Alberta’s doctors must step up for their patients

Now is not the time to be fighting over money, Colum Smith says.

The ongoing dispute between Alberta physicians and the provincial government leaves me shaking my head in disbelief. While thousands of their fellow Albertans are struggling to make ends meet, have difficulty putting food on their table, worry about jobs, concerned about livelihood and their kids’ education, Alberta’s physicians are fighting with the government about money. Fighting about money the government doesn’t have.

In a piqué of entitlement and self-righteousness, some physicians have even threatened to leave the province and abandon the patients they committed to serve. I have long abandoned the notion that politicians make decisions on moral and ethical grounds. No, politicians make decisions based on political priorities first and then may consider the moral and ethical issues. Physicians, however, need to be held to a higher standard and decisions should be made on moral and ethical grounds with patients as priorities.

Recent reports that a significant number of physicians are considering leaving the province really reflect nothing new. One of the commonest discussions among physicians is where to find a better lifestyle and how to make more money.

Instead of fighting with the government over money, physicians should focus on outcomes, accountability and service needs.

Outcomes: There are no agreed outcomes for services provided by physicians across the province. Millions of dollars are spent every year paying physicians to provide services but no anticipated, expected or agreed outcomes. We use surrogate measures such as infant mortality, life expectancy, disease prevalence and incidence to measure the general health of the population but yet for the thousands of services provided every day, we have no knowledge of the outcome for the individual patients. Patient satisfaction surveys are not acceptable measures of outcome.

Accountability: As with outcomes, there is minimal if any degree of accountability among physicians for the services provided. Sure, the College of Physicians and Surgeons exists to ensure high practice standards and modify behaviours where necessary, but it only ever intervenes in an individual physician’s practice in the event of a complaint. Few patients ever complain and the interventions rarely result in meaningful change. Physicians are not accountable for things such as antibiotic usage, prescribing habits other than perhaps narcotics or even whether they are fulfilling the terms of individual contracts.

Service needs: It’s time to change the old mantra that every town and hamlet needs a physician. Too much time, effort and money are spent trying to attract physicians to rural and remote locations when physicians have little or no interest in relocating to these places. Almost the entire training of physicians is hospital-based and located in secondary and tertiary facilities. With few exceptions, little attention is paid to primary care. The specialists involved in training physicians often have scant regard for primary care and actively encourage specialization.

It’s time to ask what services are needed by the population seeking a physician. This should be readily answerable by examining the billings of a physician’s office to Alberta Health. I would suggest that most of the services provided by general practitioners could well be provided by alternative practitioners. Such things as blood pressure control, diabetes management, depression, fevers, coughs and colds could well be managed by nurse practitioners, pharmacists and others.

The COVID pandemic has demonstrated that remote medicine is practical, useful, accessible and acceptable to both patients and practitioners. Even the follow up of patients with serious illness, such as cancer, can be effectively managed remotely.

Let’s forget about money and start a meaningful discussion about the needs of the population and how best to effectively, efficiently and safely meet those needs. It’s time for Alberta’s physicians to ask what can we do to help the province rather than asking what more can we extract from the province. Alberta’s physicians have enjoyed and continue to enjoy some of the highest payment schedules in the world. Alberta’s physicians enjoy the respect of the community. It’s time for them to pay back some of that respect.