Alberta health minister rolls back some changes to rural doctor compensation

The Alberta government is making concessions on how rural physicians are compensated in a bid to keep them from leaving or giving up their hospital privileges in communities across the province. 

Province says it will continue to subsidize medical liability insurance

Alberta Health Minister Tyler Shandro announced changes Friday designed to enhance rural health care and strengthen recruitment and retention of rural physicians. (Dave Bajer/CBC )

The Alberta government is making concessions on how rural physicians are compensated in a bid to keep them from leaving or giving up their hospital privileges in communities across the province. 

On Friday, Health Minister Tyler Shandro announced measures aimed at preventing rural physicians, who all practice in constituencies represented by United Conservative MLAs, from leaving the community or ceasing to work in rural hospitals.

Physicians say changes to their compensation, which were unilaterally imposed on them as of March 31, will cut their pay dramatically. The cuts have been particularly acute in rural Alberta, where doctors practice in clinics and in hospital emergency rooms and obstetrics departments.

Under the changes announced by Shandro, the province will continue to subsidize the medical liability insurance required by doctors to practice in high-risk areas like obstetrics, meaning they will only have to pay $1,000 a year, and increase rural on-call rates from $20 per hour to $23 per hour. On-call rates for rural physicians with special skills will increase from $11 to $20 an hour. 

Another change prevented rural physicians from billing for overhead costs when they are working in a hospital. 

Shandro said that change is being put on hold for urban physicians and abolished for their rural counterparts.

"Many rural physicians organize their business model around practising in hospital and clinics and rural hospitals, especially their emergency departments, work differently than in cities," the minister said during his news conference. 

"They depend on rural physicians for coverage and we need to maintain that coverage in Alberta." 

The province is also removing the $60,000 cap on the Rural and Remote Northern Program, which provides incentives for doctors to practice in those areas. 

When asked by a reporter if he took any responsibility for his role in the dispute, which has created anxiety among doctors and patients during the  pandemic, Shandro placed the blame on the Alberta Medical Association, which he claimed passed on incorrect information to its members about the cost of liability insurance.

However, a freeze on liability rates was one of the changes announced by Shandro on Friday.

Dr. Samantha Myhr, a family physician in Pincher Creek, said the changes announced Friday may address the financial side of the equation, but don't deal with the larger issues, trust, which physicians say was broken when the government cancelled the master agreement with the AMA in February. 

They want a new agreement that the government can't cancel unilaterally. Without that agreement, Myhr said the changes announced Friday could change after the pandemic or when the political heat is off rural members of the UCP caucus. 

"We don't know when the rug is going to be pulled out from under us the next time and there's nothing stopping [Shandro] from doing that again," Myhr said.

She said she is disappointed Shandro refused to take any responsibility in the dispute, and continued to claim the Alberta Medical Association misled its members about the government's changes.

Overhead costs 

Shandro and Alberta's physicians have been battling over compensation and other issues for months. 

In February, after contract talks failed, the government cancelled a master agreement between the province and the Alberta Medical Association (AMA), a power that came with the passage of Bill 21 last fall.

Most Alberta doctors work on a fee-for-service model and pay for staff and clinic overhead out of those earnings

The AMA has filed a lawsuit against the government demanding fair and reasonable negotiations toward an agreement and the right to arbitration.

Physicians in a number of communities, including Lac La Biche, Stettler, Sundre and Pincher Creek, have recently served notice they will withdraw hospital services due to the funding changes. 

David Shepherd, the Opposition NDP critic for health, called on the government to restore the previous master agreement and work on a new one with the help of an independent arbitrator.

He also called on the government to repeal the section of Bill 21 that gave the minister the power to unilaterally cancel the master agreement. 

"This relationship will never work until there is an agreement that is binding to both parties," Shepherd said. 

The Edmonton-City Centre MLA was joined at his news conference by Dr. Liana Hwang, who practices medicine in Canmore.

Hwang also wants a reversal of the Bill 21 powers, and rejected Shandro's claim that the AMA spread misinformation to its members. 

"The Alberta Medical Association consists of representatives that doctors have elected and we trust," she said. "So for the minister to imply that the AMA would deliberately ... misinform their members, I think is a little bit of a stretch." 

Shandro was joined at the news conference by MLAs Tany Yao, Nate Horner and Joseph Schow.

Yao, who represents Fort McMurray-Wood Buffalo, chairs the government's rural caucus for northern Alberta. Horner, MLA for Drumheller-Stettler, chairs the rural caucus for southern Alberta. Schow represents the riding of Cardston-Siksika.

Other measures announced by Shandro included a plan to pay for the education of 20 medical students over the next three years, as long as they practice in rural and remote communities for three years.

Shandro has also asked University of Alberta medical professor Dr. Lee Green to recommend alternative ways to pay primary care physicians.