From: Michael Caffaro Date: Thu, Mar 21, 2013 at 5:29 PM Subject: Letter To: robin.campbell@assembly.ab.ca Cc: president@albertadoctors.

org Dear Robin, It is unfortunate that I need to take the time to write you today regarding the extraordinarily negative interactions between Alberta Health and the Alberta Medical Association of late. I think it important that my Member of the Legislative Assembly of Alberta be very aware of the concerns of this constituent as to the "management" and "direction" being offered by the Minister of Health, Mr. Fred Horne, and the lack of respect offered by the Ministry. It must be initially acknowledged at the outset that physicians in this province have been working without any sort of a contractu aI agreement with the Province of AI berta for the better part of two years. In good faith, an Agreement in Principle (AlP) was signed between Minister Horne and the Alberta Medical Association in spring 2012, which committed the two parties towards working to an agreement. The Minister withdrew from the AlP that he signed on to in March. Over the subsequent summer and fall he refused to negotiate. He "allowed" the AlP to expire. Since then, Minister Horne proceeded to unilaterally impose a settlement on the province's physicians in fall of 2012 (subsequently rescinded, claiming he had never actually imposed an 'agreement' in the first place). With the introduction of Budget 2013, the Minister has refused to table a position at negotiations with the Alberta Medical Association. In doing so, he has suggested that the introduction ofthe Budget of the Province of Alberta substitutes for discussions with physicians. While previously agreeing to a process by which negotiations could resume in early 2013, the Minister has since declined the suggestion of binding arbitration made by the mutually chosen independent facilitators- Premier Redford, as of last week, had declined involvement in negotiations as she felt that the 'facilitated process' had merit and should continue (she forgot to tell Minister Horne this). He has further produced a letter to our president, Dr. Michael Guiffre, demanding a further $275 million to be taken out of physician services with a lead-in time of approximately 6 working days. This is on top of what is already estimated to be a proposed package of payment reduction of nearly 25% for family physicians in this province. This is the most negative I have seen relationships with government in my 20 years of practice in Alberta, even surpassing that of the mid-1990s. Concerns abound on the part of physicians, including the Ministers inflated sense of physician compensation (he was regularly quoted rates in excess of 20+ percent higher than the Canadian average, where in reality it is closer to 14%), his and his predecessors' refusal to enter into meaningful dialogue with the Association over fee schedule modernization, his refusal to recognize overhead components such as rent, staff salaries and supplies in the management of our small businesses and his previous wish to abandon any semblance of

conjoint management of the delivery of healthcare in the Province of Alberta, preferring to concentrate only on payment issues. I would like to think that there has been some considerable success in the past in the management of healthcare and delivery models in this province under the tripartite (including regional health authorities) model, such as Primary Care Networks, Alternative Relationship Plans, retention incentives for physicians working in under serviced areas and the like. It seems a real shame to be throwing all that away in the current process. The refusal of the Minister to table a stance at negotiations I find particularly problematic. Your experience in a previous working lifetime would probably suggest that it is well-nigh impossible to have any sort of discussions between negotiating parties when one side does not bring a position to the table. Unless, of course, that was always the true intent ofthe Government of Alberta. I will not lie to you and suggest that I see this is just a momentary "bump in the road" in the politics of healthcare. The disrespectful nature ofthe Minister's proclamations has ticked off more than a few of my colleagues (and our families and our patients). All of us tend to work very hard to try to provide cost-effective, consistent and accessible medical care, not only in rural family practice (where remember, many of us also provide skills such as surgery, anesthesia,obstetrics etc.) but in all areas of medicine. It is impossible for any practitioner, myself included, to plan for healthcare delivery at the 'coal face' in the future under these circumstances- and I do include our very fledgling Hinton Primary Care Network. I have to ask myself where I'm going to cut patient services to make up $275 million on top of a threatened 24% reduction in payments. I can consider shifting more of my services to the third-party world, including Workman's Compensation Board and cosmetic medicine, but that would certainly do nothing to provide care to the many patients who require it on an ongoing basis under the Alberta Health Care Insurance Plan. It would also shift a certain load to my colleagues, who are going to be paid less and less for more and more work (and who will likely have fewer office and similar resources to help provide patient care). Perhaps that is the whole point ofthe Minister's actions- to reduce costs by reducing patient access via reduced number of providers and reduce provider hours? And in fact that would look brilliant save for the fact that there's been no discussion with the patients of AI berta as to whether they find this acceptable. Nor has there been discussion with the 100,000 people expected to move to AI berta (on an annual basis) next year- has anyone told them to expect reduced or no access to health care? Never mind routine health care- would an potential employee with a high needs child or family member with complex medical disease consider moving to this province at this time, or staying here if work was available elsewhere in North America? Mike Michael Caffaro MD CCFP FCFP Assistant Clinical Professor Department of Family Medicine, Faculty of Medicine and Dentistry University of Alberta