Alberta doctors protest UCP government’s funding cuts amid coronavirus pandemic

More than 800 Alberta doctors signed an open letter to the province’s hard-right United Conservative Party (UCP) provincial government last week to protest cuts to doctors’ fees. The changes, which came into force April 1, will result in reduced services being offered at rural clinics across the province as physicians struggle to cope with increased costs and lower funding levels amidst the coronavirus pandemic.

In February, Jason Kenney’s UCP government terminated the existing master contract with physicians and imposed changes to billing and compensation fees, resulting in some rural physicians losing between 20 and 60 per cent of their gross income.

Changes include the imposition of a daily patient cap and service fee cuts for doctors who cover hospital expenditures. In a particularly brutal move, doctors will also no longer be able to file so-called good faith claims, which were used by physicians to bill for services provided to people who could not provide a provincial health-care number, like the homeless.

In addition to the more than 800 registered Alberta physicians, the open letter was signed by up to 1,700 doctors and medical personnel from across Canada and worldwide.

There are two particular funding changes that doctors say are forcing them to withdraw service: the amount doctors who work in hospitals are paid is being reduced by about 20 percent on a fee-for-service basis; and the province is reducing its reimbursement of medical liability insurance premiums. Dr. Christine Molnar, president of the Alberta Medical Association (AMA), warned these changes will force service cuts that will “be horrible for pregnant women—particularly those who live in rural communities.”

According to the open letter, at least 400 community clinics across Alberta have either been forced to close or have laid off staff. “This is going to be a low estimate,” commented Dr. Julian Gudgeon, a family physician in Red Deer. “These are just the ones we’ve been able to reach out to.”

In just one example of the impact of the government’s funding cuts, eight physicians at the Sundre Moose and Squirrel Medical Clinic announced April 1 that they could no longer afford to deliver babies or work in the emergency ward at the local hospital.

The doctors held a live Facebook meeting, attended virtually by hundreds of people from the community 100 kilometres northwest of Calgary, to announce the withdrawal of their services from 4,000 patients in the Sundre/Caroline area and at the Sundre Hospital and Care Centre effective July 1. “The absolute last thing we’re intending to do here is leave our community in its greatest time of need, during the COVID pandemic,” said Dr. Carly Crew. “We will continue to work in hospital for 90 days.”

“We have come to the conclusion that the only way that we can continue to be in the community as your medical clinic…is to give up that part of our practice that we can no longer afford to do,” said Dr. Vesta Michelle Warren. In 2016, Dr. Warren was the recipient of the Rural Alberta Physician Award of Distinction for bringing superior medical care to her community. “We’re devastated that it has come to this, but this is the consequences of the government’s decisions, the government’s cuts. If we don’t react and change, we won’t be here at all.”

Dr. Tobias Gelber, a general practitioner who runs the emergency department in Pincher Creek and does everything from anesthesiology to emergency medicine and delivering babies, says the UCP government’s fee changes have had a compound effect. “It’s been blow after blow after blow,” he said. Gelber added that before March 31 he was paid C$38.03 for every patient he saw in the emergency department at the Pincher Creek Health Centre. That has been cut to C$31, an 18.5 per cent reduction. The government’s rationale is the province should not pay the cost of overhead to the physician, when they are working out of a public building. But as Gelber pointed out, he still has his clinic where he has to pay for staff, and office expenses. “Those costs don’t stop once I walk out of my clinic and step into the emergency department,” said Gelber. “I’m being penalized for going to see the most acute and ill patients during a pandemic. It makes no sense.”

Even prior to the Kenney government’s latest round of cuts, Alberta was one of the worst equipped provinces to deal with the pandemic. According to statistics published by the Globe and Mail, Alberta has just 10.1 ventilators per 100,000 inhabitants, compared to a Canada-wide average of only 14. Ventilators are critical for the treatment of serious COVID-19 cases, since they allow patients who can no longer breathe independently to be intubated.

Earlier this year, the Kenney government tabled a review it had commissioned of Alberta Health Services that outlined up to C$1.9 billion in annual cost savings and a plan for sweeping privatizations. After releasing the report conducted by global private consultancy firm Ernst & Young, the government gave Alberta Health Services until mid-May to draft a proposal for implementing its recommendations. They include outsourcing certain medical procedures and hospital services, cutting wages, and “optimizing” staff levels.

While it cuts back on essential health care spending, the Kenney government is providing billions to big business. It has already announced more than C$1 billion in support to help the construction of the Keystone XL oil pipeline, with billions more in loans and subsidies promised to prop up Alberta’s big oil companies.

The UCP government’s utter contempt for the health and well-being of the population under conditions of the rampant spread of COVID-19 is fully in line with its broader austerity agenda. Since coming to power last year, Kenney’s government has taken the axe to public spending. In its first budget, the government announced a four-year, real-terms per capita public spending cut of 10 percent or more, and it is pushing for wage cuts of up to 5 percent from the province’s 180,000 public sector workers. The spending cuts are resulting in thousands of layoffs, including hundreds of nurses and other health workers. Last month, the government seized on the coronavirus crisis to lay off over 25,000 education workers, including teaching assistants, cleaners, and school bus drivers.

The government is determined to use the full force of the state to enforce its unpopular measures. The MacKinnon report, which was released last year and provided a blueprint for the austerity measures now being imposed, also included suggestions on anti-democratic steps that could be taken to suppress public opposition. These included the invocation of the “notwithstanding clause,” which allows governments to disregard basic rights contained in the Charter of Rights and Freedoms, in order to pass strikebreaking legislation and other draconian anti-worker measures.

Government ministers are also resorting to more direct methods of intimidation. In violation of privacy rules, Health Minister Tyler Shandro obtained from the Alberta Health Service the private telephone numbers of several physicians who had expressed concern about the government’s fee changes, then called them up after hours to berate them for their stance.

“It felt intimidating,” said one female doctor contacted by Shandro. “The Health Minister tracked me down.” “It is a concern that people in positions of authority can reach down through the organizations that they’re supposed to be leading in moral and ethical ways in order to gain information to promote their own personal intentions,” added Gudgeon, who was also contacted by Shandro.

In another vindictive move, Shandro ended coverage for 46,000 dependants under the Alberta Seniors Benefit Drug Program on March 1. Seniors enrolled in the program used to receive premium-free coverage for prescriptions and other health-related services for themselves, their spouses and dependants. Seniors’ spouses and dependants have now been forced to seek other private insurance plans to cover those medical expenses. Many will no doubt be refused coverage due to chronic health conditions.

Conveniently for Shandro, he and his wife are part owners of Vital Partners, a private health care firm that specializes in securing new customers for private health insurance plans. CBC News obtained e-mail exchanges between Shandro and private citizens, which included a threat to send the legislature’s security services after one person who wrote to Vital Partners to complain about the health minister’s conflict of interest.