'We're reasonably optimistic': Alberta Medical Association president on new payment model for family doctors

Dr. Shelley Duggan, president of the Alberta Medical Association, discusses the delayed rollout of a new payment model for primary care physicians and the impact of the delay with Alberta Primetime host Michael Higgins.

This interview has been edited for clarity and length.

Michael Higgins: Alberta’s health minister recently took questions from reporters on the status of a new payment model for primary care physicians, a deal the minister had previously indicated would take effect this past Fall.

Joining us now to discuss that and more is Dr. Shelly Duggan, a critical care specialist and president of the Alberta Medical Association. Let’s start with the delayed compensation model.

To the best of your understanding, why does this remain unresolved after more than a year?

Dr. Shelley Duggan: I think it's been mostly a budgetary issue. I am happy to say that we have been in talks over the last couple of weeks, and we're reasonably optimistic that we are going to get this over the line even in the next couple of weeks.

It is a significant investment that shouldn't be entered into lightly.

MH: Given the lengthy delay, how different a deal do you expect it to be when it is formally announced?

What, if anything, has yet to be clarified?

SD: We do need final sign off from the minister. We're under the impression that not much has changed since we submitted the proposal. Remember that the Alberta Medical Association and Alberta Health worked together on this, it was submitted to the minister with a joint agreement.

I do think most likely it won't take effect in terms of payment flowing until April 1. Obviously we had wanted this to roll out sooner, but this is what we're working with right now.

MH: What are the consequences of this lengthy wait? Why is it so critical to get this rolling sooner than later?

SD: We’ve heard a lot of Albertans state they don't have access to primary care, even those that do have a family physician often note that it's very difficult to get a timely appointment. So the consequences of delaying this any further are loss of family physicians, particularly those that are willing to do comprehensive care.

At least if we can get an announcement by the end of this year, many of those physicians who are desperately hanging on may be able to do so for a few more months, knowing that things will start to take effect in April.

It is vital that we put family medicine at the complete foundation of our health-care system. Some research that came out last week shows that one in every seven people who present to an emergency department. Those issues could have been handled in a family medicine office.

So stabilizing primary care will also help take some of the pressure off acute care.

MH: The Nurse Practitioner Primary Care program is also rolling into effect with more than 30 nurse practitioners now taking patients. How does that play into dynamics around the delay in the compensation model?

SD: In many ways. We've obviously been working with nurse practitioners for many years, and the bulk of the nurse practitioners who signed up for that deal to do primary care will do so within a family physician office. So they recognize and we recognize that a team based model is the best way forward.

What that does is allows everybody to work to their scope, and it certainly will allow family medicine docs to actually be responsible for more patients, because some of the issues that patients come forward with can be dealt with by other health-care specialists, such as nurse practitioners.

So perhaps instead of being wholly responsible for 1,000 patients, you may be able to oversee 1,500 or more because you've got that extra workforce in your office.

MH: So concerns expressed previously by the AMA about integration of nurse practitioners, that has been resolved from your standpoint?

SD: I think that what you see is that everybody who does participate in health care understands that a team-based approach is probably going to be best off for patients.

We don't really like the language that says a nurse practitioner can replace a family doctor, because the training is simply not the same.

The two specialists, the two nurse practitioners, the nurse practitioner and the family medicine specialist, they can join together to really serve patients best. That's really what we're seeing has come out of this announcement from the government.

MH: You're just a matter of months now into this role of AMA president. In that time, what has it opened your eyes to in terms of being an advocate for the medical community, and the intricacies of dealing first hand with the provincial government?

SD: It does open your eyes to a whole bunch of issues, funding being one of them, the tremendous amount of work that Alberta Health has to do in order to really make the system work. That is really an eye opener.

It's also been an eye opener to really interface with more physicians than I have before. Even just working clinically, you do interact with lots and lots of people, but I do get emails on a weekly basis from colleagues all across the province, many of them heartfelt.

They are suffering, but they are happy for the work that the AMA has done. I think the vast majority of the correspondence that I get from members is - how are we going to make the system better? How are we going to serve our patients better?

It's nice to know that we all have that that same goal at heart.

MH: As a final question, since taking on the president's role, it was announced the new provincial health agency to be known as Acute Care Alberta is behind schedule, it’s not expected to be operational until the spring.

How do you view progress being made by the provincial government in overhauling Alberta's health system?

SD: It's been a challenging time and I think they're attempting to listen to all of the concerns that we have in terms of the refocus. It does sort of perplex us as to how this is going to make the system work more smoothly, and how this is really going to lead to less administrative burden.

We are trying to have a voice at the table. We are quite happy with some of their recent announcements, in terms of Dr. Kim Simmonds and Dr. Chris Eagle, these are people that understand the complexity of the system, that really have shared goals with us.

So we are looking forward to working with them in the hopes that we can make this transition as smooth as possible.