Dr. Donovan Nunweiler taken a few years ago at his medical practice.--FILE PHOTO
gslade@medicinehatnews.com@MHNGillianSlade
A local physician is warning that Alberta’s health system could deteriorate and end up being more expensive as a result of a government-imposed contract with doctors.
“As physicians adapt and play by the rules shoved at us from the government, it will result in a more expensive health-care system with worse outcomes for patients,” said local family physician Dr. Donovan Nunweiler.
He says if he sees a patient with two health issues and bills Alberta Health $38.03, plus $9 if the visit extends beyond 15 minutes, the total cost is $47.03. If he tells the patient to return another day to address the second health issue the bill will be $76.06. If a test has to be ordered, or the patient is referred to a specialist, it can take another 10 minutes to do the paperwork after the patient has left.
The Alberta government imposed a new contract on doctors this week after talks faltered last weekend. Negotiations began in November. The new rules are effective April 1.
Tyler Shandro, minister of health, said ending the agreement was necessary because of the impasse with doctors on how to reduce costs by $2 billion in this fiscal year and over the next three years.
Drew Barnes, MLA for Cypress-Medicine Hat, says he does not know whether the government-imposed solution had anything to do with presenting a better financial picture in the provincial budget next week.
“Imposition isn’t preferred and negotiation would be much better,” said Barnes, who believes something had to be done to reduce health-care costs, necessitating a tough decision. He believes the government has made cost reductions of its own and says he has had three reductions in pay in his eight years as an MLA, including one of five per cent under the UCP.
In response to the Alberta Medical Association’s letter posted on its website after the government’s announcement on Thursday, a number of people posted comments.
Dr. Johan Viljoen said: “Throughout my whole career of 42 years we have all put the best interest of our patients first. Now we get a kick in the teeth again by a cognitively challenged government. It is time to take action. Patients may suffer, but if they don’t back their physicians they deserve what they are going to get. Thank the Lord I am retired and don’t have to eat this crap from our politicians.”
Shandro says Alberta is paying physicians more than other provinces, estimating gross clinical earnings for an Alberta doctor at almost $390,000 a year – about $90,000 more than a comparable one in Ontario.
The AMA disputes those numbers, saying they are based on faulty apples-to-oranges comparisons. The AMA’s own study found Alberta doctors get $386,000 a year on average, which is more than the national average of $346,000 but reflects the reality that wages across Alberta’s job spectrum are higher.
Premier Jason Kenney says Alberta’s doctors will still be the best compensated in Canada and he can’t understand why they would want to leave the province for perceived greener economic pastures.
Nunweiler says a family physician’s overhead costs, including staff, premises and equipment, can be 20 to 50 per cent of their fees.
Details of the government’s decision on fees for doctors were in a story in the News on Friday.
Michaela Glasgo, MLA for Brooks-Medicine Hat, says the AMA did not bring any concrete solutions to the table to control spending, and the government’s ultimate goal is to control spending growth. She does not believe there will be an issue with physicians choosing to leave the province as a result.
“I’ve had multiple meetings with local physicians … if we have real concrete solutions coming forward we can bring those forward. This isn’t the end,” said Glasgo.
Nunweiler says the AMA and Alberta’s medical schools have been promoting “patient first” principles for more than a decade but this change will promote a walk-in-style of medicine, more emergencies, and patients not satisfied with their physician encounters. There is a growing trend of graduating family physicians preferring to work walk-in clinics.
— with files from The Canadian Press
I thought these medical students went into medicine because they were primarily concerned with caring for people not maximizing annual incomes. They choose walk in clinics because it is fast money and requires a minimum amount of investment into patient well being. Alberta doctors have exploited the system for years and finally the government has said enough. The cap for patients being seen should not exceed 45. 65 is obscene unless of course you are one of the physicians who cherry picks and has patients with uncomplicated medical histories. Whoever started this practice of patient interviews, one complaint per visit nonsense has done the profession great harm. The reality is Alberta doctors are well remunerated. The government in response to their whining should publish a sunshine list. I don’t expect altruism to be their mantra, but to complain about their current fee schedule in these economic times is petty.
my2sense
4 years ago
The problem Tyler Shandro has with the fee for so called “Complex Care” is that the modifier that allows good family doctors to be compensated for providing good care for any visit is based on TIME SPENT including making chart notes or writing a letter to a consultant. And for most patients, there is a history to be taken, and examination of appropriate parts, a rational decision for either appropriate investigations or referral, or a correct treatment [read: not just slapping down an antibiotic prescription for an obvious viral infection!] And in my experience, there are questions from a patient or most often a second or third problem that starts “while I’m here…” It stands to reason that this visit is going to take more than 15 minutes. All this takes time and if a doctor spends 7-8 hours in the office, and during that time books 30 or fewer patients, the modifier will apply to a majority of patients seen that day. So a doctor whose pattern of practice can be described that way, he/she deserves to be compensated for this. Providing GOOD care significantly reduces patients going into the ER. So when AHS had to put their foot down and disincentive high volumes of patients seen in a day [ 65! that’s still way to many] but at the same time disincentive quality time spent with patients, it should make everyone upset.
But another side to this is why the minister is feeling so desperate as to act unilaterally. The AMA itself, whose motto is “Patients First” should have offered to the government YEARS ago, to agree to put a limit on the number of patients that a physician could bill for in a day. But they have this penchant for supporting all doctors, even those who scoot through 90-150!! patients a day. WHO could justify that as being in the best interest of the patient.
fd4thought
4 years ago
Thank you explaining the complex care fee. I may have been too harsh. If I consider the hourly rates accountants, and lawyers bill, physicians providing appropriate time to address patients’ concerns should be fairly compensated.
Fedup Conservative
4 years ago
Our family doctor who retired in 2010 was working 14 hours per day , thanks to what Klein had done. He worked 8 hours in his clinic plus an additional 6 hours assisting with operations in an Edmonton hospital due to the huge shortages Klein had created. He stated that the fact that he had five children and several grandchildren in Alberta and his dedication to his patients were the reasons why he remained in Alberta. I helped nine doctors and at least two dozen nurses relocate out of this province and not one wanted to go, Klein made it impossible for them to stay, by closing hospitals, 1,500 hospital beds and cutting 5,000 nursing positions.
I thought these medical students went into medicine because they were primarily concerned with caring for people not maximizing annual incomes. They choose walk in clinics because it is fast money and requires a minimum amount of investment into patient well being. Alberta doctors have exploited the system for years and finally the government has said enough. The cap for patients being seen should not exceed 45. 65 is obscene unless of course you are one of the physicians who cherry picks and has patients with uncomplicated medical histories. Whoever started this practice of patient interviews, one complaint per visit nonsense has done the profession great harm. The reality is Alberta doctors are well remunerated. The government in response to their whining should publish a sunshine list. I don’t expect altruism to be their mantra, but to complain about their current fee schedule in these economic times is petty.
The problem Tyler Shandro has with the fee for so called “Complex Care” is that the modifier that allows good family doctors to be compensated for providing good care for any visit is based on TIME SPENT including making chart notes or writing a letter to a consultant. And for most patients, there is a history to be taken, and examination of appropriate parts, a rational decision for either appropriate investigations or referral, or a correct treatment [read: not just slapping down an antibiotic prescription for an obvious viral infection!] And in my experience, there are questions from a patient or most often a second or third problem that starts “while I’m here…” It stands to reason that this visit is going to take more than 15 minutes. All this takes time and if a doctor spends 7-8 hours in the office, and during that time books 30 or fewer patients, the modifier will apply to a majority of patients seen that day. So a doctor whose pattern of practice can be described that way, he/she deserves to be compensated for this. Providing GOOD care significantly reduces patients going into the ER. So when AHS had to put their foot down and disincentive high volumes of patients seen in a day [ 65! that’s still way to many] but at the same time disincentive quality time spent with patients, it should make everyone upset.
But another side to this is why the minister is feeling so desperate as to act unilaterally. The AMA itself, whose motto is “Patients First” should have offered to the government YEARS ago, to agree to put a limit on the number of patients that a physician could bill for in a day. But they have this penchant for supporting all doctors, even those who scoot through 90-150!! patients a day. WHO could justify that as being in the best interest of the patient.
Thank you explaining the complex care fee. I may have been too harsh. If I consider the hourly rates accountants, and lawyers bill, physicians providing appropriate time to address patients’ concerns should be fairly compensated.
Our family doctor who retired in 2010 was working 14 hours per day , thanks to what Klein had done. He worked 8 hours in his clinic plus an additional 6 hours assisting with operations in an Edmonton hospital due to the huge shortages Klein had created. He stated that the fact that he had five children and several grandchildren in Alberta and his dedication to his patients were the reasons why he remained in Alberta. I helped nine doctors and at least two dozen nurses relocate out of this province and not one wanted to go, Klein made it impossible for them to stay, by closing hospitals, 1,500 hospital beds and cutting 5,000 nursing positions.