Medical Association president to tackle how doctors are paid
EDMONTON — When it comes to battling the provincial government, the new president of the Alberta Medical Association is something of an expert.
In the Royal Alexandra Hospital’s intensive care unit, Dr. Richard Johnston regularly goes toe- to- toe with failing hearts, kidneys and lungs. Yet he is also a veteran of boardroom battles with provincial bureaucrats, having served as the chairman of the AMA’s negotiating committee for more than 15 years.
The last of those battles was a bitter pay dispute in 2012- 13 that ultimately ended in a seven- year deal for doctors.
Now, Johnston is hoping to work constructively with the government to reform how physicians get compensated, which he believes can lead to better care for people with complex and chronic conditions.
“There is a lot of work that has to be done in terms of co- ordinating their care,” he said Sunday in an interview. “And right now, the family doctors who take that on, they really suffer financially because there is ton of things they need to do and time they need to take that isn’t recompensed.”
The care of patients with incurable, long- term illnesses such as heart disease, diabetes and asthma was the focus of a special report from provincial auditor general Merwan Saher last month. Saher called for immediate action to bolster the primary care such patients receive, which he said would improve their lives and potentially save the health system billions in costs.
Johnston said he believes changes to the compensation system could help form part of the solution Saher is looking for.
Currently, the primary vehicle for paying doctors in Alberta is called fee- for- service, in which physicians bill the government a pre- determined fee every time they perform a service for a patient. But the system tends to reward specialists
For the complex patient, we need to work on some mixed payment models that will include payment on a fee- for- service basis but probably also on a perpatient basis.
DR. RICHARD JOHNSTON
far above doctors practising in family medicine.
“For the complex patient, we need to work on some mixed payment models that will include payment on a fee- for- service basis but probably also on a per- patient basis,” Johnston said. “We need to do some work that will allow us to use payment models to essentially reward people for moving into those other operational models.”
Johnston said another of his top priorities is to improve the use of information technology to better share medical records. The idea is to eventually create an integrated system for the whole province that would give health professionals a common platform to view tests results, X- rays, discharge summaries and other relevant information about a patient.
Johnston said he spoke to new Health Minister Stephen Mandel earlier this month, and was impressed the minister identified hospital bed overcrowding as a major priority. Evidence indicates some of the backlog is being caused by a shortage of continuing care spaces.
“We are going to need more space. I notice it. People who work in hospitals notice it,” Johnston said. “Every time we build a new continuing care centre, for six months or a year afterwards our operating rooms run quickly, or emergency rooms are empty, and we move people through the wards. And then it all gums up again.”
Johnston, whose term lasts for a year, is the first AMA president from Edmonton since 2010- 11. He has lived in the city virtually all of his life, obtaining his medical degree from the University of Alberta and serving as head of the school’s division of critical care.