After a month of deliberations, Alberta doctors have rejected a tentative master agreement package proposed by the provincial government.
Members of the Alberta Medical Association were informed of the proposal at the end of February, and results of the vote were announced last week. Overall voter turnout was 59 per cent, with 47 per cent voting in favour and 53 per cent against.
The master agreement would establish terms between Alberta physicians and the province over matters such as physician compensation.
A main factor leading the majority of doctors to turn down the proposed agreement was the issue of binding arbitration.
Since physicians provide critical health service, it is illegal for them to strike. As a result, agreements with government usually include binding arbitration. In the event of negotiations failing to resolve a dispute, the matter would go before a third-party arbitrator, with both sides agreeing to abide by the arbitrator’s decision.
Since the tentative master agreement did not provide for binding arbitration, the majority of doctors who voted no did so out of concern for the uncertainty that would remain, says local physician Sam Myhr, president of AMA’s rural medicine section.
“That’s the whole point — that’s why this was voted down,” she says. “It’s uncertain, and we don’t have any third party to fall back on. We would be agreeing to not having that right by signing this version of the agreement.”
Although the proposed terms included non-binding mediation, which would make the issues and particular arguments of each side public, neither side would be legally obligated to accept recommendations.
Because the agreement would be enacted for the next four years, Dr. Myhr continues, physicians would have to trust the government would act in good faith — something she says many were uncomfortable doing, given everything that happened last year.
“In the absence of that trust, of course arbitration is going to be the sticking point. We need a third-party referee; we need somebody who is going to come at it objectively that will hold up in court,” she adds.
Despite the vote against the tentative agreement, Dr. Myhr says there are some positive signs that communication between the provincial government and physicians has improved.
“The format and the tone of it has changed,” she says. “It seems like they are more willing to sit down and talk with us, which is preferable to yelling and stamping our feet, which is largely what we felt we had to do before to get noticed. To draw their attention to a problem, it felt like we had to create a scene.”
Specifically, the health minister visiting the Pincher Creek Health Centre and meeting with the local physicians group March 19 was a big step in easing tension.
“What impressed me was how he listened and took quite critical feedback regarding his policies,” says Dr. Myhr. “He seemed to really understand how the policies hurt us and that we were fighting for our community, not against him.”
At the encouragement of local physicians, Health Minister Tyler Shandro also sent an open letter to the AMA membership expressing a desire to leave the rhetoric of the past year behind in order to rebuild trust. Part of that process involved expressing regret over an assertion he made during a legislature debate that there had been “no fight” with doctors.
In the letter, Minister Shandro acknowledged his comments minimized the challenges and frustrations physicians had faced last year, and he recommitted to taking concrete actions in rebuilding the trust that had been lost.
Though still skeptical of the health ministry’s intentions, Dr. Myhr says there’s reason to be cautiously optimistic.
“It’s clear that they’ve started working on many of the issues we brought up,” she says. “Some of them are provincial, some of them are local, and they were able to get back to me the next week and say, ‘Look, here’s where we’re at with all these things.’ It shows that they’re taking them seriously, and I hope it continues.”
The AMA has been without a government agreement since Feb. 20, 2020, after Minister Shandro terminated the previous contract through an order in council. The termination was but one factor in a series of disputes between government and physicians, which also included the AMA suing the government and an overwhelming vote of non-confidence in the minister.
Despite the contention, both sides have committed to continue negotiations. Such collaboration, said AMA president Paul Boucher, would be crucial to continue in order to address the economic and health challenges stemming from the Covid-19 pandemic.
“We need to get to work on concrete strategies to evolve our system toward stability and pursue sustainability in the only way it can be achieved: through quality care for our patients,” Dr. Boucher said.
“This would be an easier task with an agreement, but regardless, we need to re-establish Alberta as a good place to practise, a place where physicians feel valued, can deliver high quality care to their patients and receive fair and equitable compensation in return.”
While expressing disappointment the agreement wasn’t passed, Minister Shandro said the hours spent meeting and negotiating had helped reconcile some of the differences between government and physicians.
“The momentum gained over the past few months will not be lost,” he said. “Our government will seek to further renew our relationship with the AMA in the weeks and months to come as we work together to ensure Albertans continue to benefit from quality health care.”
Sean Oliver, Local Journalism Initiative Reporter, Shootin' the Breeze