New rules will guide Alberta doctors who want to leave a practice or take job action
Specific steps must be followed before a physician can take job action, college says
Physicians who want to withdraw services or leave Alberta due to the ongoing dispute with the provincial government have new rules to follow to ensure patients don't get caught in the middle.
A controversial draft proposal that would have compelled physicians to stagger their resignations from a clinic or hospital department did not make the final version.
"It's hard to be able to put those sorts of rules in place in a standard when it varies so dramatically depending on the clinical situation that you're dealing with," said Dr. Scott McLeod, registrar of the College of Physicians and Surgeons of Alberta (CPSA).
For example, McLeod said it would be impractical to ask spouses who shared a medical practice to stagger their departures.
The standards for job action and closing, leaving or relocating a medical practice were approved by the CPSA council earlier this month after a one-month consultation. They take effect Jan. 1.
The CPSA believes the new standards of practice provide clarity for members while balancing patient rights.
"It ensures that the average Albertan does not get pulled into a negotiation ... and their health becomes in jeopardy as a result of it," McLeod said.
"If there is a debate or a negotiation between government and physicians, it's important that Albertans are still getting safe, high-quality care."
The new standards of practice are being implemented while the Alberta government remains locked in a bitter dispute with physicians.
Last February, Health Minister Tyler Shandro imposed a new compensation framework after unilaterally ending the province's master agreement with the Alberta Medical Association.
Since then, physicians have either resigned or threatened to leave practices in smaller centres like Pincher Creek, Ponoka and Lac La Biche.
In June, Shandro directed the CPSA to change its practice standards to prevent rural doctors from resigning en masse.
Shandro wanted a response by July 20 but the college convinced him to allow time for the changes to go out for consultation.
A total of 342 physicians commented on the proposals between Sept. 15 and Oct. 15. McLeod said the level of engagement was second only to the consultation for the standards of practice for medical assistance in dying.
Job action not prohibited
The new standards set out measures a physician must take before leaving a practice or taking job action.
Withdrawing services as part of a negotiation must be a measure of last resort after every alternative has been exhausted, the document says. Any physician contemplating such action must ensure there is backup medical care for their patients. They also must provide "reasonable" written notice to the hospital or health authority.
"An entire group of regulated members or an entire hospital department must not engage in a withdrawal of services for the purpose of job action unless all the requirements of (the earlier clauses) are met," the document says.
McLeod said the standard of practice doesn't prohibit physicians from taking job action, but lays out steps that must be taken first.
"If you're going to do it, you have to do it in a way that you don't put the public at risk," he said. "And that's our professional responsibility."
Lorian Hardcastle, an associate professor of law at the University of Calgary, said the standards make the situation murkier for physicians.
Hardcastle said it isn't clear how the college will determine what rules should apply to a physician who decides to leave a practice. A doctor may decide to move to another province for family reasons or a job offer while publicly expressing frustration with the dispute with the government, she said.
"How do we know if it's a job action or you're merely closing or leaving a practice?" Hardcastle asked.
"I don't know how (CPSA is) going to filter people into one bucket or the other when many people leave for multiple reasons."
The other issue for Hardcastle is how physicians in more remote areas will be able to meet the prescribed standards for ensuring backup coverage for patients.
Dr. Paul Boucher, president of the Alberta Medical Association, said physicians will be watching to see how the CPSA applies the standards.
As for job action, Boucher said no physician would ever make that decision on a whim.
"The well-being of our patients is essential to all of us In the medical community," he said."There needs to be a balance there ... when people get put under conditions that are untenable, that they have the ability to do something about that."
Talks are continuing between the AMA and the Alberta government.