‘TEAM-BASED’ PATIENT CARE THE TREND
As the Alberta Medical Association’s newly installed president, Dr. Padraic Carr has become the voice of the province’s 10,000-plus doctors at a tumultuous and pivotal time for his profession. The cash-strapped provincial government is anxious to rein in
What is your specialty and how did you get into it?
I am a psychiatrist here in Edmonton. My home base is Grey Nuns hospital, but I also have a private office across the street from the hospital. I do general adult psychiatry so I see a mixture of everything.
Is there any benefit to having a psychiatrist in the AMA president’s chair, perhaps to bring some extra attention to mental health?
I think the role of the AMA president is really to represent all specialties equally, so I don’t think it’s a particular advantage being a psychiatrist more than being a family doctor or a surgeon. I think what’s really important is to have someone who is able to represent the profession.
Precise details of the amending agreement have yet to be made public, but can you outline some of the financial changes physicians might see?
One of the big financial changes is that we are moving toward a risk-sharing model. Essentially, physicians are putting some of their income at risk to try to have more of a say in how the system is run and more of a managerial role in the system.
There is also provision for some potential voluntary payment mechanism changes. Some trial programs, like a blended capitation model, that looks at family doctors and how they are paid.
What other areas does the tentative deal address?
A physician resource plan. One of the things we have looked at is the growth of physicians and the utilization of resources. And to date there has not been a detailed management plan in terms of how physicians are licensed, where they go, and that’s really something we need to sit down with the government and do.
A workforce plan has supposedly been on the agenda for years at Alberta Health. Do you know what state it’s in at this point? Why haven’t we seen it yet?
There has been a lot of talk, very little action. That’s why it’s part of our agreement.
If it’s a needs-based plan, which is what our goal is, then it will allow us to think about training — what type of physicians we’re training and in what areas. It will allow us to also address issues of international medical graduates: do we need more, or do we need less?
Primary Care Networks, which are largely led by physicians, have faced a lot of criticism: Failures to adopt proper team-based care, poor stewardship of public dollars and inconsistencies in services across the province. What needs to happen to improve PCNs’ performance?
To be honest, I think the PCNs are a leader in team-based care, and quite frankly, it showed good leadership on the part of the AMA in developing that.
The advantage of this amending agreement is that with these different payments models, it may facilitate more team-based care. Because a lot of the leadership of teams that physicians do now is not remunerated, and that’s a huge issue.
But are financial measures enough? Some critics would say there needs to also be a culture change on the part of the physician profession.
I think the entire profession of medicine is gearing more and more toward team-based care. Certainly, it’s something I do every day working in the hospital, where I work with social workers, and occupational therapists and nurses.
With this amending agreement, there is provision to look at PCNs provincewide so that they are run more-or-less similarly. I think you will see a lot of more consistencies in the way of how PCNs are run. But in terms of a culture change, I think that’s already there.
Doctors can’t shoulder the cost containment burden alone, so what other areas of the health system need to become more efficient?
In terms of looking after seniors, that’s an important issue we’re going to have to look at. Inpatient hospital care is another area. Physicians are also looking at things like the Choosing Wisely program, which is trying to eliminate the duplication of services (lab tests, for example).
I think we are going to have to look at budgets of everything. And we are going to have to prioritize things.