Dr Patrick White is a very smart man.  He has to be.  He’s is the lead negotiator for the Alberta Medical Association (AMA) which is negotiating a new 3 year master agreement for physicians services with the Alberta Dept of Health and Wellness (AHW) and Alberta Health Services (AHS).  The process is called Negotiations 2011, but it feels more like Rocky I, II, III, IV, V, and VI.  Just when it looks like the AMA might win a round, the pummelling starts all over again.

Let me set the stage.

The Protagonists:  AMA (led by Dr White), the Dept of Health and Wellness (led by Health Minister Gene Zwozdesky) and Alberta Health Services (led by Dr Chris Eagle).  Note: Given that the AHS reports directly to Zwozdesky and is the government’s implementation arm, Dr Eagle and the AHS are merely window dressing in this exercise.

The Plot:  Replace the 8 year master agreement governing physician services which expired on Mar 31, 2011 with a new 3 year master agreement.

The Sub-Plot:  Stelmach and Zwozdesky are peeved with Alberta doctors who refuse to  shut up about the ER crisis, wait times, intimidation, retaliation and just about everything else that pops up in the media so it’s payback time.

Plot Twists: 

• Zwozdesky threatens to cut 9 key programs which will immediately reduce doctors’ pay by $35,000 unless AMA agrees to sign a new agreement by Mar 31, 2011.  The AMA refuses to be blackmailed into signing.
• The AMA and AHW/AHS sign a temporary 3 month Agreement in Principle based Zwozdesky’s offer of a pay package of 0% increases for the first 2 years and COLA* for year 3.  Zwozdesky assures the AMA that this offer is the “norm” for all public sector settlements.  Then the Government turns around and gives the AUPE a 4% increase plus 2 lump sum payments totally $3000.
• Zwozdesky and Dr Chris Eagle attack Primary Care Networks (an AMA success story) casting doubt on whether funding will continue.
• The Agreement in Principle expires on June 30—there is no new deal, just a transition plan to get to June 30, 2012, and then what…?

Negotiations 2011 started amicably in the fall of 2010, however by Feb 2011 Dr White knew he had a problem.  Luckily Dr White is not only a patient man, he’s also shrewd.  Instead of waiting to be batted around by Zwozdesky, Dr White went on the offensive (which must have been tricky given his close connection to the PC party).  He kicked off a comprehensive communication plan with three target audiences:  the AMA members who were updated on the status of the negotiations in real time, the public through the AMA website and the media, and the politicians who were inundated with emails and telephone calls from doctors and concerned citizens supporting the AMA’s position.

Dr White captured the Premier’s attention (and by default Zwozdesky’s) twice.  The first time was right after the Government announced the 4% pay hike for the AUPE (a shock to the AMA).  The second, when 6 sections of the AMA publicly supported the call for a public inquiry into allegations of intimidation.  In both cases it was in the Premier’s best interests to sooth Dr White’s ruffled feathers and get the AMA back in their corner where they couldn’t do much damage.  The AMA may have been unable to do much about the AUPE 4% pay hike and its applicability to the AMA negotiations;  however it refused to back down when it came to supporting the need for a public inquiry—much to the government’s chagrin.

Along the way we’ve learned some interesting things about the Premier and Minister Zwozdesky.  They are street fighters who are prepared to use bully boy tactics to force their opponent to concede—they had no intention of cutting funding to the 9 programs if the AMA didn’t sign the new agreement by Mar 31.  That was just a “negotiation tactic”.

This raises a more fundamental question.  Can the government be trusted?  What happened to negotiating in good faith?  A 0% increase is not the same as a 4% increase no matter how you cut it.  Threatening to cut funding to the PCN program (which the government’s own independent expert confirmed was an excellent program) is a cheap bullying tactic at a time when cool heads and thoughtful solutions are required.

The AMA has already conceded the 0% wage hike so why won’t it bow to the wishes of the politicians?  Because there are greater issues at stake.  Physicians want joint decision making power to identify and deliver healthcare reforms and improve access, quality and productivity.  Zwozdesky is adamant that they won’t get it.  He fought hard to ramrod changes to the Alberta Health Act through the House.  These changes deliver all the power over healthcare funding and delivery into his hands.  He’s not about to share that power with anyone, let alone the very people who know best how to use it.

But Dr White isn’t finished yet.  Recently he stepped into the maelstrom of politics and healthcare in the context of the PC’s leadership race.  He responded to a request from his friend PC leadership candidate Gary Mar who wanted help shaping his healthcare platform.  Dr White obliged by sending an email to all AMA members telling them about a phone-in townhall meeting at which they could present their views.  This created a furor among some AMA members who saw the email as a tacit endorsement of a particular leadership candidate.

But there’s another way of looking at it.  The Mar townhall meeting presented an opportunity for Alberta physicians to give direct feedback to the man who might one day be their boss, or more accurately, their boss’s boss.  In the business world this is akin to a union taking advantage of an opportunity to enlighten a prospective employer about the working conditions of his employees.  Surely a worthwhile exercise considering that Negotiation 2011 failed and, in Dr White’s words, he’s back to square one.**

However to make this a truly useful exercise, the AMA should set up a series of feedback sessions with all of the PC leadership candidates, not just Mr Mar, and lay out the AMA strategy for curing Alberta’s healthcare problems.  If the leadership hopefuls rebuff the AMA’s request they should be reminded that behind every doctor are hundreds of patients who are desperately seeking quality healthcare delivered in an efficient and timely manner.  We’re in the audience watching Rocky take his lumps and we’ll keep rooting for him until he hits the mat or wins the match.

*Cost of Living Adjustment

**Calgary Herald, on-line, July 1, 2011.