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Dr. Shazma Mithani outside the University of Alberta hospital in Edmonton, Alberta on March 30, 2020.Amber Bracken/The Globe and Mail

Hundreds of Alberta physicians say changes to how they get paid should not go ahead as planned on Wednesday, arguing the new rules will create instability in the health care system at a time when doctors should be focusing on the deadly pandemic.

Roughly 850 doctors signed a letter, released Monday, that estimates about 400 community clinics across Alberta have laid off staff or closed as COVID-19 sweeps the globe and the province prepares to roll out its new billing plan. Social distancing has already made it difficult to visit patients and the new pay structure will mean less compensation.

Physicians have been warring with the United Conservative Party government for months. Negotiations over fees crumbled late last year and the government unilaterally nixed the existing pay structure in February, saying it would impose a new system on April 1. Some doctors still do not know how much they will be paid for certain services when the new deal takes effect this week.

The novel coronavirus has intensified the fight because slews of physicians are unable to perform their regular duties, and therefore unable to make money, because of social distancing and cancelled elective procedures. Doctors argue Alberta’s health-care system will be unstable if the government proceeds, particularly during the COVID-19 pandemic. The province introduced the changes to lower health-care costs.

“We have no idea what we’re going to be walking into Wednesday,” said Shazma Mithani, an emergency room doctor at the Royal Alexandra Hospital and the Stollery Children’s Hospital in Edmonton. "To push these changes during a challenging time for all Albertans isn’t right.

“We should just hold off, and let’s get through these next weeks, months, whatever it is. And then we can talk again,” she said.

Alberta proposed 11 changes to the province’s payment structure, although it took one of those off the table because of the COVID-19 crisis. That item, known as complex modifiers, governs how doctors are paid for extended face-to-face visits with patients with complex problems.

The remaining 10 proposals include capping the daily number of patient visits for which doctors can bill; eliminating payment for driver medical exams for people 74.5 years and older; and terminating the “good-faith” claims, which allow doctors to bill the province for visits with patients without proof they are covered in Alberta. This change puts vulnerable citizens at further risk because they are often lack health cards, said Dr. Mithani, who was among the letter’s signatories.

The details of the billing changes remain unclear. The emergency room doctor, for example, does not know what she will be paid for seeing a patient with mental-health concerns.

Alberta Health Minister Tyler Shandro did not directly address the physicians’ request, but said he still working with the Alberta Medical Association, which represents about 14,000 doctors. “Our government will provide whatever resources are needed to protect Albertans in the pandemic," he said in a statement. “We expect spending on physician services and health care overall to increase significantly this year."

John Julyan-Gudgeon is a family doctor in Red Deer and among the letter’s signatories. His clinic has laid off eight support staff, roughly halving his operation’s support team; shortened its hours; and closed its weekend practice. Dr. Julyan-Gudgeon said it would help if physicians were paid the same for all virtual visits as they are for in-person appointments.

The changes also affect doctors with private practices and who have hospital privileges. Those doctors will make less money when treating patients in hospitals because Alberta, he explained, wants them to cover overhead costs at facilities.

“They want the doctors to pay for the hospitals,” Dr. Julyan-Gudgeon said.

Laura Lassila, a family doctor in Calgary, said she also had to lay off staff. The fight with the government has been distracting, as well as physically and emotionally draining – an unwelcome mix in the face of the coronavirus crisis.

“We’re going into this tired,” Dr. Lassila said. “We need to be as strong as possible so we can adapt to the issues of COVID-19.”