BOW VALLEY – Recent changes to rural physician compensation in Alberta have left doctors that deliver health care in 141 communities confused as to whether they continue to qualify for it or not.
The Rural and Remote Northern Program, dubbed by the UCP as the most generous of its kind in the country, was changed on Friday (April 24) as part of a range of health care announcements made by Health Minister Tyler Shandro.
"We have already made key changes to support physicians and patients during this pandemic," Shandro said. "But we need to do more, so we are taking action in several key areas.
"First, we will be changing the Rural and Remote Northern Program to make it the most generous program of its kind in this country. This program provides financial tops ups to physicians in rural and remote communities.
"These existing top ups are in the form of a flat amount, plus a variable premium on fees that physicians bill for services provided to patients depending on how isolated a community is."
The minister announced that the $60,000 cap on what can be claimed through the RRNP was being removed. He also announced his government would reverse course on a number of changes it has made to physician compensation over the past couple of months.
However, Shandro did not mention that the flat fee portion of the RRNP was being eliminated and as a result physicians from 141 rural communities would be shutout of the compensation formula.
A bulletin released by the province in relation to the changes announced by the minister stated the flat rate portion would be discontinued effective immediately, leaving the variable fee ranging from six to 36 per cent as the only part of the compensation program.
A 2018 list of just over 600 rural locations in the program showed there were 141 communities assessed a zero per cent variable amount. With each scored on "isolation points," communities with less than five points had zero per cent variable amounts, but still had a flat rate.
By eliminating the flat fee portion of the program, it effectively removed those 141 rural locations from the $57 million a year program altogether.
As of Sunday evening (April 26), the minister's department tweeted the wrong bulletin associated to Friday's announcement was published and physicians from those unlisted communities would continue to be able to claim the flat fee.
Med Bulletin 227 was published with incorrect information and did not list 141 communities. 2/5
— Alberta Health (@GoAHealth) April 26, 2020
Out of the 141 communities identified on social media as communities that were previously listed, only 29 had physicians who claimed that flat fee. 3/5
— Alberta Health (@GoAHealth) April 26, 2020
Physicians who had previously been receiving this fee and new physicians who apply in these communities will continue to be able to receive this fee. 4/5
— Alberta Health (@GoAHealth) April 26, 2020
We apologize for this oversight and will be revising the bulletin and community list on Monday. 5/5
— Alberta Health (@GoAHealth) April 26, 2020
NDP health critic David Shepherd held a press conference Sunday (April 27) questioning why this change to the program was not clearly communicated by the minister.
"What is obvious today is that this is part of a pattern of constant deception and misinformation from Tyler Shandro that has completely shattered trust, particularly between him and Alberta's doctors," Shepherd said.
"Now, even as when he is trying to cleanup the mess he created, he fails to tell the truth about the mess he is creating."
Shandro and the UCP government have been actively trying to reduce physician compensation in the province over the past year after the MacKinnon Report identified it as an area to find savings due to the fact Alberta's doctors earn more than those in any other province.
The government passed Bill 21 in the fall, giving it the right to end its current agreement for physician compensation with the Alberta Medical Association.
Negotiations with the AMA failed earlier this year and the government cancelled the contract. At the end of February, Shandro announced a new funding framework that would take effect as of April 1.
It contained a number of changes, including no longer allowing doctors to charge overhead costs when they work shifts at local hospitals and reduction of complex time modifier fees when a doctor needs to spend more time with a patient.The new funding model took effect April 1, despite warnings from the AMA and rural doctors there would be an effect on the ability to deliver health care in rural settings.
An increasing number of physicians in rural locations across Alberta have given notice that after the COVID-19 pandemic response they will no longer be able to work at local hospitals and emergency rooms as a result of the funding framework changes.
Shandro has reversed course on a number of the changes, including those made to complex modifier fees and including overhead costs as part of the compensation formula for rural physicians working at local hospitals.
At the press conference last Friday, Shandro said forcing physicians and hospitals to make choices that would reduce access to health care for Albertans "was never our intention."
"Rural hospitals, especially emergency rooms, work differently than in the city and they depend on rural physicians for coverage," he said. "We need to maintain that in Alberta.
"I want to assure rural Albertans and rural physicians that our government is committed to supporting you during the response to the COVID-19 pandemic and going forward."
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