BOW VALLEY – Recent changes to rural physician compensation in Alberta have left doctors that deliver health care in 141 communities – including the Bow Valley – 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, a bulletin posted by Alberta Health that detailed the changes to the program contained incorrect information, according to Shandro and his staff.
The incorrect information stated that the flat fee of the RRNP was being eliminated. As a result, 141 rural communities like Cochrane, Canmore, Morley and Banff, were no longer included in the compensation formula's list of eligible locations. Those locations had a zero per cent variable rate as part of the compensation program, therefore doctors practicing in those communities could only collect the flat fee portion.
Subsequently, the government has clarified physicians in those 141 communities will continue to collect the flat fee as part of the program. The flat fee for physicians in Cochrane and Canmore as part of the program is set at $4,293, while in Banff and Morley it is $8,586.
Canmore's Mountain Maternity and Family Medicine physician Liana Hwang said the error and confusion that resulted has left her feeling unsettled and destabilized as a rural doctor.
"It does contribute stress to what we are already trying to deal with on the medical side of a pandemic," Hwang said. "To not know what the minister is going to do next and to not be able to take his written communication at face value [is concerning]."
She has been practicing full time in Canmore since 2013 and has applied for and received the RRNP funding. She said that is the why the RRNP exists – to help recruit and retain rural physicians – even in locations like Canmore.
"We have it pretty good in Canmore compared to a lot of other rural communities, but even here it is not perfect," Hwang said. "To lose any support for rural medicine in general is a problem."
What was even more concerning, however, was the implication that by removing the 141 communities from the list, that they may no longer be considered rural under the government's definition. That could change physicians ability to apply for other programs.
"The biggest thing for me was the way the announcement and bulletin was worded," Hwang said. "It seemed like doctors in Canmore would not be considered rural anymore and would not qualify for the other measures."
While Alberta Health officials took to social media on Sunday (April 26) to acknowledge incorrect information was included in the bulletin, NDP health critic David Shepherd questioned whether it was part of a pattern.
"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 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 since 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 removing 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."
For local doctors in the Bow Valley like Hwang, it calls into question why the wrong version of the RRNP list existed in the first place and whether or not the government has been considering changing the definition of rural health.
"Why did they have a this list to start with?" Hwang asked. "Unless that was something they were considering.
"Alberta doctors have always been prepared to work with the minister and this is an error that if doctors had of been involved ... we would have noticed almost a quarter of the communities had been missing."
