Opinion: Changes to compensation could lead to an exodus of doctors
By Medicine Hat News Opinon on January 3, 2020.
gslade@medicinehatnews.com@MHNGillianSlade Changes to physicians’ compensation in Alberta is in the cards and it could dramatically impact Albertans. It is an established fact that having a family doctor goes a long way in maintaining your overall health and reduces your need to go to the emergency department. About 10 years ago it was almost impossible to find a family doctor willing to accept new patients in Medicine Hat. When a physician retired more than 1,000 patients would be added to the others already looking for a doctor. It got so bad those without family doctors ended up in emergency and if they needed follow-up treatment there was nobody to refer them to. A special clinic had to be set up at the hospital, temporarily, to provide that care. It took an Alberta Health Services (AHS) south zone program to turn that around. In 2011 AHS had a goal of seeing 10 new doctors in this area and worked hard to see that happen. It was called an “ambitious target” by management. The program worked. Existing doctors with established practices were asked to encourage colleagues in other areas and countries to join them. Physicians, from outside of Canada, paid tens of thousands of dollars to go through the process of being certified to practise here. Many local doctors provided space for them to join their practice and avoid the high cost of setting up a practise from scratch. It took years but if you now need a family doctor there is a list of those accepting new patients. The government is now talking of limiting the number of patients a doctor can see in one day and how much time they can spend with a patient – or at least only pay them the minimum for that consultation. That sounds like we are going to need more doctors because doctors will not be able to handle the volume of patients they currently do. It also means patients who could not discuss all their concerns in one appointment will be making more appointments. It could also mean the doctors we have now will simply look at moving to a different province. Those with family ties to Alberta will probably stay but there are many who would be willing to move. It is important to be reminded that the fee for service that doctors get from Alberta Health is not their take-home pay. Your doctor is probably leasing space that is fitted out with a range of costly equipment and supplies that have to be replaced constantly. There are professional fees and licences plus the cost of employing staff and associated office expenses. All of this comes out of the money your doctor receives before there is any take-home pay. If physicians are being paid more than other provinces there is probably a link to the high cost of living, staff wages and cost of property in Alberta. This is always used as justification to pay higher government wages in Alberta. If we are asking physicians to take a cut it would be appropriate to determine if we are getting value for the more than $600,000 a year being paid to the AHS CEO, considering another $2 million for an independent review was considered necessary. We also have multiple levels of deputy ministers and assistant deputy ministers at Alberta Health and so far there has been no indication for a wage reduction there. We could be heading down a road with an exodus of doctors from Alberta and that will affect health care. (Gillian Slade is a News reporter. To comment on this and other editorials, go to https://www.medicinehatnews.com/opinions, email her at gslade@medicinehatnews.com or call her at 403-528-8635.) 21-20
Many changes are necessary to ensure continuing universal care including a few to regulate physician billing. There should be a limit to the number of patients physicians see in a day, but that number should vary according to rural or urban location. For rural physicians, obviously the number should be greater to accomodate the burden of evening and weekend call. There is absolutely no defence for any general practitioner in a urban setting seeing in excess of 50 patients/day. Providing quality of care should be the first priority of both the AMA and AHS negotiations. I would question the quality of care being offered by those unhappy with daily limitations being imposed and suggest that less fiscally focussed physicians would be welcome replacements. Shut down walk- in clinics or impose strict regulations with regards to patient follow up and introduce frequent practice audits. Most are a disgrace to the profession and provide less than adequate care. A license to print money is an apt description for some. License those who actually want to practice medicine, not those who prefer to concentrate on cosmetic procedures or operate medical spas. The fee for complicated patients was abused. Something had to be done. Unfortunately, physicians, like other humans, fall prey to the very human condition of greed.
Gillian, where would they go? PEI, Ontario, New Brunswick, or back to S. Africa??? I doubt it.