Myth: Government does not respect Alberta’s doctors.

Fact: The Government of Alberta values and respects the work of Alberta physicians. Respect should not be viewed as analogous to compensation. The Government of Alberta compensates physicians fairly and generously. The $5.4 billion budget for physicians represents about 10% of the entire Alberta government’s expenditures. Given the economic crisis the province is in, it is not unreasonable to seek a greater ability to control future increases in the physician compensation budget.

Myth: Government refuses to work with the AMA.

Fact: Government continues to interact regularly with the Alberta Medical Association (AMA).  The Minister and his delegates have met with the AMA President and representatives each time they have requested a meeting. Alberta Health staff also meet regularly with the AMA staff and physicians on operational items. These meetings have resulted in primary care improvements, alternative relationship plan improvements and new fee codes to provide virtual care during the pandemic.

Government files Statement of Defence (PDF, 274 KB)

Myth: Government is not willing to listen to physicians and continues to implement all the changes announced as part of the physician funding framework.

Fact: Since announcing its physician funding framework, government has continued consulting with both the AMA and physicians. Government is carefully monitoring any impacts on physician compensation and health service delivery. It has been responsive and has made adjustments as necessary, for example the decision to rescind changes to complex modifiers. It has also exempted photo light therapy and group therapy codes from the daily cap, made changes earlier than intended to the Rural Remote Northern Program (RRNP) to support physicians financially to practice in rural areas, and delayed overhead changes.

Of the 11 consultation proposals, the AMA agreed to 4.  Of the remaining 7, with the advice of the AMA, the government rescinded one (complex modifiers), and delayed 2 (overhead policy for urban physicians and clinical stipends) to allow further consultations.

Government has been responsive to the need for new virtual health service codes during the pandemic, and used the advice of the AMA in determining the addition of appropriate codes. It has also made the payment of these codes retroactive to the start of the pandemic.

Myth: Doctors are leaving Alberta because of the new physician compensation framework.

Fact: Alberta ranks amongst the highest in Canada in terms of physicians per capita.

In 2019, the number of physicians per 100K population ratio in Alberta was 254, which was above the national figure of 241. Alberta’s physicians per capita ratio has grown by 5.8% since 2015.

The number of physicians in Alberta also increased from 10,019 to 11,205 from 2015 to 2019, an increase of about 11.8%.

Table 1. Number of physicians in Alberta

Source: CIHI
Year # of Physicians Net Increase % Increase Cumulative Increase
2015 10,019 N/A N/A N/A
2016 10,294 275 2.7% 2.7%
2017 10,680 386 3.7% 6.6%
2018 10,806 126 1.2% 7.9%
2019 11,205 399 3.7% 11.8%

Between 2015 and 2019, the number of doctors in rural Alberta increased cumulatively by about 6.9% (726 in 2015 to 776 in 2019).

Myth: An agreement between government and the AMA is necessary.

Fact: Just as with other health care providers such as optometrists, podiatrists or dentists, there is no need for a formal agreement to allow government to compensate physicians for insured services, provide supports such as Medical Liability Reimbursements, and assistance through programs like Rural Remote Northern Program.

Government compensates physicians for the services they provide just like other providers, contractors or vendors; this relationship continues.

Myth: The AMA has saved government money – over $500 million between 2015-19.

Fact: While the 2016 amending agreement included cost savings measures such as Schedule of Medical Benefits (SOMB) rule changes estimated at $100 million, expenditure rates increased in each of those years. From 2014-15 to 2019-20, overall physician expenditure growth was 22.5% and the average annual growth was about 4.1% for the same period. Growth at this rate has not resulted in $500 million in savings.

Chart 1: Physician Compensation and Development Expenditures Alberta Health Ministry Consolidated ($ in millions)

Chart depicting Physician Compensation
Source: Alberta Health, figures are not restated

Myth: The daily cap of 50 visit services adversely affects physicians because they all perform 50 or more visit services in a day.

Fact: The daily cap is 65 visit services. The 66th visit service is paid $0. Visit services 51-65 are paid at 50%.

On average, a family physician performs 22 visit services per day and a specialist performs 17 visit services per day in an office. Out of 10,326 physicians providing services in Alberta in 2018-19, only 517 (5%) had one or more days where they provided 65 or more visit services. Of the 517, about 320 had less than 10 days where they provided 65 or more visit services.

A visit service takes time, and a visit with a specialist usually requires more time due to complexities. Typically, a non-complex visit service is between 10-15 minutes (government has heard from AMA that physicians do not practice 10 minutes medicine). This translates to approximately 11-16 hours, without any breaks, if a physician performs 65 visit services per day.

Government is capping the number of daily visit services to enable physicians to practice within reasonable patient loads, thereby reducing burnout, and improving patient care.

To ensure Albertans continue having access to appropriate care, the daily cap does not apply to tests, procedures, hospital or emergency visits. In addition, the daily cap does not apply to services provided in rural locations.

Myth: Clinical placements for new doctors are disappearing in Alberta.

Fact: The Government of Alberta funds both the University of Alberta and University of Calgary to deliver rural medical education programs. These programs allow medical students and residents to have experience in rural health care with the goal of increasing interest in, and ultimately choosing a career in rural medicine.

The Rural Integrated Community Clerkship provides 23 third-year medical students at each university with clinical learning in rural communities over a one-year period. In addition, the rural medical education programs at the two universities offer a rural-based family medicine program and provide over 900 medical students and residents with rural rotations in communities across the province.

While some of these placements have been temporarily paused as a result of the COVID-19 pandemic, government expects these rural learning opportunities will continue at the same level once the programs are able to return to normal operations.

Myth: All physicians in Alberta, whether family medicine (GPs) or specialists, are paid less than elsewhere in Canada.

Fact: Physicians in Alberta have the highest average gross clinical payment per full-time equivalent (FTE) among comparator provinces.

Chart 2: 2017-18 Average gross clinical payment per FTE (% Alberta Higher)

Source: CIHI National Physician Database 2018

Myth: Access to rural health care is decreasing because of government actions.

Fact: Access to rural health care is a priority and government has taken proactive action.

With the release of the Alberta Health Services (AHS) performance review in February 2020, government confirmed its commitment to keep rural hospitals open. AHS is taking necessary steps to maintain appropriate medical services in all communities.

In April 2020, the Minister of Health announced new supports to protect access to rural health care in Alberta. This includes creating one of the best incentive programs for rural physicians in Canada and ensuring rural doctors are supported financially to remain where they are.

For example, the Rural Remote and Northern Program is improved by removing the cap on the amount eligible physicians can claim. On-call rates for rural family medicine physicians with special skills has increased from $11 to $20 per hour and for rural on-call from $20 to $23 per hour.

Government is implementing service guarantee agreements for medical learners in exchange for financial incentives. It is also engaging physicians to improve health care in rural communities. These changes will ensure rural Albertans have access to safe and high quality health care.

Myth: Rising spending in the physician compensation budget is due to inflation and population growth.

Fact:  From 2009-10 to 2018-19 actual physician expenditures have gone up by 73% compared to an increase of 33% for the Consumer Price Index and population over the same period.

Chart 3: Cumulative growth of actual physician expenditures since 2009-10 (compared with the combined cumulative growth of CPI and population for Alberta)

 

Source: Financial Statement Alberta Health 2017-18
Note: Actuals reflect payments made by Alberta Health for services or grants in each of the respective fiscal years. 2017-18 and 2018-19 figures included retroactive payments for Cost of Living Adjustment; 2018-19 actuals include the $50 million paid in advance for 2019-20 CME benefit. Annual average CPI for Alberta and Alberta population size (captured by July 1 of each year) are from Statistics Canada.

Myth: The previous government made significant cuts to physician pay, already.

Fact: There were no cuts to physician pay. There were 0% rate increases, however even then expenditures increased by 5.57% on average between 2014-15 and 2018-19, due to increased billings. This is essentially more money going to physicians.

Myth: Alberta Health has not offered Alternative Relationship Plans (ARPs) to physicians.

Fact: Alberta Health offers annualized models for full-time work and sessional (hourly) models for part-time work. Alberta Health has also developed population or patient-based funding models, called capitation models, which it intends to make more broadly available once payment and health information systems have been updated. Physicians who are interested in looking into an ARP can visit www.alberta.ca/alternative-relationship-plans.aspx or contact arpinfo@gov.ab.ca

Myth: A physician should not join an ARP because they are Ministerial Orders and government can rip these up on a whim.

Fact: The current ARP Program Parameters (Section 9) lays out requirements for the Minister of Health. The requirements are very similar to a typical contract arrangement (consultation with all parties and written notice).

Physicians can also exit an ARP by notifying Alberta Health and following the conditions in the ARP Program Parameters if they find the model does not fit their practice needs.

Government has also passed Bill 30 in part as a response to the AMA’s feedback that a contract option be available.