EDMONTON -- Health Minister Tyler Shandro is getting an earful from Alberta doctors - current and future - for ending the government's master agreement with physicians and replacing it with what they call a dysfunctional top-down relationship rife with instability and distrust.

Eighteen rural physicians from Westlock added their voice to others in a public letter Thursday that says they no longer trust the government. They said some of them will not work in hospitals after the COVID-19 pandemic despite the province revising some of its recent changes to fees and billing.

And 127 medical students from the University of Alberta and the University of Calgary, in a separate letter, said many of them are looking to leave the province after graduation due to uncertainty in their field.

“The actions and policies of the provincial government are destroying the trust of physicians across the province,” said the students in the letter.

They criticized Shandro for cancelling the negotiated agreement with doctors in February then imposing fee and billing changes that he has been rolling back piecemeal as doctors announced their intention to stop working in hospitals for financial reasons.

“Alberta physicians are not protected from unilateral government changes because the existing contract protecting them was torn up in bad faith,” read the student's letter.

“(Subsequent) sporadic policy changes have left us with profound uncertainty about our future. Many newly graduating physicians are looking to leave Alberta.”

Justin Haylin, one of the medical students who helped organize the letter, said he and fellow students saw reports of doctors leaving and wanted to weigh-in and show support for their colleagues.

“That's what concerns us the most. There's profound uncertainty about our future and the climate (for doctors) here in Alberta,” Haylin said in an interview.

The 18 Westlock doctors, spread over three clinics in the community north of Edmonton, said lack of trust is the fundamental stumbling block.

“Some of us will be handing in our letter of intent of resignation of hospital-based services,” the doctors said in their letter posted on Facebook.

One of the Westlock physicians, Dr. Vicci Fourie, could not say how many of the 18 will be resigning hospital duties.

“That's a personal (decision),” Fourie said in an interview. “(But) we wanted to get the message out.”

They are the latest rural doctors to announce in recent weeks that billing changes imposed by Shandro had made it financially impossible to work in a hospital while also carrying the costs of their clinics.

Shandro addressed those key concerns last week when he announced some revisions to the changes. Rural doctors will once again be allowed to charge overhead while working in hospitals, and the province will not go ahead with planned subsidy cuts to medical liability insurance.

That decision has delivered mixed results. Ten doctors in Lac La Biche have said they will reverse course and keep working in hospitals. But nine doctors in Pincher Creek say trust is gone and they are still giving 90 days notice to end hospital duties, including emergency work and delivering babies.

The Westlock doctors said there can be no trust until the province negotiates a new agreement with the Alberta Medical Association.

Opposition NDP health critic David Shepherd again called for Shandro to quit or be fired. He said the doctor file needs a reset and that can't be done with Shandro.

“Tyler Shandro has burned his relationship with Alberta doctors to the ground,” said Shepherd.

Alberta Health spokesman Steve Buick, in a statement, said Shandro's new changes deliver the most generous incentives in Canada for rural doctors.

“If some physicians choose to voluntarily withdraw from hospitals, we'll work with (Alberta Health Services) to maintain services, including replacing physicians as needed,” said Buick.

This report by The Canadian Press was first published April 30, 2020