'A fee for service is what we know': Physicians group open to compensation changes but says challenges remain

The blue ribbon panel's report on Alberta's finances is calling for changes in the way physicians are paid in order to help tame the provincial deficit, but the Alberta Medical Association says the report isn't recognizing the contributions physicians have already made to the system.

AMA president Dr. Alison Clarke says the report fails to recognize that doctors have already made concessions, which includes several years with no pay increases and cuts that add up to $500 million in savings.

"We also have to recognize that a number of our members are small business owners meaning they run practices," Clarke said.

"So there is there are some market pressures that they would have to deal with in that regard that you know some of the other groups may not have to."

She said doctors are willing to negotiate but they still need to be fairly compensated to pay for things like staffing and other overhead costs.

Still, Clarke said she does agree with some of the recommendations in the report, which she believes would improve health-care delivery.

The report also calls for a shift away from the dominant fee-for-service model for physician compensation.

'A very expensive way to pay doctors'

"Fee-for-service works well in clinical settings, like emergency rooms or in surgical settings, but it does not work well for an aging population with chronic conditions," the report says.

"Also, it is not suited to the primary health care model, where a team of health professionals — from mental health professionals to physiotherapists to nutritionists — is available to address the underlying conditions causing health problems. It is also a very expensive way to pay doctors."

In the 2016/17 fiscal year, the report says the average fee-for-service earning for Alberta physicians was $413,000, which is 35 per cent higher than the average in comparator provinces.

The interactive chart below shows per-capita spending on health care in Alberta, adjusted for inflation, over the past 40 years:

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The report recommends moving toward alternative methods of physician compensation, something Clarke says doctors are "open to" but have found difficult to do, under the current system.

"A fee for service is what we know and that's how we've been doing things since publicly funded health care has been around," she said.

"Certainly there are other ways of doing things and we are looking at that and we are supporting any physician that wants to proceed. There are alternative payment plans in existence now, but for those physicians who would like to move to that ... there have just been so many barriers to it, that it's made it hard for physicians to want to do it."

'We're saving the system money'

Dr. Rick Ward, a physician at Crowfoot Village Family Practice, says the clinic has been funded through an alternative payment method for more than a decade and it's been working for them.

"We've had great patient outcomes. We've got happy physicians and staff and guess what, we're saving the system money," he said.

He said he and his team receive yearly, block funding to care for a patient and that the amount stays the same no matter how often a patient is seen or whether they want to see a physician, pharmacist or psychologist.

"It allows patients to have the benefits of team-based care and it allows the physician to have the flexibility to not have to run patients through the treadmill in order to make enough money to keep the system going, economically," he said.

"I'm very happy with the compensation that I'm making and it's very similar to what I was making under the fee-for-service [model]."

The report recommends the government renegotiate the agreement with the Alberta Medical Association and consider using its legislative powers to change the terms of the deal, if need be.

"Every effort should be made to achieve a negotiated agreement, but the government should also consider its legislative options," the report says.

Clarke hopes it won't come to that.

"Legislation has always been something that the government has had the authority to do; we've never had to have legislation to reach an agreement in negotiations," she said.

"We've always been able to agree with governments to lead to a successful conclusion to negotiations, and we're entering the negotiation process, which will be starting in the next little while, with that expectation that we'll be able to sort things out."