Alberta physicians express alarm over proposed health-care bill

Alberta doctors are speaking out against a new health-care bill introduced by the provincial government.

Bill 30, the Health Statutes Amendment Act, proposes to cut approval times for private surgical facilities, allow the ministry to contract directly with doctors and allow private companies to take over the administrative functions of physician clinics. 

The changes affecting physicians' pay come after the government terminated the master agreement with the Alberta Medical Association in February.

At the time, the health minister said ending the agreement was a necessary move because the province was at an impasse with doctors over how to reduce costs and improve service in the $20.6-billion health system. 

If passed, Bill 30 would allow doctors who so desire to move away from the fee-for-service model, where they bill for each patient visit, and instead sign contracts and be paid salaries.

In a letter to members dated July 7, AMA president Dr. Christine Molnar said it's concerning the association was not consulted about Bill 30, but there are some positive aspects among its many provisions.

"Most notable is the increased opportunity for Albertans to participate in their health-care system. There is an increased focus on patient-centred care," she said in the letter.

Molnar said the AMA's board of directors would hold a special meeting Wednesday evening to go over the legislation.

"We will also consider the findings of last week's member survey, which points to clear distress in the profession," she said. 

Dr. Christopher Ewing, an Edmonton pediatrician,  says he has been scouring Bill 30 and is worried about what it contains.

"First reaction from me is that this is the start of further privatization of the health-care system, which we've been advocating against for many months now," he said.

The bill would make it easier for private surgery facilities to set up shop as well as allow the ministry to contract directly with private companies to run medical clinics.

Dr. Kerri Johannson, a lung specialist with the University of Calgary, says the bill seems to be the UCP's tool for privatizing health-care services in Alberta.

"And what we as the medical and health-care community are concerned about is that this will compromise the care of patients in Alberta," she said. "Anytime you bring privatized services in, it places the emphasis on profit rather than patient care."

Johannson says privatization of health care will lead to multiple tiers in the quality of care available to patients.

"This is not a pathway that we as Canadians value or one that we want to go down," she said.

Lorian Hardcastle, an assistant professor at the University of Calgary who specializes in health law and policy, also says the shift toward increasing private delivery options is concerning. 

"Wait times in the public system can tend to get longer because, of course, there's a finite number of doctors and a finite number of hours that they have in a day," she said.

"The concern is that these patients with less complex medical needs will be seen quickly in private facilities. Whereas, others will end up waiting longer in the public system."

The bill also proposes to make it easier for physicians to negotiate individual contracts — called ARPs — directly with the government.

These agreements move doctors away from fee for service to a salary model. But Bill 30 would see physicians negotiate without the Alberta Medical Association.

Johannson says the problem is the provincial government lost the trust of doctors when it tore up their agreement with the AMA.

"Nobody is going to sign that directly with the UCP government at this point without going through the Alberta Medical Association, because we don't trust them."

Johannson and others are calling on the province to resume negotiations with the AMA. 

Calgary family physician Dr. Brendan Vaughan also says trust has been broken between physicians and the provincial government. And he says this bill fails to address that.

"The way that they've proceeded to terminate the master agreement really failed to even address the fact that physicians are quite concerned about that, and then ultimately have made signing a contract directly with the government — bypassing the AMA — easier, when in fact that is precisely the thing that physicians are less confident than ever to do," he said.