There’s still a lack of public awareness re. @shandro’s actions (not the #shantrums, the cuts & control of our health-care).

Albertans: you need to KNOW about what is going on & pls WRITE to your local newspapers to shine a spotlight on this.

As it is absolutely terrifying.

1) Bill 21 - PRIOR to negotiations with docs, was introduced by AB gov’t. Allows the Minister to tear up the AMA contract solely upon 1 vote of Cabinet. No notice beforehand, no opposition or debate, no media/public awareness. ++bad faith; & an alarming precedent for all workers.

2) Bill 21 - also allows the Ministry to control licensing of AB physicians and unilaterally set requirements for where (and possibly what) new physicians practice. Whether the physician feels able to or it is within their scope/training, the Minister controls where/how they work

3) @shandro has interpretted the AB Health Care Insurance Act’s phrasing “by authority of law” to equate “Minister decides”. This includes de-listing med services if HE alone decides they are medically unnecessary. By law, the AMA is to be consulted; in reality, a facade at best

3) (cont). What this means for patients: the Minister (one person) can decide what services they cover and what pts have to pay for. Given the Ernst&Young report suggesting de-listing procedures such as tubal ligations, certain hernias, etc... thus the patient would have to pay.

4) Contrary to what AB Health has tried to “sell” to the public: the complex modifiers cuts were held, not cancelled as, in tearing up the AMA contract, @shandro ended the Phys Compensation Cmte which prev made decisions WITH AB Health on fees/rules. Now, the Minister decides.

5) Also contrary to communications, AHS is proceeding with “review” (i.e. cancellation) of clinical stipends. They’ve also unilaterally & w/o notice to AMA expanded the scope from stipends they claimed duplicated Fee-For-Service payments to those “in addition” to Fee-For-Service.

5) (cont) Further, AHS has been disputing AMA’s representation of docs in AHS contract negotiations and denying binding arbitration. Removing stipends paying for availability and services otherwise not compensated = docs will be forced into not being able to offer those services.

6) In Nov, AHS also, with the assistance of AB Health, unilaterally decreased Physician On-Call payments, some by 1/3. Esp hard hit were rural docs who did experience >30% reductions in on-call payments. Which already initiated difficult choices by docs on clinic vs hosp coverage

7) March 31 - despite docs’ pleas to #pausethecuts, esp while needing to focus on COVID which was already throwing the system into chaos, @shandro continued to turn an unlistening ear. As did many UCP MLA’s who ignored or denied doc & pt fears about devastating impact of the cuts

7)a) Exercising his belief that the “Minister should decide”, @shandro de-listed Good Faith Claims (pts w/o ID), Seniors Driver’s Medicals, some radiology imaging tests & Comprehensive Care Plans which gave fam docs/teams protected time to review all care mngnt w/ pts. All GONE.

7)b) Hosp “overhead” payments removed: THE disastrous cut forcing docs, esp rural docs & community specialists to withdraw hosp services. A 30% cut to hosp codes +++undercut clinics (that STILL have overhead even when docs are in the hosp) so many cannot afford to do both anymore

7)c) Daily “visit” capping - capped at 50 services/day (not indiv appts but >200 different services, eg, calls, team/fam conferences, etc). And up to 65 total (50-65 at 50% payment as if time or cost of doing those services decreases...). Massive impact on pt access to THEIR doc.

7)c) (cont) As another example of bad faith, @shandro’s crew snuck in several additional services under this cap: with NO notification or consultation to AMA or docs. These include home visits and long-term-care facility visits. Forcing docs to limit what services they can offer.

8) Virtual codes - increased somewhat from initial $20 rates, still vastly underfunded compared to in-person appts. And with no modifiers so a 10 min call is the same as a 60 min call. Major issue for care of complex pts or for consultations. Penalizes docs doing the RIGHT thing.

9) @shandro and @jkenney continue to promote episodic electronic care (Telus’ Babylon) and NOT continuity of care by a pt’s long-time physician. Bounce-back messages from the Premier’s office persist in advertising Babylon, and completely decline to mention pt’s own physician.

10) Seemingly forgotten at the moment, AHS/ @shandro unilaterally provided notice to ALL AHS radiologists as of March 31, 2021. At which time, the “lowest common denominator” options will be invited to vie for a contract providing radiology services to Alberta patients.

FINAL THOUGHTS: this is a broad summary of the major attacks that @shandro has employed against physicians in the last 5 months. It is not all-inclusive but I attempted to cover the most critical elements and what they mean for Alberta’s health system and patients...

... This IS terrifying. It is an AB where contracts mean nothing; a Minister decides what is/isn’t medically necessary, & docs have been thrown into chaos (in addition to dealing w/ COVID).

PLEASE write your MLA & newspapers to protest @shandro’s destruction of our health-care!

Addendum: apologies as I tried to hit the big points but knew I would end up missing some. These ones are challenging as they are still somewhat unknown in terms of absolute dollars, but they are critical in what they will mean for patients.

11) Medical liability coverage - major issue for higher risk medical specialties like obs, neurosurg, ER. Likely meaning costs increasing by 10’s of thousands... meaning many docs may not be able to continue high risk practices. Major issue for rural obstetrics/ER services.

12) Business costs program - introduced over a decade ago to assist community clinics with high overhead so docs stayed in community rather than all going to AHS facilities. Approx 8-10% hit to docs as of Mar 2021... endangering the viability of community-based clinics further.

13) Rural physician recruitment and retention - gov’t has not even shared with AMA/docs how they [unilaterally] plan to change this. One of the major reasons rural physicians have been able to stay and offer services in their communities. Rural AB in real danger of losing ++docs.

14) Continuing med education assistance - implications of this are sneaky as this was one of the few benefits docs did negotiate over many contracts, in lieu of previous compensation increases. Unilaterally ended by AB Health with 1.5 months notice for physicians to access/use

FINAL final thoughts(!): AB docs did NOT ask for an increase or even a freeze. We offered an across-the-board reduction equal to these targeted/disasterous cuts. We asked for arbitration. We asked for a *pause* during the pandemic.

ALL ignored by @shandro as “Minister decides”.