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.
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.
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.
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.**
“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