“Nice business you got here, be a shame if something happened to it.” – Gangster in a B-grade movie
Alberta’s doctors are tired. They’ve been fighting covid for over a year while at the same time fighting with the Health Minister, Mr Shandro, who has filled their lives with misery.
In Feb 2020 Shandro ripped up the original AMA agreement (the AMA launched a lawsuit to protect their charter rights). He created chaos by cancelling programs, screwing up billings codes, bringing in Telus/Babylon to provide virtual doctoring, and shifting administrative responsibilities from the AMA to Alberta Health.
Then he reversed some of these decisions, but still rammed through changes to physician compensation (including reducing Business Cost Program payments, changing Z-codes and eliminating stipends) that caused nothing but heartache.
Now when the doctors are physically and mentally exhausted from battling the worst public health crisis ever, he’s pushing them to ratify a new AMA agreement by the end of the month.
This is like the gangster who trashes your store and says he’ll keep trashing it until you give him what he wants.
Many doctors think the new Agreement is a bad deal. They’re understandably fearful, wary, and concerned it will negatively impact them and their patients.
They are not alone.
Albertans are also concerned and suspicious. We’ve seen how Shandro treated our doctors in the past and have no confidence he’ll treat them any better in the future.
So why would any doctors want to ratify this agreement?
Perhaps they take comfort in the language that says Shandro will “consult” and “discuss” matters with the AMA, but the right to consultation and discussion is meaningless given the Health Minister retains the sole discretion to do whatever he likes, including withholding physician payments if expenditures exceed the physician budget.
Would the Health Minister abuse his discretion?
Gosh I don’t know: the Health Minister has a statutory obligation to engage with the AMA in “good faith” and yet Shandro ripped up the original AMA agreement last February when negotiations weren’t going his way.
The AMA took Shandro to court to enforce its right to binding arbitration. The government says it will table legislation by December 31 that will prevent the Health Minister from ripping up this Agreement like the last one, but that doesn’t stop Shandro from ripping up any other agreements he may sign or even this Agreement in the nine months between now and December 31. Meanwhile he insists the AMA drop its lawsuit.
I don’t know about you, but I see this as a Checkpoint Charlie situation. I wouldn’t drop my lawsuit until the government passed (not just tabled) legislation protecting the AMA Agreement and any other agreements Shandro signed with the AMA. The fact Alberta doctors need legislation to enforce the sanctity of their contracts with the UCP government is mind boggling.
Good faith and trust
Some doctors argue the new Agreement has some good points.
For example, it says the $200 million in covid-related underspending in last year’s budget will be redirected to physician programs and overruns in this year’s budget. It brings a level of certainty to the budget question, it returns the programs that were shunted off to Alberta Health back to the AMA, and it buys time for further negotiation on Z-codes and clinical stipends.
They also worry that failure to sign the new Agreement will encourage the government to continue its aggressive agenda, keep cutting, shift the $200 million in covid-related spending elsewhere, and take away what little the AMA has gained.
Yes, this is a risk, but at the end of the day this Agreement is about trust, it is not about making the best of an abusive relationship.
The real question is this: Do Alberta’s doctors ratify the Agreement and trust Mr Shandro to exercise his discretion compassionately, or do they refuse to ratify the Agreement and trust Albertans to have their backs if and when Mr Shandro decides to escalate his fight with Alberta’s doctors.
Obviously I’m not a doctor, so if I’m missing something important here please let me know and I’ll post your comment below.