WHEREAS it is becoming more difficult to recruit and retain physicians in rural Alberta such that municipalities are now forced to expend resources to supplement the Province’s responsibility and efforts to recruit and retain physicians in rural Alberta;and

WHEREAS many successfully recruited physicians, unless trained in Canada, are required to complete lengthy assessments in locations other than where the physician was recruited prior to being licensed by the College of Physicians and Surgeons of Alberta; and to complete an assessment prior to receiving privileges to perform specialist services from Alberta Health Services;and

WHEREAS this assessment period may be financially difficult for physicians with families as they may have to keep a residence in the recruitment municipality and in the assessment municipality while only receiving a stipend during part of the assessment process;and WHEREAS these physicians may become connected to the first community in which they reside, which would be the assessment community, and choose to remain there to practice resulting in wasted recruitment efforts and frustration to the recruiting municipality;

 THEREFORE BE IT RESOLVED that the Alberta Association of Municipal Districts and Counties urge the provincial government to increase its efforts in recruiting physicians to rural Alberta, especially Canadian trained physicians; work with the College of Physicians and Surgeons of Alberta to shorten the assessment period; and/or allow assessments to occur in the recruiting community; and ensure that Alberta Health Services review and streamline its assessment process for granting privileges.

 Health care and physician recruitment is a provincial responsibility. The increasing lack of physicians in rural Alberta suggests that recruitment and incentive programs are lagging to the point that municipalities are being forced to augment these efforts with financial and human resources. Even if a municipality’s recruitment efforts are successful, there are still several hurdles to overcome prior to the realization of the physician practicing in the community. First, the doctor must become licensed. The College of Physicians and Surgeons of Alberta has the responsibility to license doctors in the province. If the recruited physician is Canadian trained, however, this assessment period is not required. Prior to receiving a license, those recruited physicians who received their training outside of Canada must successfully complete a two part assessment process. The first part is a pre-clinical assessment.  This pre-clinical assessment can take up to 3-months and is completed at a facility with an assessor but cannot be at the clinic, or even the community, to which the doctor was recruited. The second part of the assessment is the clinical assessment.  During this phase, the physician does practice in the actual clinic to which the physician was recruited. If the doctor is coming from another province, is trained in Canada and is fully licensed in that province, internal trade agreements insure that the doctor will be fully licensed. If the doctor is from another province but is trained out of country, the assessment period is not required but there may be exceptions. With regard to a physician that is recruited and has the capability to provide specialist services, the physician requires a medical staff appointment followed by a further assessment as relates to the specialty and then must be granted privileges to perform in hospitals. The assessment and the granting of the privileges are provided by Alberta Health Services. These assessments can take anywhere from two weeks to a month and even longer depending on the specialty. These assessments take place in the larger urban centres. Even though a specialist may come from another province within Canada, Alberta Health Services may still require an assessment period. There are concerns with the length and location of the assessments especially since the College of Physicians and Surgeons of Alberta have recently increased the length of the assessment period.  Physicians certainly can become attached to the community in which they are completing their assessments to the point that they decide to practice there instead of the location to which they were recruited. This results in a waste of resources and frustration to the recruiting community. This is only exacerbated by the length of the assessment. Also, if a physician does have a family and wants to establish the family in the recruiting community for reasons such as not having to have children switch school jurisdictions during the assessment period, they are forced to maintain a residence in both the recruiting community and the assessing community. This causes a financial hardship as these physicians only receive a small stipend while they are completing the first part of their assessment. This leaves a disincentive to locate to the recruiting community. In order to resolve this inequity, the Province must increase its efforts on recruiting physicians to rural Alberta, especially Canadian trained physicians; work with the College of Physicians and Surgeons of Alberta to shorten the assessment period; and/or allow assessments to occur in the recruiting community. Please note that a similar resolution was presented at the 2012 AUMA Convention by the City of Brooks and was carried.

Resolution 6-12S, 2-10F

The Government of Alberta does not actively recruit physicians to work in Alberta. Recruitment initiatives are the responsibility of Alberta Health Services (AHS), the community that requires physicians, and physicians already established in the community.  However, Alberta Health has put in place a number of programs and initiatives to support physician services in rural communities, such as the Alberta Rural Physician Action Plan, the Rural Remote Northern Program, a Clinical Stabilization Initiative, a Rural Integrated Community Clerkship program, and several others.  Please see the attachment for more details on these programs that assist with both recruitment and retention of rural physicians.

The Health Professions Act mandates the College of Physicians and Surgeons of Alberta (CPSA) to determine physician registration criteria and assessment methodologies for doctors wanting to practise in Alberta.  All Canadian provinces and territories have entrusted similar regulatory authorities with establishing, monitoring, and enforcing standards of qualification and medical practice across their respective jurisdictions.  The Alberta government will not interfere with the assessment process developed by CPSA.

The Government of Alberta sets policy direction for the health system; AHS is responsible for operations, including giving hospital privileges to physicians to work in its facilities.  AHS determines the need for physician privileges based on community health needs.  In addition, AHS must ensure that the physicians receiving privileges are suitable candidates.  AHS is working to standardize its privileging processes across Alberta.  Clinical privilege lists will be developed in sequenced groups through 2013/2014, beginning with Diagnostic Imaging and Pathology, which will be implemented by April and May 2013.

Appendix:

Details on Programs and Initiatives to Support 

Physician Services in Rural Communities

There are a number of programs and initiatives to support physician services in rural communities:

The Alberta Rural Physician Action Plan (RPAP) is an independent not-for-profit company funded by Alberta Health.  The RPAP works closely with rural communities to provide provincially focused programs for the education, attraction, and retention of physicians for rural practice.  Since the RPAP’s inception, an integrated and comprehensive series of initiatives have been implemented: 

•The RPAP offers up to 10 return-for-service bursaries annually which cover medical students’ full tuition, including differentials if they agree to work in certain areas of the province for a set period of time upon graduation.  Nine bursaries were awarded in 2011. 

• •The RPAP works extensively with rural communities to develop physician attraction and retention committees.  It also provides one-time grants and an annual award to rural communities in recognition of innovative and collaborative approaches to rural physician attraction and retention. 
• • The RPAP administers a Recruitment Support Program that reimburses costs associated with physician practice-ready assessments required by the College of Physicians and Surgeons of Alberta.
• • The Physician Locum Services Program ensures that communities with four or fewer physicians have access to continuous medical coverage if a physician is unable to provide services due to short-term absences.  The program also encourages retention of rural physicians by supporting a work-life balance for vacations or professional development.  In 2011-2012, 397 locum assignments in 31 rural communities were filled with an average duration of three days.  

The Rural Remote Northern Program offers financial incentives to attract physicians to Alberta rural practices by paying physicians practising in eligible communities a fee premium on each insured service provided.

• •In 2008/2009, the RPAP piloted an Alberta ‘working holiday’ concept for United Kingdom (UK)-based general practitioners.  The 89-day Locum Program allowed UK-based generalist practitioners to experience rural medical practices while providing locum coverage for 89 days.  The program gives UK-based physicians the opportunity to choose to permanently relocate to Alberta to practise rural medicine.  Four of the five participants in the program have permanently relocated to Alberta and established rural medical practices.
• • RPAP also administers a provincial website, www.AlbertaPhysicianLink.ab.ca, which links interested physicians with practice opportunities in all communities in Alberta.

The Clinical Stabilization Initiative (CSI) was established in 2007 to address specific emerging issues for general physicians and specialists in Alberta, including high overhead costs for physician offices and the recruitment and retention of physicians in under-serviced communities.  The CSI implements/administers the following programs:

• •The Business Cost Program addresses the rising cost of medical practice. It is a supplement provided to all Alberta physicians who provide services in an office-based setting including rural physicians.  
• • The Rural Remote Northern Program (RRNP) provides financial compensation to physicians who practice in under-serviced areas.  A Variable Fee Premium is applied automatically to all insured health services provided by any physician in an eligible community, whether or not they live in the community.  A Flat Fee Payment is also available to physicians who practise and reside in an eligible community for at least nine out of twelve months in a fiscal year and earn a minimum of $50,000 (including regular billings) in that community.  Payment amounts vary by community, based on a point rating system that measures the medical isolation of each community.  Total RRNP payments (flat and variable fee combined) are capped at $60,000 per physician, per fiscal year.  All Alberta communities are eligible except: Airdrie, Calgary, Devon, Edmonton, Leduc, Lethbridge, Medicine Hat, Red Deer, Sherwood Park, St. Albert, and Stony Plain. 

Rural Integrated Community Clerkship programs were established at the University of Alberta in 2007 and at the University of Calgary in 2008.  The programs support 

third-year medical students in clinical learning who work in rural communities over a nine-month period.  The Health Workforce Action Plan, a budget held by Alberta Enterprise and Advanced Education, has provided funding to the two programs since 2008/2009.  A total of 117 students have participated since 2007.

The Rural On-Call Program is part of the Physician On-Call program and applies to rural physicians providing on-call services in facilities located in rural and remote areas.  Funding is shared among the physicians providing the services at each facility based on the number of hours of service provided by each physician.

Family Care Clinics (FCCs) are local, team-based primary health care delivery organizations that provide individual and family-focused primary health care services aligned with the needs of their community.  The application process for FCCs will be announced in the coming months.  

The AAMDC Accepts in Principle the government’s reaction. However, the Association has failed to receive a response from the College of Physicians and Surgeons, and will follow up with the College.

There have been many programs put in place in the past few years to attract doctors to rural Alberta, as is shown in their increasing rural doctor recruitment efforts. As well, progress is being made toward hospital granting privileges as Alberta Health Services examines throughout 2013-14.