Laying it Out: Seriously though, he’s still the health minister?
By Medicine Hat News Opinion on April 25, 2020.
If you asked me to name 44 rural communities in Alberta, it would probably be a struggle. So, when I heard that was the number with doctors threatening to or outright resigning from essential hospital services due to cuts implemented by the provincial government, let’s just say it sounded like a lot. When Premier Jason Kenney announced a personal protective equipment giveaway — then replaced it all with dollar-store wannabes — in what could only be described as a political stunt aimed at getting certain provinces to back Alberta’s oil and gas interests, let’s just say it wasn’t a big surprise. And when oil prices dropped into the realm of “Hey, man, I’ll give you a dollar if you buy this barrel of crude from me,” mere days after the province committed billions to a pipeline through Montana that Montana might not actually allow to be built, let’s just say it seemed all too typical for the UCP. Despite most of the province doing as little as possible these days, a whole lot has transpired since I last wrote, when, if you recall, I suggested we should get a new health minister because our current one has the self control of a drunk teenager. I still think Tyler Shandro is an embarrassment to the position he holds — I can say that with added cockiness since I don’t think he knows where my driveway is — and as long as he’s allowed to make decisions that affect the safety of people I care about, I’m going to be here to remind everyone that he once sauntered down the street to sob-scream at a doctor over an internet meme, and he did it in a pandemic. We can talk all damn day about beating a dead horse, but the minister of health is inarguably unqualified to lead 4.4 million people through this and I’ll wallop that mortal equine until COVID-19 becomes part of our bitumen-based curriculum. Obviously there are problems coming out of the Ministry of Health bigger than Shandro’s behavioural issues, such as the above-mentioned pending crisis in rural communities that is directly due to actions of the government, but for whatever reason the fact that he can’t even carry calm demeanour while he oversees the gutting of our public health system is almost more bothersome. Maybe it’s because I’m a city boy who won’t yet have to give up the privilege of hospital access. At least rural communities had nothing to do with the UCP’s election, so I’m sure they won’t have to worry about too many lost votes. Anyhoo… As is becoming a theme since the start of the pandemic, our illustrious health minister was in front of the cameras Friday to announce a partial rollback of these fee changes, in what he predictably presented as an additional $81 million to keep dissenting rural physicians (from 44 communities, I’ll remind) from retracting services. But let us never forget that, in reality, Shandro’s government gave itself the power to tear up binding contracts, then tore up a binding contract with doctors, then forced them into unreasonable fee structures, then pushed those through while a global pandemic arrived, then rolled back some of those forced changes when public backlash reached a point where the UCP felt its political capital waning. And while the health minister announced it, he made sure to repeatedly accuse the Alberta Medical Association of deceit. You’ll have to excuse Alberta’s physicians and their patients if they don’t organize a drive-by pandemic parade to thank the government for this gesture. And, on the off chance the entirety of Alberta’s populace just got back from the moon this week, Shandro actually looked a reporter in the face Friday while suggesting certain April 1 fee changes were being rolled back because the policy had unintended consequences. “… this policy forces physicians and hospitals to make choices that reduce access. This was never our intention.” Um, what? Are we supposed to pretend that doctors and hospital officials hadn’t been making themselves crazy trying to warn Albertans and the UCP for weeks that these changes would have these exact consequences? Does this government honestly believe Albertans are dumb enough to see that $81 million and view it as generous? View it as some sort of added funding? View it as something Shandro won’t immediately undo when COVID-19 passes? Sorry, but even UCP supporters couldn’t defend this with a straight face. Good governing is not doing something stupid, getting hammered for it, then undoing parts of that stupid thing and shouting, “Ta-da.” Opposition health critic David Shepherd had the quote of the week in a perfect description of what Friday’s announcement was. “Tyler Shandro knifed rural Albertans and our rural doctors in the back, and now he’s offering a Band-Aid.” Precisely. And his other hand hasn’t even let go of the knife yet. Unless temper tantrums turn out to be the cure for COVID-19, maybe we shouldn’t trust our health minister anymore than our doctors do. Scott Schmidt is the layout editor for the Medicine Hat News. Contact him by email at sschmidt@medicinehatnews.com, or follow him on Twitter at @shmitzysays. Scott’s opinions are his own. 23-22
There are two sides to every story Scott, and you represent only one. Imagine this scenario. Alberta physicians, understanding current fiscal projections, approach Minister Shandro and offer a 5% fee reduction across the board. These are intelligent, well educated men and women who, as I understand it, during interviews for medical school admission expressed a passion for helping people and a life long dream of practicing medicine. Now, when times are challenging these same individuals threaten to leave for greener pastures. What happened in the interim? Hmmm! Sarcasm aside, I do not expect altruism but rather realistic expectations of remuneration. Unfortunately, within the Alberta Medical Association, you have section heads fighting for their share of the pie, each believing that their speciality or subspecialty is more deserving of higher pay. It’s ugly and frankly no different than the current battle between our health minister (Shandro) and AMA president (Molnar). What all have to understand is resources are limited and expenditures have to be reined in. According to current statistics the average Alberta physician earns a gross income of $386,000.00 annually. I understand many are incorporated allowing tax benefits not available to most and reducing the impact of overhead expenses. A 5% cut would amount to $366,700.00 which compared to the average Albertan seems more than adequate. If, and this is a big if, egos could be reined in and physicians could come together as a collective with a willingness to reduce fees, our problem would be solved. I don’t like the idea of unilateral decisions being imposed, but at some point, difficult choices have to be made. What would you do Scott? An impossibly high deficit looms. Where will the money come from?
“Where will the money come from?” Have you been in a coma for the last year? How about the billions of taxpayer $ the “UCP Caucus” gave the the O&G corporations. How come when it comes to the great unwashed public taxpayer, money for public services is scarce and we just don’t understand finance 101?
Cry me a river!!
@fd4thought – Now that you have provided “food” perhaps you should do some thinking. First of all and easiest to refute, being incorporated does NOT reduce the impact of overhead expenses as a person (physician or otherwise) operating as a sole proprietor is also allowed to deduct the expenses.
Alberta doctors spent 30%-45% of their previous gross income on the clinic’s rent, building maintenance, utilities, equipment, supplies, insurance, staff salaries, and other office expenses so $115k – $173k. Let’s pick the middle, $144k. That does not provide for a pension or any kind of personal insurance for accident or illness. So we take the 144 from the 367 (I gave you an extra 300 bucks there) we get $223k.
A derrick hand gets a base pay of $37/hour so for a normal 40 hour week (which they don’t have and neither does a doctor) that would be $74k. Most full timers get well over $100k.
So what makes a doctor worth an additional $125k over an oilfield worker? Education for one. At least 7 years university plus internship and residency. Post secondary requirements alone would leave payments on a $350k loan just to start work.
Meanwhile, a college drop-out with a few years at his daddy’s bible school and an innate ability to pander to the dumb makes $186k has no legal responsibility for any of his “work” decisions, pays next to nothing in living expenses, and gets a fat indexed pension.
If you want to talk egos, once Shandro and Kenney’s are in the discussion the Province is full.
You are paid for residency training and the cost of your education is highly subsidized by both federal and provincial governments ( approximately 75%). As well, medicine was your choice. You could have been an accountant, dentist, lawyer, politician or tradesman. What were your expectations? If you did your homework you were also aware of the low probability of first application acceptance into medical school with a bachelors degree. On average it takes three applications. You also knew the years of post graduate training required to qualify for a license to practice.
… “There are two sides to every story Scott, and you represent only one. Imagine this scenario. Alberta physicians, understanding current fiscal projections, approach Minister Shandro and offer a 5% fee reduction across the board. These are intelligent, well educated men and women who, as I understand it, during interviews for medical school admission expressed a passion for helping people and a life long dream of practicing medicine.”
You are probably not aware that the AMA proposed exactly this in February. And that if Minister Shandro had rejected this offer outright, under the master agreement then in place, the AMA could have triggered binding arbitration. So the only option he had to force through his ill-conceived changes was to trigger Bill 21 and tear up the contract.
Ratified by members?
Alberta has the lowest debt-to-GDP and the lowest taxes of any province. When the UCP says Alberta is broke it is a lie. You don’t even need to look at the debt-to-GDP numbers to realize that. You just have to remember that they were willing to do the $4.7 billion dollar corporate tax giveaway or the billions to an oil company, recently announced. Corporate taxes are the weakest and most wasteful way of stimulating the economy. Multiplier numbers from Harper’s Economic Action Plan showed that. Other methods get you several times more bang per buck. Even doing a sanity check: on $50 oil and with an average 6.5% oil company profit margin, the eventual 4% reduction in the corporate tax would only amount to a 13 cent increase in the price of oil. That’s dwarfed by the daily fluctuations in the oil price, never mind what’s happened to the oil price recently. The UCP don’t actually care about being fiscally responsible. They only pretend to to fool people. Remember Kenney was in Harper’s government and they racked up a lot of debt by cutting the GST _before_ the recession. The federal Conservatives are responsible for twice as much debt as the Liberals (although that’s going to change now.)
You’ve been informed that the AMA had in fact proposed a 5% across the board cut. It is mighty suspicious that Shandro didn’t take “yes” for an answer. Keep watching for more of his specific changes to increase business to his family’s health benefits brokerage company.
Quoting gross income as physician take-home pay is “grossly” misleading. 30-40% typically go to overhead, and ignoring that is simply careless. 60% of 386,000 is 231,000, and that number is skewed upward significantly by radiologists’ and ophthalmologists’ gross income, both of whom have enormous overhead expenses, typically.
Add in 10-15 years of schooling, training, and sacrifice, and your screed against doctor pay seems rather strange.
It is not strange at all. After reading a recent article in the Medical Post about the generational gap in attitudes regarding this profession, I obviously identify with the boomers. FYI my husband and three of my four children are physicians who believe they are well remunerated for their efforts. What can I say. They inform my opinions. Yes, they all have many years of university and a collection of degrees as well as substantial debt. They knew what they were getting into and made the decision to proceed. They accepted the inherent challenges to work/life balance and the associated challenges to relationships and mental health. The fourth of my children invested as many years, holds a PhD, and for post doctoral research in a class three virology lab was paid $50,000.00 annually. As an assistant professor at a well known American University he takes home far less than any GP. So, I guess the question here is who deserves what and how much is enough? A consensus will never be reached.
I am not defending Kenney nor supporting his misguided attempt to revitalize a failing oil and gas sector. I am not a student of macroeconomics and realistically am in no position to comment on how to save Alberta’s future. I am however married to a physician and have sufficient insight into fee schedules, overhead costs etc. to understand the impact of a 5% cut. This entire situation could have been averted had physicians demonstrated a willingness to accept less. Alberta physicians have enjoyed one of the highest standards of living among their contemporaries for years. They flocked from other provinces with fee schedules that could not compete. Now that Alberta is no longer a have province, but rather a have not province, they threaten to abandon their patients and relocate. I find this disappointing. Unlike so many, they still have employment, enjoy a much higher than average income and frankly have little to complain about. No, i have not been in a coma. It is easy for all of us to point fingers and assign blame, but in the end we all share some responsibility in the creation of this mess. Nothing was ever enough. The time has come for everyone to take a step back and accept a more modest lifestyle…even physicians.
The TOTAL government changes imposed were about a 20-30% cut for physicians depending on speciality. Lets assume 25% cuts for most doctors.
If a doctor made $100 before the cut, they had $30 in overhead. They took home $70 as in most rural practices. Now after the cut, they made $75 and they have $30 in overhead. They take home $45.
You went from $70 to $45 this is effectively a 36% cut in pay for physicians who work in hospitals and clinics. There is no valued profession that would not walk at the sight of that cut at the whim of a government. The money paid to physicians especially in primary care doesnt all belong to them.They higher nurses, pay rent, pay for the blood pressure equipment they use in their offices.
Healthcare is an essential service, they will always have a job, there is a reason they cant strike. And the doctors working right now who are “lucky to have a job” are risking their lives and the lives of their families doing so. 10% of all COVID cases in Italy are health care workers, let that sink in.
. For general practitioners who at the moment are the most vocal about fee cuts, i would suggest risk is minimal if proper precautions are taken. They have the option of conducting a large number of visits via internet, greatly reducing exposure. The greatest risk would no doubt be in intubation which few GPs would be in a position to perform. As to your numbers, I would question the average hourly billing at $100 for the majority of rural docs and certainly dispute a 25% reduction in their fee schedule. Where did that number come from? Also nurses who work for physicians within the primary care network are paid by the provincial government not the physician.
1. The majority of physicians who go exposed to covid in Italy and New York were general practictioners. -This is because they get exposed to asymptomatic patients have have the least available PPE (N95s)-FACT.
Take a look at the Italy infographic for healthcare workers https://www.epicentro.iss.it/en/coronavirus/bollettino/Infografica_24aprile ENG.pdf
https://www.france24.com/en/20200409-italy-says-number-of-doctors-killed-by-coronavirus-passes-100
2. It only task one exposure to get Covid regardless of the internet visits they have -FACT
3. The question of $100. I never suggested that rural doctors billed $100 per hour, its a calculation to show the overall % reduction assuming they made $100.
4. As for the 25% cuts, you can take a look at the fee schedule
https://www.albertadoctors.org/fee-navigator/hsc/03.08A
-this shows the pay for physicians before the cuts
https://www.albertadoctors.org/fee-navigator/hsc/03.08AZ
These are their fees after the cut if they worked in hospitals…etc. Like our rural doctors
For family physicians they go from $124.25 to $90.70. That is a 27% cut. Almost every payment code they had like this was cut 20-30% depending on specialities.
https://www.alberta.ca/assets/documents/health-ahcip-bulletin-med-223.pdf
-Feel free to review what AHS sent them at your leisure.
Removal of the 03.04J which paid family Dr $190 for a complex patient is at least a 15% pay cut for most family physicians with that change alone.
https://www.albertadoctors.org/fee-navigator/billing-tips/03.04j-complex-care
This code paid $190 per complex patient. Assuming a family doctor only had 300 complex patients in their practice, that is a $57,000 reduction in income from removing this code alone
I work for a clinic as a chief accountant and I’m also married to a physician like you. I complete the payroll for nurse who work for the doctors. The PCN does not supply every nurse or staff in the clinic. -FACT
Depsite the large number of internet visit, phyisicans are currently making 20% of what they made pre-covid while still running a clinic to occasionally see patients needing to be seen.
These insane 20-30% cuts on gross income are the reason physicians were walking. The governement gave themselves the power to rip up a binding contract, then did just that and then imposed a 20-30% paycut, in the middle of a pandemic where healthcare workers are most likely to get sick. That is a massive slap in the face.
You have the numbers, read through the changes, do the math and you’ll see. that the government almost butchered rural medicine in its entirety
“. For general practitioners who at the moment are the most vocal about fee cuts, i would suggest risk is minimal if proper precautions are taken. They have the option of conducting a large number of visits via internet, greatly reducing exposure. The greatest risk would no doubt be in intubation which few GPs would be in a position to perform. ”
See, the thing is, *you* don’t get to decide for someone else what an acceptable risk is.
Already, Alberta had to pay a premium to attract physicians. That’s what it really means, that Alberta physicians had high gross income — that, in addition to higher cost of doing business and inflation, the province had to pay extra to recruit and retain doctors.
The problem that Shandro and Kenney have now created is that no sensible person would believe any offer they made, no matter how generous, will be binding.
The outcome is predictable: Alberta will have to pay even *more* to attract new physicians. We will have to pay a risk premium.
Alberta physicians are fairly remunerated, but then I don’t get to decide what is fair. I do have eight physicians in my family, five of whom work or have worked in this province and frankly feel privileged to have had an Alberta license. They all have a very comfortable lifestyle despite the numerous demands on their time and the level of responsibility they carry. I guess the difference for them is that they love their work. For those who do not, no amount of money will change their discontent or disillusion with the provincial government. I wonder where they will all go? Certainly not Ontario or the Atlantic provinces. Perhaps Manitoba. We could always bring home our internationamedical school grads to replace them. There are many that would be thrilled to come home to work, even in Alberta.
I call BS on a few on your numbers. I do billing for physicians so, I know the fee schedule intimately. I also know how it is regularly abused…especially the complex care fee. 75% of those billings submitted were made by 3% of physicians, the really fiscally focused ones!!! It was ill conceived and allowed unnecessary billing by those maximizing income. A complete physical and routine follow up by a conscientious GP is more than adequate. As to the modifier for office visits exceeding 15 minutes, it was also open to abuse. Without random billing audits, or reports by patients to the CPSA Alberta doctors have been able to cheat the system for years. Also, most family docs see more than four patients per hour. Yes, there are some who take longer, but a lot take less. You cannot seriously compare the situation for physicians in Italy to those in Alberta. That is laughable. A GP has as much chance of being infected in their clinic or rural hospital as they do shopping for groceries. Only a carless one would not follow self protective measures. It does sound dramatic though. Yes, I am aware of the PCN provisions. If physicians are not aligned with the PCN, they do have the option of hiring a nurse or LPN. That is their choice. I do apologize for my comment regarding incorporation and expenses. That was incorrect. Regardless incorporation has many benefits not open to others.
You appear very passionate about this issue and feel physicians are overpaid from the line I can draw.
You call BS on my numbers and tell me that you would challenge a 25% cut in fee codes, I provided you with a document with said cuts and a 27% example. And you ignored it, if you are intimately familiar with codes, this shouldnt be a surprise to you.
1. Again I don’t know where you get the 75% of those billings are submitted by 3%
-You are a non physician but have come to the conclusion that the complex care plan was ill conceived. That is an opinion that the AMA disagrees with and many physicians. But you are entitled to it
2. You have come to the decision that the complete physical was enough based off your own opinion.
3. You have come to the conclusion that the modifiers were abused, definitely true in my understanding.
4. The average family doctor works 8 hours a day and sees 22 patient a day. Shandro tweeted out this number and sent it out in reports. Thats 2.75 patient an hour. You are incorrect, I have attached a media post with shandro confirming the number.
https://calgaryherald.com/news/politics/health-minister-to-outline-alberta-governments-steps-for-changes-to-doctor-pay/
5. You, not a physician, have determined what an appropriate risk to a GP is.
6. You have brought up incorporation which physicians should have access to given that they run a business and pay overhead, like other incorporated businesses. Any Albertan can set up a corporation as a contractor, this is not unique to physicians. I am incorporated as an accountant and I share the same benefits as physicians. Unlike employees, physicians and self employeed individuals d nt have a pension. There are pros and cons to this. The biggest pro of a corporation is tax deferral, not evasion. Only 50% of physicians incorporate.
Ultimately physicians are free to do what they want and go where they want just like anyone else. We have a lot of foreign trained doctors in Alberta who came here for better opportunities.
The UCP can make whatever cuts it wants like they did with rural docs only to watch rural docs close services in 44 communities. Prior to the cuts, Shandro said he would replace any doctors that wanted to leave immediately.
I took 3 weeks after making cuts to rural physicians for Shandro to walk back once doctors started sending letters to close practices.
I was alive during the Klein cuts when our doctors went to the US in droves as well as to Ontario. There was a time where I had to get on a 1 year waiting list to get a doctor. Its always easy to say you’ll bring in more doctors, the question is what doctors from other provinces that didn’t come here before the cuts would run here after.
The government can do whatever it wants, ultimately physicians are in high demand, they will slowly migrate where they see fit.
Shandro rammed through his rural changes only to back track and add $81million in additional rural spending in 3 weeks. Our government is now spending MORE on a group of physicians that were willing to accept a 5% cut.
The AMA offered a 5% cut across the board, the same cut that Alberta MLAs thought was heavy handed and fought aggressively. Despite our MLAs being the best paid in the nation
https://globalnews.ca/news/5732940/alberta-mla-pay-ucp-premier/
Remember, physicians are one of the only services that do not get to set their prices. Unlike dentists, accountants, construction contractors, lawyers, home builders. This in my opinion is great and necessary for universal healthcare. We cap doctors on what they can charge and do not let them runs a free market.
BUT
If you want to know the fair price of anything, you let a free market decide, see what people are willing to pay.
And if you want to know the “fair price” of healthcare, look south of the border. And I hope we never have that system in Canada. That is what “fairly” compensated looks like.
With that said, I do think our doctors were appropriately paid prior to the cuts, thats my opinion. But just because Alberta’s economy isnt going well doesnt mean the price of bread will go down or the cost of a lawyer, minimum wage or your car will go down. But some how we assume the pay to doctors must go down. That is not fair.
If Alberta is bent on matching other provinces we should increase our personal taxes, corporate taxes and add a 8% provincial sales tax like Ontario. But thats a conversation we aren’t ready for
That 75% by 3% came from a study done at UofC focused on physician billing patterns. You are right i am not a physician, but my husband is a well respected, dedicated GP who is of the opinion that specific code was ill conceived and abused by many. He feels a complete full physical with comprehensive history, and proper documentation is sufficient, but thinks many bill for that without actually doing what should be done.. His sister, a GP and her husband, an internist strongly agree.
My husband works long hours and takes call for OR assists (for the last 21 years) without an on call stipend and thinks that is okay. IMAGINE. I think my problem is that he is my example and he may be exceptional. He has worked harder and longer than most, truly loved the profession and has always been willing to go the extra mile for his patients, whether he was paid or not. My children have followed his example so anything less I suppose disappoints me. I do actually believe some specialities are overpaid, but that is an entirely different conversation. Were GPs overpaid? Yes the many that abused the system. Most were fairly remunerated. It is really hard to listen to physicians complain when so many Albertans are taking cuts or losing employment. I guess I think it fair physicians be willing to do the same.