Thread by @kandrusky

If a certain Premier can *decide* to be an Epidemiologist-for-a-day, I figure I can take a crack at being an Economist. A lot of “party line” misinformation is still being circulated by @shandro et al. Docs’ concerns are about MUCH more than money, but Facts are still impt: 👇

Myth 1: AB doc pay is 35% higher than comparable provinces

Fact: CIHI “small print” warns against using data out of context & NOT to compare. Adjusting for ALL types of payment (not just Fee-For-Service); differences in specialist:GP numbers; incldg ALL comparable prov = 16.6%

(Myth 1) Facts (cont): a significant number of ON “technical fees” and other clinical payments (eg. BC funding pools) were not included in CIHI’s national physician database. Adjusting for this omission = 15.4% higher

(Myth 1) Facts (cont): Cdn Med Assoc’n Workforce survey revealed that AB physicians spend more time doing clinical work than other provinces; post adjustment = 13.3% higher

Other provinces’ doc assoc’ns have negotiated Increases for 2019-2022; adjusted = AB is merely 5.7% higher

(Myth 1) Facts Context:

“Once proper adjustments are made, Alberta’s average physician compensation is projected to be 5.7 percent higher than our comparator provinces by 2021/22...”

albertadoctors.org/services/media… by @Albertadoctors

(Myth 1) Facts Context (cont):

“But again, context matters, which is why it’s important to point out that this projection is based on current status and does not factor in any government cuts (i.e., [when] consultation proposals are implemented).”

AMA President Dr. C. Molnar

Additional Facts: AB industrial aggregate wage level (impacting staff and overhead costs) is 15.4% higher than other provinces.

According to an independent consultant, with other prov increases, & expected population/doc #’s, by 2021/22, AB will be BEHIND comp provinces = -2.5%

Even with AB docs soon to be -2.5% BELOW comparator provinces, @Albertadoctors recognized AB’s tough economic realities. Rather than @shandro’s disastrous cuts that unevenly cut different specialties (and devastated primary care), the AMA offered a 5% across the board REDUCTION.

Numerous AMA & indiv docs warned @shandro about the “consequences” to patient care & the functioning of the health system if he imposed his targeted cuts. Despite the -5% reduction offered being equivalent to projected “savings” by the Minister’s cuts, the hatchet job proceeded.

Myth 2: AB physicians received 300% increases since 2002.

Fact: 18 years is an odd “arbitrary” timeframe. Increases in the early-mid 2000’s were catching up following Klein’s cuts. Since then, AB docs have not even kept pace with CPI increase, with total freezes the last 7 yrs.

Myth 3: @jkenney promised to “maintain health spending” and a physician budget of “$5.4 B”

Fact: not a complete myth but rather “myth-leading”. Keeping a flat health budget ignores pop’n increases, aging and growing complexity of pts & increased docs (many recruited by AHS)

Myth 4: “docs promise to cut costs but this never yields any savings”

Fact: AB docs HAVE “bent the cost curve” with savings initiatives and system stewardship changes. All negotiated (and honoured) under the last two AMA Agreements. Savings of $438 M that WOULD have been spent.

(Myth 4) Facts (cont): $438 M NOT in physician pockets was a considerable “win” for gov’t in partnering with AMA. But, in addition, these savings are GONE from the Phys Budget, meaning savings compound annually as the billing/services changes docs made have not been reversed.

Myth 5 (associated with 4): “docs just increase utilization of codes (i.e. provide more services) to compensate for any reductions/limits”

Fact: aside from an ugly accusation of inappropriate billing underlying this myth (their myth-take!), this is NOT shown to be the case...

(Myth 5) Facts (cont): data obtained directly from AB Health itself reveals that docs have been consistent in utilization of billing codes.

Myth 5 Conclusion: docs partnered with gov’t to find savings - we delivered & did NOT “game” it. Docs take system sustainability seriously.

Myth 6: docs should be responsible for any overtures in the Physician Services Budget

Fact: as demonstrated, docs do NOT inappropriately ramp up billings to make up for cuts. Docs can NOT control population, political policies/promises, CPI, aging OR the unknown (eg. COVID)

(Myth 6) Facts (cont): docs recognize fiscal responsibility and system sustainability are critical for ALL of AB. We WANTED to work with gov’t to keep making changes that incent high quality, evidence based care; while recognizing medicine evolves & stewardship/changes are needed

DESPITE the poor faith shown in rejecting AMA’s offer of -5% across-the-board reductions, denying docs the right to arbitration and tearing up our contract... Docs STILL want a strong AB health system & excellent pt care. So we REMAIN willing to partner with gov’t towards this.

Should have put at outset: ALL credit for the analysis/presentation is to @Albertadoctors Health Economics staff. Amazing & super talented bevy of economists (whatever grps of econ’s are called!).

My part was merely some minor “translating” & wedging into 280 character snippets.