Alberta doctors push back against planned pay reductions for being on call
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Some Alberta doctors, facing pay cuts for their on-call work, are warning the changes could make staffing problems in hospitals worse.
Under the physician on-call program doctors get an hourly stipend for being available to treat patients as needed.
But changes following a review of the program — run by Alberta Health Services and funded by Alberta Health — mean physicians will no longer be paid for daytime on-call hours on weekdays.
While doctors had been compensated for the entire 24-hour period, they've been notified that once the program updates are implemented, they'll be paid for only 14 hours.
"We're hearing from lots and lots of people.… We were getting an influx of concerns," said Dr. Shelley Duggan, president of the Alberta Medical Association.
In a recent letter, she told members she's aware of dozens of on-call programs preparing to appeal the decision and "advising that they intend on reducing their availability to see unattached patients or cancel their availability entirely."
According to Duggan, some new programs were added through the review process. But the budget was not increased.
"Nobody begrudges that these new programs should have been added. But really what was needed was an increase in the budget," she said.
Doctors get the hourly stipend to be available to attend to patients and to respond, in some cases, in under half an hour. Some are required to be at the hospital. Physicians also bill for the clinical services they provide when they're on call.
Duggan believes the program changes will affect a variety of doctors in both urban and rural areas.
"That obstetrician [for example] really can't say, 'I know you're about to deliver, but I'm not coming to attend to you.' It's just not possible.… So these physicians are handcuffed in many ways," she said.
"Clearly they have to care for people and they will care for people, and now they're not getting remunerated as much as they were before. So we are not incentivizing the system that we want."
Physicians were told the stipend cuts would take effect April 1.
However, in an email to CBC News, Alberta Health Services said it is now extending that deadline to ensure a thorough appeals process.
Specialists respond
"Understandably, most physicians are upset," said Dr. Cameron Sklar, an Edmonton-based obstetrician.
He's required to be in the hospital when he's on call. That means he can't work in his clinic or be in an operating room during that time.
With the stipend change, he won't receive on-call pay between 7 a.m. and 5 p.m.
"Our clinics cost a significant amount of money to run," said Sklar, the president of the AMA's section of obstetrics and gynecology.
"You can't afford to sit there not earning an income if you have a medical practice to run and staff to pay and lights to keep on and patients to see."
He expects some specialist groups will consider withdrawing services.
"I think it's going to increase barriers to care, without a doubt, to patients."
The AMA said doctors have a duty to look after their own patients but they aren't required to treat a new or unattached patient who comes into the ER, for example, if they're not being paid to be on call.
Dr. Chris Rudnisky, an Edmonton-based ophthalmologist, said his colleagues in all five health zones are appealing the decision.
"This, I think, will tip some physicians over into moving or retiring," he said.
"Right now, we have a human health resources crisis. We don't have enough doctors. And it's yet another way doctors don't feel respected."
According to Rudnisky, ophthalmologists performed 587 urgent eye surgeries in the Edmonton zone alone last year, including repairing major cuts to the eye or detached retinas, and consulted on more than 2,800 cases.
"These are things that can't wait," he said.
Funded by province
AHS said the changes were made to the physician on-call program in an effort to make eligibility criteria and payment rates transparent.
That meant everyone had to reapply and 189 additional groups became eligible, which, according to AHS, increases after-hours coverage and health-care access.
AHS told doctors the decision to cut on-call daytime compensation was made due to the large number of programs that applied.
The physician on-call program is funded by the provincial government.
"We are monitoring the implementation and are considering funding changes as part of Budget 2025," according to a statement from the health minister's office. "These discussions are part of overall government spending on Alberta physicians, which has gone up $1 billion, or 22 per cent, since 2022-23."
The advisory committee that conducted the review included people from AHS, Alberta Health and two representatives from the Alberta Medical Association.
"We didn't necessarily agree to the drop in the daytime hours. But we recognized that [AHS] had to make a difficult decision," said Duggan.
She worries this will prompt more physicians to leave hospital-based work if they feel they can make more money in the community.
The AMA's acute care stabilization proposal, submitted to the Alberta government in the fall of 2023, included a request for an increase in on-call pay, according to Duggan.
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