AMA president Dr. Brian Wirzba says some Alternative Relationship Plan rates haven't been updated in more than 20 years. "You know if you need an emergent plumber on a Saturday night, you're going to pay more than if it's an elective shift on a Tuesday afternoon. So that's really where the impasse is right now."--NEWS FILE PHOTO
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The president of the Alberta Medical Association says physicians may not sign on to pick up new shifts as part of a relief measure introduced by the province because of the outdated model proposed for compensation.
The triage liaison physician role was announced by Minister of Hospital and Surgical Health Services Matt Jones at a press conference Jan. 15. With a Feb. 1 launch date, the position was framed as an urgent response to what Jones called extreme pressure in Alberta’s emergency rooms.
The new position will schedule a physician to work in ER waiting rooms. The doctor will be able to order diagnostics and stratify concerning cases, which officials say will help patients access more timely care.
According to Dr. Aaron Low, the chief medical officer of Acute Care Alberta, the first phase of the rollout will require two seven-hour shifts, seven days per week, at each of the five participating emergency departments. Low says physicians will be compensated with a daily rate for their triage shifts.
But Dr. Brian Wirzba says years-long stalled negotiations with the province about physician compensation mean hospitals might not find staff willing to take on the extra role by the time of its launch next week.
The AMA has been negotiating for updates to the alternative relationship plan, a pay model used for medical services that are not well-suited for typical fee-for-service pay. Many Alternative Relationship Plan (ARP) rates have not been substantially updated in 10 or 20 years.
In a statement to the News, the Ministry of Primary and Preventative Health Services said with this being a new service role in emergency rooms, the ARP model will provide stable and predictable compensation for physicians where service volumes are uncertain.
But Wirzba says the outdated rates and lack of differential pay for evenings, weekends and extra hours offers little incentive for already over-burdened physicians to take on more.
Jones told reporters the position would be drawing on existing staff during the first phase, with further recruitment to follow.
“This triage position is a high-risk position, primarily because you are out front trying to manage and triage patients in the waiting room, but as a physician the bar of what you are held to if anything goes wrong is higher, and you don’t necessarily have all the supports that you would have in the regular department,” Wirzba said in an interview with the News on Friday.
“Again, physicians are willing to do this. Our emergency department colleagues think this is going to be beneficial. But they are concerned that what’s being offered them doesn’t represent what the challenges are.
“I’m not sure we’re going to have any emerge group actually sign on the way it is.”
When Jones announced the TLP position, Wirzba says he assumed compensation would proceed according to the modernized rate calculations the AMA had developed with the government based on 2024-2205 fee-for-service rates. He says he was surprised to find the outdated model was suggested.
It has undermined some of his initial optimism about the program, which was at its best still a temporary fix.
“It’s a bandaid,” he said. “The bandaid just might be a lot smaller than we anticipated.”
ARP negotiations take place between the AMA and the Ministry of Primary and Preventative Health Services. The ministry says while ARP modernization remains important, it is a long-term structural initiative.
“Government will continue working with the Alberta Medical Association on ARP improvements while prioritizing measures that deliver the fastest impact in emergency departments,” the ministry said in a statement.
Low says he understands where the AMA is coming from. Family medicine physicians received differential pay as part of their new ARP, and he says he sees how emergency physicians find the lack of a similar policy in their ARP inequitable.
But he says he’s frustrated to see bargaining disagreements get in the way of a measure he thinks will provide some level of needed, immediate relief to the province’s ERs.
“Unfortunately, what might be happening here, this is a highly public ARP – it may be being seen as an opportunity to bump up physician rates outside of the normal negotiation process,” Low said.
“I hope people are willing to take this. We offered it in good faith, because it’s a solution that will make a difference. But ultimately we are not a signatory to this agreement. My job is to hopefully get it across the line as far as I can, and then it’s up to the physician group and the ministry PPHS to seal the deal.”
Low says all the province’s health-care woes come back to issues about patient flow in hospitals. Emergency departments are the most visible expression of a systemic issue. He says long-term solutions are needed, and coming, but in the meantime, ACA is looking to measures like this one to mitigate pressure.
“In an ideal world, we wouldn’t need this,” said Low. “We would have enough capacity and physicians and nursing staff in all of our emergency departments so that people got seen in a timely way. Obviously we’re in a tough place in Alberta, with population growth and various pressures on our health system, so we need to do the best with what we have right now.”
“While I understand the criticism, it is a very reasonable thing that could help us, so ultimately, I hope it does.”
