Province, doctors still at odds over compensation deal
AMA pushing for long-term agreement as pact expires, talks go into 5th month
EDMONTON Negotiations between Alberta Health and the province’s 10,000 doctors on a new compensation agreement is now dragging into its fifth month as the NDP government knuckles down on efforts to cool the growth of its $22-billion health budget.
The province’s current sevenyear pact with the Alberta Medical Association officially expires Saturday, and there are indications the two sides remain at odds on resolving some complex issues required to complete a new deal.
The latest provincial budget released March 22 calls for more than $5.3 billion in total spending on physician compensation and development this coming year.
The government said that represents an increase of $167 million, or 3.5 per cent, to accommodate higher patient volumes, but there has been no mention of potentially raising fees for doctor’s services.
Whether the province intends to stand firm on that figure remains unclear, although Health Minister Sarah Hoffman has suggested there is little financial room to manoeuvre.
“We do have targets we need to achieve and we’re hopeful we will be able to reach those very soon,” she told reporters on budget day.
Hoffman went on to say she is looking for a deal similar to the “sustainable agreements” recently finalized with the United Nurses of Alberta and the Health Sciences Association of Alberta. Those three-year pacts included two years of pay freezes, followed by a requirement to negotiate wages in the third year.
The AMA declined to comment on how far apart the two sides are on reaching terms. However, in a handful of recent letters to members, association president Dr. Neil Cooper was clear the AMA wants a long-term agreement — which means a three-year deal may not be sufficient.
Cooper told members in a March 8 letter that a facilitator has been brought in to advance the talks. If that fails, the two sides could trigger a dispute resolution process that involves mediation or binding arbitration.
In addition to the pay freezes for nurses and other health workers, the government has noted that new frameworks for dentists and pharmacists have gone even further by including fee decreases.
In his letters, Cooper told colleagues the AMA is willing to assist with the province’s financial struggles, though he also suggested doctors have already made significant contributions in recent years.
As an example, he noted the expiring seven-year pact included three years of fee freezes, two years of 2.5 per cent hikes, a cost of living increase that ended up being 1.1 per cent, and another cost of living increase that could be forfeited.
As well, in a separate “amending agreement” in effect for 2016-17 and 2017-18, the AMA agreed to a number of measures to help the government rein in health system costs. These included doctors risking their annual retention benefit (worth between $5,000 and $12,000), and a review process to curb inappropriate billing.
“Meanwhile the expenses physicians accrue to run our practices are always increasing, and quickly,” Cooper wrote on Jan. 17. “Effectively, we have taken decreases in compensation.”
Alberta Health officials say the amending agreement is expected to save the government $300 million, though the goal was to save $500 million.
At the time the deal was signed, spending on physicians was rising eight to nine per cent annually and vastly exceeding the province’s budget — in part due a rapidly rising doctor workforce that was racking up fees beyond what was expected.
Hoffman said then the goal going forward was to limit growth of physician compensation spending to between three and five per cent annually, and to ensure costs adhere to the budget.
It appears the province is now pushing for a figure on the low end of that range, and may also be asking for other concessions.
Besides fees and salaries, doctors receive several other forms of compensation.
Included is the Rural Remote Northern program that provides up to $60,000 a year to doctors to serve in small communities, as well as the Business Costs initiative that provides a maximum of $146 per day to community physicians to help with overhead.
The expiring compensation deal categorizes such programs as “non-evergreen,” which means the province has the power to end them any time after March 31.
While it’s unknown if the province is willing to pull the plug, it’s clear some doctors are worried.
“I cannot emphasize enough how critically important both of these programs are to maintain the ability of our clinics to provide care,” Dr. Darryl LaBuick, who leads the AMA’s section of general practice, wrote to colleagues in a Jan. 18 letter.
Other forms of compensation are considered “evergreen” programs, including funding for physicians’ medical education and liability insurance.
Such programs can’t be summarily ended, and instead are subject to binding arbitration if negotiations fail.
However, Cooper said the province has raised the spectre of introducing legislation to remove those arbitration rights if “budget certainty” can’t be achieved.
“Our expectation remains, however, that government will follow through on its commitments,” he wrote on March 8.
Statistics from the Canadian Institute for Health Information show Alberta doctors were the best paid in Canada in 2015-16 with an average gross income of $380,384. The AMA says the figure is misleading since Alberta physicians are also burdened with some of the highest overhead costs.