‘They cannot keep the lights on’: Alberta docs group pushes for longitudinal family practice compensation model

The Alberta government is “starting to hear and understand” the problems plaguing the health system, and the province’s relatively new health minister has agreed to work with the Alberta Medical Association on long-term and interim stabilizing solutions. But doctors continue to feel demoralized and burned out, and many think the public doesn’t grasp just how much they’re struggling, AMA president Dr. Paul Parks said during a recent media briefing. “A lot of the conversations I'm having are with physicians that are saying ‘Does the public understand that we really are having difficulty paying for our overhead and our staff, so we can serve patients and do the job we love?’” said Dr. Parks, who has been touring the province since October 16 to talk to doctors. “I'm visiting the clinics of family physicians who are closing their doors because they can't pay their overhead. They cannot keep the lights on in their office because they're not making enough money to pay all of their overhead and all the pieces and the components to do primary care.” Read: Primary care reform 'piecemeal and incremental,' study finds The media brief was held on November 2, just one day after Minister of Health Adriana LaGrange—who was sworn into this role in June 2023—announced that 255 physicians have registered to practise in the province over the last four months and that 248 have decided to stay in Alberta after completing their training. One solution proposed by the AMA is the switch to a longitudinal family practice (LFP) physician compensation model that “reflects family physicians’ and rural generalists’ extensive training, experience and leadership in primary health care.” In an October 24 letter posted on the AMA website, Dr. Parks said that this proposed model would include elements such as fees based on the type of patient encounter, time-based payment—including for payments for direct and indirect care as well as clinical administrative services—panel-based physician services payment, and team-based funding. “The LFP will be one of a number of options available to quickly help family physicians transition to a more stable and robust funding model that incentivizes longitudinal comprehensive care,” he wrote in his letter. During the media brief, Dr. Parks noted that other provinces—namely British Columbia, Manitoba and Nova Scotia—have already changed their funding models to make it more attractive for physicians to practise comprehensive family medicine that, essentially, follows a patient from cradle to grave. Consequently, Alberta doctors who are grappling with the status quo are looking at these provinces with more attractive funding models. “So our doctors are looking at those options … elsewhere in our market in Canada,” said Dr. Parks. “Physicians and healthcare workers are very scarce resource so they can choose to go anywhere, and many are staying here because they love their patients and their communities and they're doing it at a sacrifice.” Read: Alberta announces changes to allow family doctors to see more patients As Alberta’s rate of population growth has outstripped that of other provinces, its healthcare infrastructure has failed to keep up, said Dr. Parks. Patients are finding it increasingly difficult to get care in hospital settings and some that provide specialty services are looking at putting caps on the number of patients they serve. “They’re saying it’s no longer safe for patients if they continue operating in overcapacity,” said Dr. Parks. A big concern among doctors is equitable sharing of human resources for patient care, as availability gets squeezed for support staff such as nurses, physiotherapists, occupational and respiratory therapists, and social workers. “We're in a national competition—actually, really a global competition—for healthcare workers,” said Dr. Parks. “We have to compete for every physician and every healthcare professional who's looking for a place to live and to work … We are losing our competitive position and that makes retention very, very challenging.” Read: Nova Scotia docs ratify four-year agreements with province with pay bumps, overhead funding and more

‘They cannot keep the lights on’: Alberta docs group pushes for longitudinal family practice compensation model

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