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Alberta Health Minister Tyler Shandro is escalating his pay dispute with doctors, asking the College of Physician and Surgeons to make rules to stop doctors from withdrawing services en masse.

Mr. Shandro, in a letter dated June 18, says patients – particularly those in rural areas – have a right to timely access to care and that the college has to do more to make sure that happens.

He says the college needs to take numerous steps, including prohibiting entire groups of physicians from withdrawing services at the same time.

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The letter was posted on the college’s website and discussed Wednesday at a meeting, where the college decided to ask for an extension to Mr. Shandro’s July 20 deadline for a response.

College registrar, Dr. Scott McLeod, said in a statement that the association is open to better understanding the minister’s concern.

“We would like to work with the minister and Alberta Health to develop standards of practice that allow for an appropriate period of consultation with experts, regulators, Albertans, physicians and partners,” it said.

Mr. Shandro, in his letter, says the college’s standards of practice “do not go far enough to protect patients, particularly in rural or smaller communities. Patients in these communities should not have to face an entire group of physicians withdrawing services.”

He says the revised college rules must ensure doctors who withdraw services take steps to mitigate the impact, including making reasonable efforts to ensure other physicians are available to fill gaps in care.

The college must also “prohibit an entire group of physicians from withdrawing at the same time. This could be identified as ‘job action’ rather than a closure of a medical practice,” he says.

Mr. Shandro has been involved in an escalating dispute with doctors since he tore up a master agreement with their bargaining representative, the Alberta Medical Association, in February and imposed a raft of billing changes that prompted doctors in numerous rural municipalities to announce a withdrawal of hospital services.

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Many have said the changes to hospital billing make it financially impossible to work in those facilities, where they perform services such as emergency care and delivering babies.

As some family doctors quit or withdrew services, the United Conservative government rolled back on many changes in March and April. But some doctors have continued to withdraw services, saying they need a master agreement and have no trust that Mr. Shandro won’t change his mind again.

Opposition NDP health critic David Shepherd said Mr. Shandro’s letter runs counter to pronouncements that his fee concessions would keep doctors from leaving or pulling services.

“This utterly puts the lie to any claim that Tyler Shandro has made that he has any shred of competence in dealing with this situation,” Mr. Shepherd said.

“He repeatedly claimed doctors weren’t leaving. Once doctors started to actually show they were leaving, he claimed he had replacements ready to go.

“Now we find out that in an act of desperation, he is trying to actually imprison doctors and force them to practise against their will.”

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Health spokesman Steve Buick said in a statement “the suggested changes would not ban physicians from changing their practices, or penalize them for doing so. They would balance the right of physicians to change their practices with due consideration of the impact on patients and communities.”

Mr. Buick noted that other provinces, such as Ontario, British Columbia and Nova Scotia, have similar conditions.

The AMA is taking the province to court over the abandoned master agreement, alleging breaches of Charter rights because it was not given access to third party arbitration.

Last week, a survey by the AMA suggested more than 40 per cent of physicians have at least considered looking for work elsewhere in Canada. It also found 87 per cent were making changes to their practices, including layoffs, reduced hours and early retirement.

Mr. Shandro has said $5.4-billion earmarked in this year’s budget for doctors’ salaries is the best in Canada, but it must be kept at that level to keep health care sustainable.

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