I recently encountered a thread on Twitter outlining several myths that Tyler Shandro, Alberta’s minister of health—as well as other members of the UCP government—keeps perpetuating as they continue fighting against doctors.
The thread was written by Kathryn Andrusky. She’s a family physician in the Edmonton area. She’s also a clinical lecturer at the University of Alberta and the past president of the AMA Section of Family Medicine. The information in her tweet was based on research and compilation performed by AMA Health Economics staff.
Given that her Twitter thread debunks several myths commonly used by the UCP and their supporters, I thought it’d be useful to have them listed here, in a more shareable format.
Kathryn has given me permission to adapt her Twitter thread for this post.
Alberta doctor pay is 35% higher than comparator provinces
The Canadian Institute for Health Information warns against using data out of context and to not compare. Adjusting for all types of payment (not just fee-for-service), the differences in specialist and GP numbers between all comparator provinces is only 16.6%.
A significant number of Ontario “technical fees” and other clinical payments (e.g. BC funding pools) were not included in CIHI’s national physician database. If we adjust for this omission, the difference drops to only 15.4% higher.
The Canadian Medical Association’s physician workforce survey revealed that Alberta physicians spend more time doing clinical work than those in other provinces. Accounting for this brings the differential to 13.3% higher.
Other provinces’ doctor associations have negotiated increases for 2019–2022. If we include those increases in the salary the government uses to calculate their 35%, the adjusted difference drops quite significantly, to merely 5.7% higher.
See the following image from the Alberta Medical Association website for more information.
As Christine Molnar, AMA President, summarizes, “Once proper adjustments are made, Alberta’s average physician compensation is projected to be 5.7 percent higher than our comparator provinces by 2021/22. But again, context matters, which is why it’s important to point out that this projection is based on current status and does not factor in any government cuts.”
Furthermore, the Alberta industrial aggregate wage level, which impacts staff and overhead costs, is 15.4% higher than that in other provinces. According to an independent consultant, accounting for other province wage increases and expected population–doctor ratios, by 2021–22, Alberta will actually be behind comparator provinces by 2.5%.
Even given that Alberta doctors will soon be 2.5% below comparator provinces, AMA recognized Alberta’s tough economic realities and offered a 5% across-the-board reduction. Tyler Shandro, on the other hand, introduced cuts unevenly, targeting specific specialties and devastating primary care.
Numerous doctors and AMA members warned the health minister about the consequences to patient care and the functioning of the health system if he imposed his targeted cuts. Despite the 5% reduction offered by the AMA being equivalent to the projected savings by his cuts, he proceeded with his hatchet job.
Alberta physicians received 300% increases since 2002
18 years is an odd, arbitrary timeframe. Increases in the early-mid 2000s were catching up following Klein’s cuts from the 1990s. Since then, Alberta doctors have not even kept pace with increases to the consumer price index. The fee schedule has not increased in 5 of the last 9 years, and the remaining 4 increased at CPI or less. Plus, doctors have had wages frozen for the last 7 years.
Jason Kenney promised to “maintain health spending” and a physician budget of $5.4 billion
This isn’t a complete myth; it’s more like “myth-leading”. Keeping a flat health budget ignores population increases, aging, growing complexity of patients and increased numbers of doctors (many of whom were recruited by Alberta Health Service).
Doctors promise to cut costs, but this never yields any savings
Alberta doctors have “bent the cost curve” with savings initiatives and system stewardship changes. All of which were negotiated (and honoured) under the last two AMA agreements. They found savings of $438 million, which would have been spent otherwise.
That $438 million not being in physician pockets was a considerable “win” for the government at the time in partnering with the AMA. But these savings are gone from the physicians’ budget, which means that those savings compound annually for the current government, as the billing/services changes doctors made have not been reversed.
Doctors just increase code utilization to compensate for any reductions/limits
Aside from an ugly accusation of inappropriate billing underlying this myth (their myth-take!), this has not been shown to be the case. Data obtained directly from Alberta Health itself reveals that doctors have been consistent in their usage of billing codes.
In fact, if you include all Alberta physician fee-for-service payments, then adjust them for inflation, fee-for-service payments have actually declined the last 3 years for the average physician in Alberta.
In other words, doctors partnered with the previous government to find savings. They delivered and did not “game” the system. Doctors take system sustainability seriously.
Doctors should be responsible for any overtures in the Physician Services Budget
As demonstrated above, doctors do not inappropriately ramp up billings to make up for cuts. Doctors can’t control population, political policies or promises, consumer price index, aging, or the unknown (a COVID-19 pandemic, for example).
Doctors recognize that fiscal responsibility and system sustainability are critical for all of Alberta. They wanted to work with the current government to keep making changes that incentivize high-quality, evidence-based care, while recognizing that medicine evolves and sometimes stewardship/changes are needed.
Despite the poor faith shown by the health minister in rejecting AMA’s offer of 5% across-the-board reductions, denying doctors the right to arbitration, and tearing up their contract, doctors still want a strong Alberta health system and excellent patient care. So they remain willing to partner with government towards this.
Kathryn’s concluding note: All credit for the analysis/presentation is to AMA Health Economics staff. Amazing and super talented bevy of economists (whatever groups of econists are called!). My part was merely some minor “translating” and wedging into 280 character snippets.