I’m from Stettler, where nine physicians (including my family doctor) have decided to give up their ER practicing privileges.
Why, you ask?
First and foremost, let me be clear: the reason many doctors are so upset is lack of trust.
The Alberta Government tore up the negotiated contract that it had previously negotiated with doctors.
An employer that doesn’t honour negotiated contracts made in good faith isn’t someone you’re going to be eager to work for.
I don’t think that the lack of trust and damage to the relationship can be overstated.
Doctors don’t trust that the government won’t switch the game again just to score political points or try to save a buck.
Ironically, most physicians I speak to have very concrete ideas and solutions which they believe would save the government hundreds of millions of dollars every year.
Unfortunately, they were not seriously consulted about their ideas, despite being the ones actually in a position to see waste every day.
Next up are the cuts. Repeated cuts, in a variety of areas, over the past few years. Especially where rural physicians are concerned.
For many years, rural physicians were given incentives to attract them away from the cities (and those incentives are NEEDED).
In the past six years those have all but disappeared.
Here are a few examples to give you an idea of what rural doctors have lost.
First, a bonus percentage on top of normal billing fees which paid them a small percentage more per billing up to a set maximum.
Second, the rural on-call stipend is gone. For every day a rural doctor was on call, he or she was paid an extra $200 for the inconvenience to them and their family. Even 50 days on call a year means $10,000 in lost income (and many work more than that).
Finally, let’s examine the on-call levels of pay. There are three.
The highest level of on-call pay is for on-site or under one hour. This means the doctor is expected to attend to a call within an hour, severely limiting their movements.
Next is rural on-call, which is fairly high due to the fact that there aren’t many rural doctors, and they have a lot of different emergencies placed on only a few sets of shoulders.
Last is the lowest form of on-call pay, called 1-4 hour on-call.
This was always the lowest rate since a doctor wasn’t expected to be there immediately. This rate (already the lowest) was actually cut in half again last year.
And here comes the kicker: my rural doctor, who is ethically required to respond as soon as possible to a call, lives five minutes from the hospital. Thus, when he is on call, you would assume he would get the highest rate (or at least the rural rate).
Instead, the government decided he would only qualify for the 1-4 hour on-call rate. Imagine him being on call, and receiving an urgent request to come to hospital for resuscitation.
Ethically and professionally he MUST respond quickly or a patient who could have lived will very likely die. But he is paid at the 1-4 hour rate. If he came in after three hours, and the person had died, the family could arguably sue him, and the College of Physicians (that self-righteous body which sucks up so much physician income in fees for…not much) would almost certainly prosecute him!
But it’s the rate at which he is paid, and it’s garbage.
These are the cuts which rural physicians have endured over the past decade (while the big-city doctors remained quiet because it wasn’t their problem).
So, why did the Stettler physicians give up their ER practicing privileges? Because the ability to bill for providing multiple services simultaneously was about to be cut.
Here’s the scenario (and remember that it’s rural: he IS the only doctor on site). The physician is working on site in the ER getting paid to be there, and then gets called to give an epidural in another part of the hospital for a mother in labour.
He has to leave the ER (which he is still legally responsible for and getting paid for) to do the epidural.
If something happens in the ER, he can’t be in two places at once! But if he can bill for both services, he can hire a locum privately to be in the ER to cover his shift (which means he’s not double-dipping, he’s paying someone else to do his ER shift so he can be there to properly care for the mother in labour and childbirth.
So if he can’t bill for both, he just won’t do the one, and Alberta Health will be forced to send a locum out to cover the ER. Which is more expensive because it’s through Alberta Health so that locum must also be paid mileage, meals and accommodations.
So in the end, it actually costs more money and patients are seen by a doctor in the ER who doesn’t live in the community.
Let’s be clear. Physicians are well paid. They should be. But for rural (and sometimes female) doctors, the incentive to practice is decreasing.
To sum it up, the government wants rural physicians to do more for less. Far less! And work for free in the ER while they’re at it!
There are two sides to a budget. And in a province without much oil revenue, the choice is to slash spending or raise taxes.
If we want to keep our doctors, it needs to be the second choice. But that’s a letter for another day.