Alberta government to remove cap on doctor daily visits

When Dr. Omid Pour-Ahmadi arrives each day at the SantiMed Family and Walk-In Clinic in northeast Calgary, he's greeted by a line-up of patients — and some of them have been waiting for hours.

A provincial daily cap on the number of patient visits each doctor can be fully paid for requires patients to arrive early if they want to be seen, Pour-Ahmadi says.

On Monday, all doctors at the clinic had reached their caps by 2 p.m., and staff closed the doors early.

"It's tough. It's really tough," he said.

Earlier Monday, Health Minister Jason Copping announced the government would be removing that visit cap — at least temporarily — until March 2023, while they evaluate the effect of the change. It should cost about $22 million per year.

"The intent was to promote quality care and safety for patients and physicians," Copping said at a virtual news conference Monday. "And those are valid goals. But the impact of the cap was limited, and we think it's outweighed by the need to support access for patients."

The United Conservative Party government introduced the cap, along with other changes unpopular with doctors, when they unilaterally terminated a master agreement with the Alberta Medical Association (AMA) in February 2020 and imposed a new contract.

That contract said doctors who had more than 50 visits with patients per day would get paid half their fee for any additional work, and could charge no fee at all once they saw more than 65 patients. It was supposed to be a cost-saving measure that prevented doctors from burning out.

Copping said Monday it caused problems.

Specialists like ophthalmologists, for example, would perform multiple tasks in a day with each patient, which quickly racked up the number of visits they could bill for.

Meanwhile, doctors say billing codes have stayed relatively flat while inflation drives up their costs of running clinics.

AMA president Dr. Fredrykka Rinaldi said Monday some physicians went out of business, closed their clinics, moved away, or took lower-risk jobs.

It became more difficult to find a family doctor in Alberta. Some clinics tried extending their hours into the evenings to meet demand.

"When you ask physicians to open extra hours, and they've already hit their caps during their daytime hours … we're not Florence Nightingale," Rinaldi said.

Patients who can't get into clinics are turning to emergency rooms, which are more expensive and overrun, Copping said.

Copping said as soon as the government can update the medical billing system, the government will lift the cap. This should help get more patients into primary care waiting rooms and out of emergency rooms, he said.

Until they see the effects, they won't commit to extending the change past next March, Copping said.

Other issues outstanding

When the AMA inked a new agreement with the provincial government in September, many disputes remained unresolved. The parties committed to striking committees to negotiate the details later. The agreement committed the government to revisit the issue of the cap within 60 days of the agreement signing.

Dr. Mareli Powell, who practises in both Fox Creek and Edmonton, was "very pleased" the visit caps are going away for now. The president of the North Zone Medical Staff Association said it shows the relationship between the government and doctors is improving.

However, Powell says the change should be permanent immediately.

"The fact that this will be reassessed will not assure doctors that this is a stable province to practice in, and that is what we need at this stage," Powell said.

The long-term solution to climbing demand is to improve doctor retention in Alberta and recruit more physicians, Powell said.

In the agreement, doctors will also receive a one per cent lump sum of cash to recognize their efforts during the pandemic, and about a one per cent pay raise for each of three years.

The agreement also commits doctors and the government to review and adjust their pay rates for all services by 2025, and postponed a discussion about pay for virtual visits.