WHEREAS the delivery of medical services in Alberta by legislation is the responsibility of the Province of Alberta; and

WHEREAS there is a shortage of physicians in the Province of Alberta, and this shortage of physicians has more acutely manifested in rural Alberta; and

WHEREAS the provincial effort to address the shortage of physicians has not produced satisfactory results; and some policies have actually resulted in making rural physician recruitment more difficult; and

WHEREAS the lack of success by the province in addressing the physician shortage has compelled rural municipalities in Alberta to form and fund their own rural physician recruitment and retention programs; and

WHEREAS the municipally formed physician recruitment and retention programs have resulted in communities competing against each other, which does not serve to motivate the province to meet its responsibility to effectively address the physician shortage issue in Alberta;

THEREFORE BE IT RESOLVED that the AAMDC actively and continually hold accountable and encourage the Government of Alberta to fully attend to its federally and provincially legislated responsibilities of providing sufficient funding, staffing and programming so that there are enough physicians and other medical support staff in place to deliver universal and accessible health care in all of Alberta.

A. The Canada Health Act contains a number of statements that relate to this issue:

i) In the preamble: “that continued access to quality health care without financial or other barriers will be critical to maintaining and improving the health and well-being of Canadians;” (emphasis added);

Section 3: “Primary Objective of Health Care Policy: It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” (emphasis added)

ii) Section 7: “. . . the health care insurance plan of the province must, throughout the fiscal year, satisfy the criteria described in section 8 to 12 respecting the following matters: (a) public administration; (b) comprehensiveness; (c) universality; (d) portability; and (e) accessibility.”

iii) Section 10: “In order to satisfy the criterion respecting universality, the health care insurance plan of a province must entitle one hundred percent of the insured persons of the province to the health services provided for the plan on uniform terms and conditions.” (emphasis added)

iv) Section 12: “(1) In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province (a) must provide for insured health services on uniform terms and conditions and on a basis that does not impede or otherwise preclude either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons.” (emphasis added)

While it may be argued that the health care insurance plan is not under question here, it is also arguable that by not only allowing but encouraging municipal physician recruitment and retention plans, the province is not meeting the spirit or intent of the Canada Health Act. When an environment is created and fostered by the province where insured persons in certain areas are indirectly paying through their property taxes a fee or charge for physicians to practice and deliver health care insurance plan services in their communities and other areas are not incurring these costs, the criterion of accessibility is not being met. When certain areas of the province are in a position where the only way for them to attract/retain physicians is to agree to terms and conditions of paying extra monies that other areas of the province do not have to pay to have health care insurance plan services delivered, the criterion of universality is not being met. It is also quite arguable that having to pay extra monies through property taxes so that there are physicians in one’s local community to deliver health care insurance plan services is contrary to the primary objective of the Health Care Policy that health services are delivered without financial or other barriers.

B. The Alberta Health Care Protection Act contains a number of statements that pertain to this issue:

(i) In the preamble: “WHEREAS the Government of Alberta is committed to the preservation of the principles of universality, comprehensiveness, accessibility, portability and public administration, as described in the Canada Health Act (Canada), as the foundation of the health system in Alberta.”

 (ii) In the preamble: “WHEREAS regional health authorities are accountable to the Minister . . . determining priorities in the delivery of health services and allocating resources accordingly and ensuring reasonable access to those health services.” (emphasis added)

 This piece of provincial legislation clearly recognizes the objectives of the Canada Health Act and compels the province to allocate resources to ensure reasonable access. The determination of priorities may be in place, however, provincial oversight of an environment where municipalities have no choice but to subsidize physicians in order to receive provincial health care insurance plan services does not meet the provincial obligation of “allocating resources accordingly” in order to deliver on the priorities.

C. The yet to be proclaimed Alberta Health Act, a new piece of draft legislation that the provincial government intends to enact also contains a number of statements that pertain to this issue:

(i) In the preamble: ”that Alberta is committed to the principles of the Canada Health Act (Canada)”

(ii) In the preamble: “that accessibility to publicly funded health services is based on need, not on the ability to pay.”

(iii) In the preamble: “that health decisions, financial stewardship and the allocation and use of resources are done in such a way that they are transparent to Albertans and ensure that Alberta’s publicly funded health system is sustained for the future.”

Recently, the province is clearly recognizing its obligations under the Canada Health Act and intends to enact new legislation stating such. Background provided earlier suggests that the current health care environment is not meeting those obligations. Health services are based on need but are not being delivered in certain areas without extra pay. Municipalities are competing with each other and are not fully disclosing all of the fiscal incentives provided to health care professionals as an attempt to mitigate ‘bidding wars’ between communities when it comes to physician recruitment and retention. This is neither transparent nor sustainable but municipalities are left with little choice but to operate in this manner.

The AAMDC has sent a number of resolutions to the province over the past few years pertaining to this and other like issues on health care. Unfortunately the provincial response to them has not resulted in solving this issue. Granted, a number of programs are in place and have made inroads but much more needs to be done. The program for providing locum services has provided much of the progress on those inroads but from it there are unintended negative consequences. Under the program’s current rules, a locum can provide health services in a community with a very low share of their income directed to clinic overhead costs. So low in fact, that if the locum is considering setting up their practice in that clinic, their share of overhead costs as a clinic partner, make it more attractive to continue providing health services on a transient basis and never locating in that community.

 Legislative issues and obligations aside, the current environment of municipal subsidization of the provincial health care system is not sustainable and will become more unmanageable and unjustifiably more expensive the longer the situation persists. Albertans and their communities are depending on the province to provide a level playing field and not continue expecting certain communities to pay considerably more for health services than other communities.

Resolution 1-10F: 

THEREFORE BE IT RESOLVED that the Alberta Association of Municipal Districts and Counties work with Alberta Health and Wellness to modify its locum program to accommodate regions that have no physicians and allow these areas access to the locum doctors and allow the length of stay of these locums to be several months.

Resolution 2-10F: 

THEREFORE BE IT RESOLVED that the Alberta Association of Municipal Districts and Counties encourage the Provincial Government, through Alberta Health and Wellness, to consent to pay travel expenses for out-of-province physicians willing to investigate relocating to “Communities in Need”.

Resolution 18-09F: 

THEREFORE BE IT RESOLVED that the Alberta Association of Municipal Districts and Counties advocate the Province to ensure the rural health care system is maintained, and that all decision-making processes and future intentions be transparent and thus sufficiently acknowledge the interests of rural municipalities and all rural Albertans.

Health:

The Government of Alberta is committed to providing every Albertan with adequate and accessible health services.

The government has a number of provincial initiatives which support the recruitment and retention efforts of Alberta’s rural communities by providing financial incentives for physicians to practise in rural Alberta, and providing programming which supports the physicians once they are practising.

The recruitment of physicians to Alberta’s rural communities is a joint responsibility of the rural communities, the community physicians, Alberta Health Services (AHS) and the Government of Alberta. 

Alberta’s rural communities need to work proactively with AHS and their community physicians to recruit and retain physicians. 

Municipal Affairs:

While Municipal Affairs does not actively promote the use of grant funds for physician recruitment and retention initiatives, municipalities may choose to support these activities through the Municipal Sustainability Initiative (MSI) Operating Program.  Eligible physician recruitment and retention expenditures include:

•advertising, promotional materials and costs related to recruiting prospective physicians, such as travel and accommodation costs;

•retention committee costs, including meeting hosting costs, administrator salary, councillor honoraria and travel costs;

•maintenance and operational costs of medical clinics; and

•maintenance costs of municipally-owned physician housing.

Municipalities may also directly support physician salary incentives, including benefits and cash incentives, when the physician recruitment and retention initiative is undertaken in partnership with at least one other municipality.

The AAMDC acknowledges the work that the provincial and federal government have made toward ensuring access to medical staff in all areas of the province. The Association is aware that the doctor shortage persists and that it will take many years to fix, but it also acknowleges the work that is already being done to find immediate and long term solutions. The AAMDC was pleased with the April 2013 announcment that doctors can earn up to $40,000 in debt forgiveness for working in rural areas. The AAMDC will follow up with the Rural Physician Action Plan, as well as through formal minister meetings to ensure that this issue remains a top priority.