Last week, the Government of Alberta announced that members of the Alberta Medical Association had ratified the new provincial agreement.
The Alberta Medical Association is a professional organization representing physicians in the province.
The AMA’s previous agreement with Alberta Health expired in 2020, and this new agreement is retroactive to only April 2022 and will be effective until March 2026.
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One of the first things mentioned by the provincial government is that in the first 3 years of the agreement, physicians will receive a 1% annual increase.
There are a few things to keep in mind regarding this.
First of all, physicians received no rate increases for clinical services during the final two years of the previous agreement (2018–2019 and 2019–2020). Plus, since the previous agreement expired in 2020, there were no rate increases for the last two years either. So this 1% increases between 2022 and 2025 come after 4 years of no increases.
Second, considering that inflation in Alberta hit 6.0% in August and 7.4% in July, this 3.03% cumulative rate increase hardly seems sufficient to cover inflation over just the last year, let alone the 13.8% inflation between the last rate increase and this past summer, or whatever inflation might be over the next 3 years.
Third—and this must be emphasized, considering how easily misunderstood this is among the general population, particularly among UCP supporters—these are not wage increases.
These rates are what physicians use to cover all the costs of their practices. Of course that includes their own salaries, but it also includes the salaries of the healthcare and administrative workers employed by their practice. It covers the cost of contracting out janitorial services. It covers the cost of supplies, materials, and equipment replacement. It covers the cost of leasing, maintenance, and utilities. And so on.
The provincial government has also promised an additional lump sump payment this year in recognition of the additional labour physicians have had to perform during the last 2.5 years of the ongoing COVID–19 pandemic, particularly since COVID-19 hospitalizations in Alberta remain higher than they were in July, and overall hospitalization have been on the rise for the last 3 months. That lump sum payment is based on 1% of their funding.
In the final year of the agreement, the rate physicians will receive depends on several factors.
For example, the province plans to review the market rates in Ontario, Manitoba, Saskatchewan, and British Columbia. The results of that review could affect the rate physicians receive in the final year.
There will also be a global rate adjustment that will reflect general economic and fiscal conditions. Both the market rate review and the global rate adjustment could be influenced by potential binding arbitration.
Finally, if the AMA can achieve costs savings through keeping cost growth “below population and complexity”, they could receive half of those savings, and their members could participate in “gainsharing” in the final two years of the agreement.
In addition to rate increases, the provincial government promised to provide up to $94 million over the 4 years to help with what they call “practice viability”.
It includes $12 million over 2 years to support physicians who adopt technology to “improve patient care”, as well as $2 million to assess management supports for physicians who want to use “alternate payment models”.
It will also include roughly $20 million in each of the 4 years for additional funding to the Business Costs Program, which helps physicians meet business costs.
That may seem a lot, but keep in mind that as of the second quarter of this year, there were 11,069 registered physicians in the province. That works out to $1,806.85 per physician per year, or about $150.57 per physician per month.
That’s enough for every physician in the province to increase one staff member’s full-time wages by 87¢ an hour.
Now, to be fair, not every registered physician is practicing, or practicing in Alberta. And even if they are, not every physician will necessarily have increased costs.
But even if we were generous and said that the Business Costs Program’s rate applied to only half of the registered physicians, that’s still only enough for a $1.74 an hour raise for just one full-time employee. That’s not even counting all the other costs increases physicians have to deal with under skyrocketing inflation.
The agreement also includes $158 million in funding to recruit more physicians and retain the ones we have; although, the bulk of that will be focused on “underserved areas”.
Primary Care Networks will receive $40 million over the first two years of the agreement while “the Modernizing Alberta’s Primary Health Care System work takes place”.
Finally, this agreement has postponed changes to stipends, overhead, Z-codes, caps to daily visits, virtual code enhancements for psychiatry, and extending physician support programs to medical examiners. It does “outline processes and other commitments” at an undetermined future date, however.
Less than half of the members of the Alberta Medical Association participated in the vote—45.8%, to be more precise—but of those who did, 70.2% voted in favour of the agreement. This works out to be 32.15% of all AMA members.
Voter turnout was lower this year than it was when 59% of AMA members showed up to reject a package proposed last year.
By comparison, 66.6% of AMA members participated in the 2020 non-confidence vote in the health minister (with 97.83% voting no confidence).
I put out a callout on Twitter asking for feedback about the agreement from doctors. No doctors responded to me who claimed that they voted in favour of it. That being said, I did find this tweet from Raj Sherman, a physician who was once the former leader of the Alberta Liberals and who recently attempted to enter the race for the United Conservative Party:
I did, however, have two physicians reach out to me who voted against the new agreement.
For example, Dr. Mukarram Ali Zaidi, a family physician in Calgary, who’s also a clinical assistant professor at the University of Calgary, had this to say.
I have a lot of respect for our AMA reps, board members, and AMA staff, but it’s clear from other meetings that I have attended and this 2022 fall session that primary health care and family medicine are not a priority. Family medicine and primary health care will suffer the most with the new agreement — that should have never brought forward by the AMA. I plan to sell my clinic; I just don’t have any more strength in me to fight any more.
I also heard from Dr. Parker Vandermeer, a locum doctor who works in emergency departments throughout the province, particularly in rural communities.
I felt that while the agreement was good for the AMA as an organization, it accomplished very little in regards to equity and stability for primary care. Committees and working groups years from now will not help the crisis we are in now, and the vague promises to primary care in this agreement pale in comparison to the actual dollars put behind initiatives like the ASI, which makes me doubt that the future will be any better for family medicine.
I also heard from Dr. Samantha Myhr, a physician currently working as a locum in the community of Sundre as well as the president of the rural medicine of the AMA, who had this to say:
I try my best to consider not only my own opinion, but also the voices of the rural physicians I represent. Overwhelmingly, their feedback was that this agreement did not demonstrate an understanding of the dire situation rural medicine is in, nor does it provide the means by which to address the crisis in our communities. There are still opportunities outside of an agreement, like with the “MAPS” initiative, where I hope to see government invest in the supports we desperately need.