Province adjusts rural physician funding

By Sean Feagan, Local Journalism Initiative Reporter

The government of Alberta has adjusted some financial rules regarding rural physicians and their practices, in what some local doctors are describing as a walk-back from changes announced earlier this year.

In February, the provincial government announced changes to its physician funding framework outlining how and at what rate physicians are paid for their services. After hearing concerns about how some of these changes could affect rural healthcare, the province adjusted some aspects of the framework, said Tyler Shandro, Minister of Health, in an announcement made on April 24.

“Over the last several weeks, discussions with rural caucus and rural physicians have made it clear that there are unique challenges to recruiting and retaining physicians in communities outside of Alberta’s major cities,” said Shandro. “These changes recognize that difference and will significantly improve access to health care for patients in rural communities.”

As part of the funding changes announced in February, the provincial government said physicians will no longer be able to bill overhead costs for work performed at AHS facilities. However, the government has now said rural physicians will be exempted permanently from any changes, and that these changes are paused and under review for urban physicians.

The provincial government also is freezing the medical liability deductible to $1,000 after previously proposing cuts to the associated Medical Liability Reimbursement program, is increasing hourly rates for on-call services, and will spend about $81 million for programs for rural physician recruitment and retention.

Also affected is how rural physicians are paid under its Rural and Remote Northern Program (RRNP), which provides additional funding for doctors living and working outside Alberta’s major population centres.

By announcing these changes, the provincial government is trying to rebrand a “partial rollback” as “being very generous for rural Albertans,” said Dr. Joni McNeely who has practiced family medicine in Gleichen for the past 28 years. “But that rebranding is a little bit sour, because they are more or less giving back what they have taken away.”

Still, the adjustments will result in better outcomes in rural healthcare, said Dr. Allison Clarke, the immediate past president of the Alberta Medical Association, who has practiced as a family doctor at Strathmore’s Valley Medical Clinic for the past 22 years.

“Thankfully, the health minister has recognized that his department had not fully thought through all of the changes that they were going to implement, and that there were consequences to the new funding framework that would really impact rural healthcare delivery,” said Clarke.

However, the adjustments to the RRNP program, which incentivizes physicians to live in the communities where they are working, could make rural practices less attractive for physicians, added Clarke.

The RRNP pays doctors through two mechanisms: the variable fee premium (VFP) – paying a percentage of a physician’s total billed services – and a flat fee. Under the program, physicians receive a higher percentage or a larger flat fee amount the more isolated the community is in which they work.

The changes abolish a cap on the amount physicians may receive from the VFP, previously set at $60,000. However, for some communities, the flat fee has been abolished as well.

For example, physicians working and residing in the villages of Rosebud, Standard and Rockyford would have previously received a $7,271.54 flat fee, in addition to a 6.46 per cent VFP. Physicians living in Gleichen would have received a flat fee of $13,416.51 alongside an 11.9 per cent VFP for work there.

Now, a physician working in these places will receive the VFP only, at unchanged rates. With these changes, a physician could theoretically make more money by increasing billing, but that could provide difficult in less populated areas with less demand for services, said Clarke.

Under the new physician funding framework, daily patient visits have been capped to 65 patients per day to “give physicians more time with patients and help reduce burnout,” according to the provincial government. However, rural locations are exempt from this restriction.