Dr Giuffre & Minister Horne
To borrow a phrase from Renee Zellweger in the movie Jerry Maguire, Dr Michael Giuffre had me at hello. He battled Health Minister Fred Horne for months, finally getting the Health Minister’s signature on the AMA Agreement settling doctors’ compensation. We were pleased. Tensions eased…
…and then Dr Giuffre sent the President’s Letter of August 8, 2013.
In this letter, Dr Giuffre sets out three new focus areas for the AMA’s 2013-14 Business Plan. Two of these were old hat; helping physicians stay in good health and encouraging them to take up leadership roles is not new. However Dr Giuffre added a third focus called “Financial Health”.
How does the AMA propose to improve a physician’s “financial health”? Well, in addition to assisting them with practice management and providing access to specially priced financial products (again, old hat) there was this little nugget: “The AMA assists and supports members in maintaining their financial health. This includes negotiating with payers to ensure fair compensation”.
That’s where you lost me Jerry Maguire. I’m so far gone you’ll never get me back.
“Financial Health”
The AMA already settled doctors’ compensation; not just for the time period covered by the 2013-14 Business Plan but right out to 2018. The doctors agreed to a pay ladder: a 0% increase for 2011 to 2014, a 2.5% increase for 2015 and 2016 and a cost of living increase for 2017 and 2018.
So what does “negotiating with payers to ensure fair compensation” mean? What’s left to negotiate? Who’s the payer? Fair compensation for what?
The answer lies buried in the legalese of the AMA Agreement itself. (Yes, that would be the very same agreement I just congratulated Dr Giuffre for signing…silly me.)
There are two scenarios in which the 0% to 2.5% plus inflation pay ladder does not apply.
Over-utilization
Any additional costs arising from over-utilization of the healthcare system due to population increases or other factors beyond the physicians’ control are the responsibility of the Alberta government, specifically Health Minister Horne.
Ms Redford & team
The government will have two courses of action. It can increase the healthcare budget and make additional payments to the doctors or if this is politically unacceptable, it can hold the line and allow Alberta’s healthcare system to deteriorate further. Three guess which way Ms Redford and her crew will roll.
Concierge Clinics on Steroids
There is nothing in the AMA Agreement to prevent Primary Care Networks and Redford’s new Family Care Clinics from offering “uninsured” medical services. ”* Furthermore, the agreement states that the 0% to 2.5% plus inflation pay ladder does not apply to uninsured services so physicians are free to overlay the “concierge clinic” model onto Primary Care Networks and the yet-to-be-developed Family Care Clinic model and charge whatever they’d like for uninsured services.
The AMA will, as it so delicately puts it, negotiate with the “payer” (in this case the government, which in reality is us) to ensure that physicians receive “fair compensation” for their services.
It’s difficult to regulate concierge clinics in their existing form. It will be next to impossible to regulate concierge clinics disguised as Primary Care Networks or Family Care Clinics.
You had me at hello
Everyone wants more money. Lawyers charge high fees, investment bankers are ridiculously expensive and CEOs of major corporations are grossly overpaid. We thought doctors were different. And guess what, we’re not alone in this view.
The Canadian Medical Association, like the Alberta Medical Association, bills itself as an advocate for physicians and patients. It assists doctors with practice management, education, wellness and wealth management. It’s an effective advocate for patients with the federal government and individual MPs.
In May 2012, the CMA approved a policy statement with respect to the accountability of physicians to society and the healthcare system.**
Dr Francescutti
“In general, society and the health care system in Canada provide physicians with financial compensation, with a significant degree of clinical autonomy as reflected by professionally-led regulation, and with a high level of trust. In some cases, physicians are also provided with a facility in which to practice and with access to necessary resources such as MRIs and operating rooms. In return, physicians agree to make their own individual interests secondary in order to focus on those of their patients, and they agree to provide necessary medical services.”
The concept that a physician should focus on patients first and his own interests second got a boost this week with the appointment of the quirky Dr Louis Francescutti (he’s an amateur stonemason) as president of the Canadian Medical Association.
Dr Francescutti is patient oriented. He doesn’t like the fact that the healthcare system is designed for the convenience of doctors and health care practitioners, but not their patients. “There’s no disease I know of that shuts down at 5 pm and opens again at 9 am the next morning.”***
He’s asked doctors to renew their passion for their profession. “What unique value do physicians bring to the system, do they love what they’re doing, do they love the systems they work in and are they prepared to be held to a higher standard than in the past?”****
Or, like the AMA, are they simply dreaming up new ways to “show me the money”.
Dr Francescutti, you had me at hello.
*AMA Agreement, Sections 3(a)(i) and 3(b)(v)
**The Evolving Professional Relationship between Canadian Physicians and Our Health Care System: Where Do We Stand? p 9
****Calgary Herald, Aug 15, 2013, A8
Susan on the Soapbox 
Sorry, but that is heavy reading and I will have to take a breather to further digest contents of this gimme, gimme, gimme scenerio.
And that’s the real problem…the gimme mentality is pervasive right across the board, not just with the AMA. I don’t know why people think a quality life requires an expensive lifestyle. Dr Francescutti is working to raise awareness around the social inequities that lead to poor health and premature death. He says studies show that a minimum, guaranteed income has the greatest impact in improving an individual’s health. A healthy population would mean decreased healthcare costs over the long term.
I liked your post but I liked your reply to Tom even more. The reality is in that answer.
I saw Dr. Francescutti once in some conference and I was very impressed. I had no idea he is now the president of the Medical Association. Maybe now they will go back to a more reasonable approach to their demands and be more concerned about quality of care then how to maximize their income. The levels of deaths from mistakes and drug reactions is appaling and that would be a way better project than figuring out when to strike. I must confess I am surprised he was appointed president of the Medical Association. It is a good sign.
Susan I loved the photo of Ms. Redford and team. This time she forgot the baby or the senior.
Thank you Carlos. I’m very encouraged by Dr Francescutti’s appointment as head of the CMA. A good friend with years of experience in the healthcare system says Dr Francescutti is a highly ethical man. This is exactly the type of person we need in key leadership roles given the increasing emphasis on the doctors’ “financial health”. I know that we see this kind of self serving behavior in business all the time but the big difference is that the mega-salaries and bonuses for CEOs and investment bankers are paid by willing shareholders, not captive taxpayers.
PS Loved your comment about Ms Redford and team. The smiles all around are quite remarkable given the knockdown-drag-out-fight that preceded the signing of the agreement. But it’s politics…all is forgiven if you get your way in the end…until the next time.
The AMA has always been concerned about the financial health of its members [that, after all, is a legitimate concern of any union]. Perhaps the disappointment is the power we have given the AMA over matters which extend far beyond what is necessary to ensure a fair reward for the work they do. There aren’t many, if any, other unions which have so much control over how work is organized and services delivered. When we also put them in charge of designing and managing publicly-funded public service delivery points, like the PCNs and the FCCs, they become like any other business organization controlled by a Board of Directors and managed by persons with a financial interest in the works. Airlines, car manufacturers, pharma companies, breakfast cereal manufactures all claim to put the customer first …
I don’t know much about Dr. Francescutti , and I certainly can’t argue that he isn’t a highly ethical person. I attended one forum, sponsored by the Alberta Party, which featured Dr. Francescutti; That experience was an unpleasant recollection of an evangelical mission experienced more than 60 years ago, with Dr. F on a mission to get us to change our behaviour so we didn’t need health care. We’ll see if he has changed his focus from Injury Prevention [www.cbc.ca/canada/edmonton/story/2010/10/19/edmonton-francescutti-college-president.html] .
Interviews with Dr. F on the occasion of his becoming President of the Royal College e of Physicians and Surgeons of Canada [http://www.calgarysun.com/comment/columnists/2011/03/13/17596621.html and http://blogs.vancouversun.com/2011/02/01/doctors-too-self-interested-to-put-patients-first-royal-college-of-physicianssurgeons-president/%5D don’t lead me to optimism.
Good point Carol. I think I was taken in by the AMA’s huffy insistence that it was not a “union” and as a result was blind-sided by the focus on “financial health” as a Key Performance Area. I’ve been going through Judge Verte’s report of his findings in the Preferential Access (Queue Jumping) Inquiry for this week’s blog and was struck by the AMA’s position on “professional courtesy”. The AMA argued that professional courtesy is a good justification for physicians to care for other physicians and their families and friends preferentially. To be fair, the AMA says that these professional courtesy visits would occur on off-hours and would not negatively impact the queue (who knows?). In any event, what struck me was the reasons the doctors gave for allowing preferential access in their case. These include (1) doctors would be distracted and upset if they or members of their families were ill and had to wait in the queue and (2) doctors, given their specialized knowledge, would assume they have a life-threatening diseases and it would be cruel to make them wait in the queue and worry needlessly. The implication is that this distraction and needless worry is OK for the hoi polloi but not OK for our good doctors. Very peculiar sense of entitlement.
Re: Dr F. I too read that he has a focus on injury prevention. This is fine and good, but clearly not the only cause of disease so one would hope and expect that he’s broadened his perspective.
Carol you called it a Union and so do I but like Susan mentions in her reply they do not think so and that is something you are not supposed to ever say 🙂 . ‘huffy insistence’ are the right polite words. Their view is that people with their society status and education levels cannot be called a Union. Are you kidding? Not long ago they were at the level of the Pope. They are an Association that genuinely puts the patients first!! We all know that right?