Doctors and government need time to prove they can work together: AMA president

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Concerns about management of a budget cap on doctors and a lack of trust in the government appear to have been major stumbling blocks to getting a new contract with doctors passed, according to the president of the Alberta Medical Association.

In an interview with Postmedia Wednesday, a week after doctors voted down a proposed new deal, Dr. Paul Boucher said both sides need to take some time to prove to doctors and the public that they can get along and potentially work on issues including virtual care funding even before a new deal is presented.

“I think if we can show together that we can work on those (issues) and come up with some solutions that are good for patients, good for Albertans, good for doctors, good for the system, that’ll go a long way with the membership to say we are rebuilding a relationship where we can see ourselves working together within an agreement,” he said.

Fifty-three per cent of doctors who voted said they didn’t want the deal that the AMA and government spent a contentious year negotiating.


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While the association hasn’t asked doctors yet specifically what they would need to change their mind, Boucher said there were concerns about uncertainty in the agreement in the lead-up to the vote.

Government officials, including Health Minister Tyler Shandro, have insisted they need to keep spending under control. While doctors were prepared for austerity, “a lot of the risk (in the rejected deal) was put on physicians to keep that budget stable,” Boucher said.

Instead of changing what doctors are paid for individual services, under the proposed deal billing could have been withheld if doctors hit a budget cap.

Exact details about how that would work hadn’t been settled before doctors were asked to sign off, Boucher said.

“Having some kind of way to manage the budget is not an unreasonable notion. It’s just where does the responsibility fall and how do we do that so that it’s fair and transparent and predictable? I think (that) is part of where a lot of docs struggled,” Boucher said.

Binding arbitration

The AMA also failed to get the government to agree to binding arbitration. The proposed contract allowed for mediation but it wasn’t binding on the minister.

If the two sides had a better relationship, mediation might have been enough for some doctors, Boucher said.

“When there are issues of how we’re going to behave and work together within an agreement, people are not convinced that it’s going to be successful, then they’re looking for stronger dispute resolution mechanisms, which we weren’t able to get.”


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The fight between doctors and the minister has been contentious since February 2020 when Shandro ended the contract and made changes to how they are paid, many of which were later rolled back.

The AMA has sued over the deal and at one point held a vote where nearly 98 per cent of those casting ballots said they didn’t have confidence in Shandro.

The minister has been criticized for yelling at a doctor in his driveway over a social media post and calling doctors on their personal phones. He also threatened to create a sunshine list.

Some have suggested the deal could have been passed under another minister or called for Shandro to be shuffled out of his portfolio.

“My position is that we need to have a working relationship with government and Alberta Health and the minister of health,” Boucher said.

“It’s my job to try to do that and I do think it’s possible. But was that an issue for some members? The answer is sure it was.”

There are a handful of concerns the two sides could work on even without a contract, he said, to prove they can work together. That includes better funding for virtual care and support programs.

The cost of having offices

Parts of the budget are being underspent because doctors are using virtual care which costs the government less than in-person visits, he said, but doctors still need to pay the costs of having offices.

“We don’t want those offices to close.”

According to data provided by the AMA, a standard 10-minute virtual visit with a family doctor plus five minutes of charting and follow-up costs the government $38.03. That’s compared to $56.51 if a person sees their doctor in an office.


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In a statement, Shandro’s press secretary Steve Buick said the government agrees rebuilding trust with physicians will take time and Shandro will be meeting with AMA leadership “very soon.”

“The draft agreement included a commitment to reinvest surpluses in the physician budget back into physician practices. We’re open to options to support practices that have suffered in the pandemic, including a focus on primary care and virtual care as Dr. Boucher suggests,” Buick said.

Looking back, Boucher said he knew that some doctors would have concerns about the proposed deal but there was “too much for me to say you shouldn’t even look at this.”

He said the province needs a contract with its doctors.

“My view is that Albertans, and the patients of Alberta, suffer when the organized medicine doesn’t have a voice at the table.”


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