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Alberta Health Minister Fred Horne coughs while ministers lined up for a news conference to answer questions following a meeting of provincial health ministers at the Lord Nelson hotel in Halifax, N.S., Nov. 24, 2011

Sandor Fizli/The Globe and Mail

A brief truce between Alberta's government and its doctors appears to be over, with the Alberta Medical Association warning members to "batten down the hatches" in a battle over health funding.

In a letter to doctors Monday, AMA president Michael Giuffre said talks over a new deal fell apart over the weekend, with Minister Fred Horne refusing to drop an unspecified list of conditions. The minister, in turn, said his only condition is that he has no more money to give doctors.

Dr. Giuffre said Mr. Horne has now lost the trust and confidence of doctors. "So I am asking you to batten down the hatches and prepare to face a storm," he told his members.

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On Nov. 16, Mr. Horne ended 20 months of fruitless talks by imposing a five-year deal unilaterally. It included a one-time bonus, cost-of-living increases but also phased out some programs. Mr. Horne argues it's a raise, with $463-million in extra funding over the next three years; the AMA said it amounts to a pay cut.

Last week, the two sides agreed to return to the table. Now, both sides saying they don't know what comes next.

"I fear we are in for a long haul. It will be a difficult time. The minister will say all the things he is so good at saying and that sound so reasonable. He will continue to protest that he is open to negotiations. Yet, he will only come to the table with the same pre-determined conditions that he imposed several weeks ago," Dr. Giuffre wrote Monday.

Mr. Horne replied by saying he'd go around Dr. Giuffre if he had to. "If I can't work with the AMA, I'll continue to work with doctors," the minister said, later adding: "I needed the AMA to understand there's a limit to additional funding the government can contribute to this… for the AMA's part, the issue appears to be more money."

Mr. Horne said he's willing to bring in a mediator, and denied the impasse is centred around his government's plan to reshape the provincial health system around Family Care Clinics – multidisciplinary hubs that would phase out existing, doctor-run Primary Care Networks. The new model takes funding out of the hands of doctors. FCCs haven't hurt negotiations, and "I don't think it needs to," Mr. Horne argued.

The minister wouldn't say what the next plan is, but said he doesn't "want to be in a position where we don't have an agreement," suggesting he'd be set to once again impose a unilateral fee structure.

The Canadian Institute for Health Information says that, on average, Alberta's doctors and specialists are the best paid in Canada. Alberta's government has been trying to freeze or rein in costs, as it faces a ballooning deficit despite billions in energy revenue.

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