CMA when they renew this year.

The all-party Standing Committee on Resource Stewardship is conducting a review of the Public Sector Compensation Transparency Act, better known to physicians as the sunshine list legislation. The bill became law in 2015 and provided for regular legislative reviews. The committee has invited public submissions to inform its 2019 review and the AMA was asked to comment.

This week we will hold the 114th Annual General Meeting of the Alberta Medical Association, in conjunction with our Fall Representative Forum. We will have many discussions at both events about the challenges and opportunities facing physicians in caring for our patients.

As my tenure as President comes to a close, I find myself reflecting on a challenging and rewarding year. Looking back, I am proud of what the Alberta Medical Association tackled this year.

It is a great honor to represent our profession as AMA president. I have been a physician for 43 years. I have practiced my dual specialty in Calgary at the Foothills Medical Centre and in EFW Radiology’s community clinics for 34 years. I now come before you simply as a physician devoted to our profession.

Many of you will have received an Alberta Health Services bulletin last week: Physician On-Call Program Changes Effective October 1, 2019, that highlighted changes in the number of on-call categories from five to three, and a reduction of stipends paid for those services.

On November 3, Alberta Health Services will launch the first wave of Connect Care in the Edmonton Zone. Supported by a fully integrated clinical information system, Connect Care will consolidate the patient’s story, including goals, problems, plans, investigations, treatments and all prior AHS health records. Connect Care is the AHS record of care.

Government has tabled legislation: Bill 21 Ensuring Fiscal Sustainability Act. This omnibus bill amends a number of statutes. Having received it late Monday afternoon, we have been exploring its implications. There are important provisions relating to the Alberta Health Care Insurance Act.

Our rural physician colleagues have recently been in the media with concerns related to reductions in on-call payments by Alberta Health Services. Our rural members, who are already stressed by a heavy burden of service, know that reducing on-call support will make it even more difficult to recruit and retain physicians to rural areas.

On November 7, a United Conservative Party MLA tabled a private members bill: Bill 207, Conscience Rights (Health Care Providers) Protection Act. I wanted you to know that I have written to Minister of Health Tyler Shandro to express the opinion that this legislation is unnecessary and inappropriate. You can review my letter here.

This is in regard to recent developments in our negotiations with government that are deeply concerning for the profession. I want to provide you with information regarding what government has proposed, what work the AMA is doing to review these proposals and how you can contribute. On November 14, government tabled several proposals which, in their view, were outside the negotiations. They asked the AMA to respond by November 20 as to how we would like to be consulted.

The special meeting of the Representative Forum took place on Saturday, December 7 in Calgary. Delegates received a full update on the current negotiations with government for a new financial agreement. There was a presentation on the evolving AMA response to the 11 consultation proposal items that government has released and that were the subject of my November 29 President’s Letter. The RF also endorsed the Board of Directors’ proposed plan to respond to these challenges and ensure that government hears our concerns.

On December 9, the Health Quality Council of Alberta (HQCA) released its Final Report of the Crowfoot and Taber clinics case study evaluation.

I am writing today to provide a brief update of the work and activities that have taken place since the Special RF on December 7.

On November 14, the Alberta government tabled several proposals, which they considered to be outside of negotiations, and gave the AMA until today (December 20) to formally respond. We received feedback from over 1500 physicians and I am writing today to provide members with the AMA’s response to the Alberta Health and Alberta Health Services Insured Services Consultation proposals.

Last Friday you will have received a copy of the AMA’s final response document for government’s Insured Services Consultation. The December 20, 2019 President’s Letter is on our website if you missed it. It contains our perspective on the consultation items.

I will provide you with updates on discussions with government and negotiations frequently in the weeks ahead.

Within the set of 11 insured services consultation proposals that Alberta Health provided to the AMA on November 14, proposal 8 plans to eliminate some stipends that are currently paid to physicians practicing in AHS programs.

Our negotiations with government are moving to a new stage. We have been at the negotiating table since November 2019. While we have seen some advances in recent weeks, both sides have agreed that discussions would benefit from mediation. A mutually agreed upon mediator has been appointed this week with the first mediated discussion occurring today. Meetings are currently scheduled to the end of February.

Today government released the long-awaited Ernst & Young summary report of Alberta Health Services Performance Review. We have had a little time to review it, but much more time will be required given the scope and the potential implications.

The 57 recommendations in the Alberta Health Services Performance Review are a compendium of cost-cutting opportunities that purport to improve value in health care by either reducing cost with no impact on quality of care, or by reducing cost and improving quality. It’s an interesting concept. We can understand the exercise of looking at the current state and seeking efficiencies; the report provides many ideas to consider. The picture is still incomplete, though, if we don’t also look at what the health care system needs to deliver for patients today and in the future.

 As reported last week, Alberta Health and the AMA have brought in a mediator to assist with negotiations. There is still a long way to go, but I believe it is positive that both parties are doing what they can to reach an agreement.

In my President’s Letter last Friday, I shared our negotiations objectives and what we consider to be key requirements for reaching a deal with government: Better information – government is using misleading physician payment figures Clear vision required – a lot of ideas out there, they need to be brought into focus; Provincial physician compensation strategy – essential for true system improvement; A way to deal fairly with physician supply and control practitioner ID numbers. Today I would like to focus on the first requirement: better information.

On January 31, I wrote to inform members that our negotiations with government were moving to mediation. Unfortunately, that voluntary mediation process was not successful.

 write to you today with great concern for our public health care system in Alberta. Today, the Minister of Health announced that government is ending its master agreement with physicians and enacting the 11 consultation proposals they tabled in November of last year. I wanted to share with you the following statement that we have issued in response.

The termination of our master agreement is an outrageous action that must be challenged. Government is putting physicians and patients at risk. The AMA Board met last night and will meet again Sunday. We are reaching out to all sections and zone medical staff associations to discuss: legal options;  plans for engaging the public; the results of our surveys (“Yes” patients overwhelmingly value their time with their doctor and feel that sometimes more is needed; “No” patients don’t agree with the tearing up of contracts); and next steps needed to get government’s attention.

Tomorrow government tables its latest budget in the Legislature. This event will generate a lot of noise in the media and spark further public debate. We do not expect a significant change to our situation. Government has torn up the agreement with the profession and continues with some ill-conceived changes that will be destructive to your practices and to our health care system.

Government has tabled its second provincial budget. The budget reflects the devastating cuts to physician payments that were announced last week and the hostile action of this ministry in tearing up our Alberta Medical Association contract.

Government has unilaterally terminated our agreement and imposed their dictates on the profession. My February 26 President’s Letter provided a list of actions and activities that the AMA is undertaking in response. Today, I provide an update on a number of those items.

I am pleased to advise you that discussions continue next week with the Alberta government in an attempt toward a physician agreement that provides value for patients, fairness for physicians and affordability for the system.

The AMA has been consulting with public health leaders with respect to holding the Representative Forum in person this weekend during the current COVID 19 pandemic. (Just this morning, the World Health Organization officially announced that COVID-19 can be characterized as a pandemic.)

The COVID-19 pandemic represents an unprecedented public health challenge. During these times of crisis, adhering to the public health direction as a single source of truth is imperative.

As we push to get the Physician Comprehensive Care Model over the finish line and continue to call for immediate stabilization of our collapsing acute care system, we know that investment in health care matters. It not only matters, it’s critical.

Today we launched the third topic in our Acute Care Concerns advocacy series.

PRESIDENT'S LETTER: Today the Supreme Court of the United States struck down the landmark Roe vs. Wade ruling. While we have anticipated this possibility with dread, the actual overturning of this decades-old jurisprudence decision on abortion is much worse for women of our neighbouring nation. It may be a harbinger of further erosion of equity, diversity and inclusion in that society. The immediate effects will be felt most keenly by already marginalized populations.

This afternoon, government announced that the proposed changes to physicians’ payments for the Complex (Time) Modifier will not go ahead as planned on April 1, 2020. 

In my President’s Letter yesterday I mentioned there are issues with enabling the profession to respond to the COVID-19 pandemic. I wanted to share with you what I believe is needed in order to provide patients with the care they need.

It has come to my attention that things were said yesterday on social media and outside of it that are deeply troubling. Whether you agree with public officials or not, making personal attacks and threats on them and their families is never acceptable.

In my letter yesterday, I spent too little space on fully explaining the facts and issues around the new Telus Babylon product and the AMA’s concerns.

Good News today! Following discussions between the Alberta Medical Association and government, I’m very happy to let you know that three new categories of virtual care codes have been established so that family physicians and specialists can provide more telemedicine, such as teleconferencing and video, for an expanded scope of patient needs during the pandemic.

Today, we received the Minister's 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. 

We find ourselves in the midst of a perfect storm. Physicians are working hard in the face of the COVID-19 pandemic. 

This is a very stressful time as we enter the COVID-19 surge environment. Our normal life and work patterns are disrupted and anxiety-laden.

If you told me a year ago that I would serve the Minister of Health with a Statement of Claim for a constitutional challenge, in the midst of the worst public health crisis in a century, I would have been incredulous. Yet, that is what happened this morning.

The level of disruption in our lives and the “new normal,” doesn’t feel normal at all. We are more familiar than we ever wanted to be with things like PPE, doubling times, burnout rates, the impact of testing and isolation and the emerging data on flattening the curve.

Recently government MLAs have been in touch with members to discuss the current situation between doctors and physicians. Dialogue like this is very helpful in creating common understanding of the issues facing physicians and Albertans at this time.