Max Fawcett is a freelance writer and the former editor of Alberta Oil magazine and Vancouver magazine
We still don’t have a good sense of how much damage the coronavirus will do in North America, but it has already reshaped our day-to-day lives in a way that was unimaginable even a week ago. Professional sports have been put on hold, cultural events have been cancelled, global financial markets have been roiled, and people have resorted to stockpiling toilet paper as a kind of shared defence mechanism against the sudden surge of uncertainty and chaos. The only thing that hasn’t been affected by COVID-19, seemingly, is the Government of Alberta’s fight with its doctors.
In its ongoing effort to cut costs and balance the budget, and in the wake of what it described as “failed negotiations,” Jason Kenney’s United Conservative Party (UCP) government decided in February to rip up the province’s master service agreement with doctors, which expires on March 31. The Kenney government also decided to launch a very public campaign against Alberta’s doctors and what it sees as their excessive levels of compensation, one that was led by its pugilistic health minister, Tyler Shandro, and supported by an ever-expanding phalanx of issues managers and their Twitter accounts.
The new contract the government intends to legislate into place includes a bunch of major changes, from capping the number of patients a doctor can see in a day to provisions that encourage a shift away from fee-for-service billing and toward three-year contracts. But it’s something called a “complex modifier” that has attracted the most attention. That’s an extra fee that was introduced a decade ago to account for the fact that some patients have more involved issues that require more time and attention; if a visit ran longer than 15 minutes, the doctor was able to bill an additional $18 on top of the standard $41 per patient.
The government, for its part, has essentially accused the province’s doctors of over-using the fee modification, which didn’t sit well with either doctors or their representatives. “This attack on physicians – particularly the disproportionate attack on family physicians – is disturbing,” said Christine Molnar, president of the Alberta Medical Association. Mr. Shandro didn’t shy away from the implication, telling reporters that “it was being used on patients that weren’t complex […] We don’t think the population of Alberta is that complex.”
The fighting only intensified in recent weeks, even as the shadow cast by the novel coronavirus continued to grow in size and scope. The doctors, for their part, took to Twitter in growing numbers, with both official accounts and a growing array of satirical ones taking aim at the government’s position. Mr. Shandro and his digital deputies continued to advance their position, with the Health Minister tweeting that he was “happy to explain again Bill 21 and the termination of the AMA Master Agreement” on March 12 – the same day the COVID-19 death toll passed 1,000 in Italy and satellite photos revealed mass graves in Iran that were almost certainly for those killed by the virus there.
This fight with the province’s doctors is within the UCP’s purview, if not in their best interests, as a duly elected government. There’s no question that rising health-care costs are a challenge that every government in the Western world needs to face up to, and that Alberta has a particularly steep hill to climb here. The province’s doctors do make more than their peers in the rest of the country (35 per cent as of 2016-17, according to the MacKinnon Report on Alberta’s Finances), and that does contribute to the province’s unbalanced finances – although, it should be said, not nearly as much as the absence of a provincial sales tax.
To its credit, the government has already announced that it will postpone the layoffs that had been planned for as many as 4,900 front-line positions over the next three years, a figure that included 500 nurses. And after including a $220-million cut in health-care spending in its 2020-21 budget, it shifted course and announced a $500-million increase on Sunday.
But it seems intent on continuing the skirmish with Alberta’s doctors, and in the face of a global pandemic, this seems akin to an act of self-defeating stubbornness. At a time such as this, you would think governments would want their doctors, nurses and paramedics devoting all of their available energy and attention to the crisis at hand, not worrying about how they’re billing or whether they can afford to continue practising medicine in Alberta.
It’s probably too late for the UCP government to repair the damage that’s been done to its relationship with Alberta’s doctors. But by postponing the changes that are set to take effect on April 1, it can allow the province’s medical professionals to focus on meeting the enormous challenge that lies ahead. Perhaps, when the crisis that’s in front of us finally abates, we’ll all have a better appreciation for the work they do – and the value it has.