Province, doctors quietly work toward agreement
Ugly, bitter dispute was bad for both sides, and it's not over yet, but there is optimism
One of the ugliest features of Alberta politics in 2020 was the government's dispute with doctors over pay and other issues.
It deteriorated into emotional insults that damaged the government's approval ratings and convinced some doctors they should leave the province.
Now, the tone is changing dramatically as both sides quietly work on an agreement.
In a recent year-end interview, I asked Premier Jason Kenney if he was sorry about how the conflict escalated.
“Yes, I do regret how that disagreement evolved,” he said.
“As I always say, we profoundly appreciate having world-class physicians here at the heart of our health-care system. We think they should be not just fairly, but generously compensated.
“We don't mind that they're the best compensated in Canada. We simply, however, had to get some tools to control the future growth, because it was going up by six per cent a year.
“But I think we showed some flexibility in response to concerns that they raised.
“We walked back proposed changes to the so-called complex modifiers and a number of other things. We put an extra $80 million into supporting rural doctors, given the challenges of recruiting and retaining them.
“I'd like this to be seen as expressions of good faith.”
On the Alberta Medical Association side, there's hope for agreement, although hurdles remain.
On Tuesday, AMA president
Dr. Paul Boucher said in a note to members: “As discussions continue with government toward a negotiated agreement, new payment models are emerging and are being offered to physicians.”
The note makes it clear there are still many issues, including the AMA'S influence in decision-making.
On the crucial question of Alternative Relationship Agreements, which would pay doctors a set amount rather than a fee for each service performed, Boucher said:
“The AMA will be seeking a multi-stakeholder government structure for developing and approving ARPS.”
He warns of “clinical ARP models that are very different from the ones we are familiar with.”
The government has always been determined to keep most decision-making power to itself. Generally speaking, the UCP doesn't want cost-cutting to be contingent on AMA approval.
The AMA desperately wants input, both to protect both physicians and the quality of health care.
So there are complex problems to solve. But at least the rhetorical war appears to be over.
Boucher's letter doesn't criticize the government. Kenney, in turn, appears to have dropped his earlier claim that all doctors must be doing well because the overall pay is higher.
One side-effect of COVID-19 is to cut the incomes of many physicians, especially surgeons who perform elective procedures. The income losses extend into many related specialties.
Some family doctors have also seen their incomes sharply drop as patients shun the whole health-care system.
As a result, the government is saving a great deal of money, some of which could be used as a one-time sweetener in a contract agreement.
But this cushion hardly matches the vast amounts spent by
AHS on COVID-19 response.
Kenney said: “You'll probably see in next February's budget that we've added $1.5 to $2 billion, like 10 per cent, to what is already the largest health-care budget in our history, to support our COVID-19 response.”
He added: “We've got to have some way of managing costs in the future and we hope that we can find a way forward with the Alberta Medical Association on that.”
Earlier this year the government often acted like a bull in a china shop, cancelling the contract with doctors and attacking the AMA on social media.
But as the premier's remarks suggest, the government now wants a mutual agreement as soon as possible.
There's still plenty of anger among doctors. And it would be a big mistake to assume the UCP has suddenly gone soft.
But there is hope that in coming months the bitterest dispute of 2020 will finally come to an end.