The UCP, in their quest to make the working class pay for the crisis, are even prepared to wreak havoc on public health care. Alberta’s doctors are threatening to leave the province en masse in the wake of a long-running dispute with the UCP government. Many began to warn that they were considering leaving due to mismanagement of the health-care system and cuts to doctors’ compensation.
Doctors first raised concerns after an August 2019 government economic report that proposed austerity for health care in the name of “balancing” the budget. In practice these cuts have taken the form of changes to billing codes, which determine how much doctors can bill the Alberta government for their services. As a result of these changes many rural physicians have withdrawn certain services, including emergency departments. Some doctors have already left.
Since coming to power the UCP has repeatedly attacked the public sector as part of its general austerity plan. Their first and foremost target was the health-care system. In the face of bitter opposition, the UCP have been forced to reverse some of their attacks, notably the decision to prohibit physicians from billing overhead costs. But the change to billing codes was only the first in a string of attacks on doctors in Alberta. After failed negotiations with Alberta doctors, the UCP passed Bill 21, which allowed the government to cancel the master agreement with physicians and the power to unilaterally impose new rules. The cancellation of the master agreement also removed the arbitration process guaranteed under the old agreement. In other words, this gave the UCP government the power to dictate doctors’ working conditions and pay.
The government went on to force a new “agreement” on the Alberta Medical Association (AMA) without consultation or negotiation. Under the old regulations, doctors were able to charge $41 for each visit by a patient as a base fee. Doctors were also able to add an additional 10 minutes if the patient required a longer visit and could charge $18 for this added visit time. This gave doctors the flexibility to spend more time with a patient who was seeking help for multiple or more complex health issues.
The UCP, however, changed this so that doctors could only bill the extra fee if an appointment took longer than 25 minutes, rather than 15. This pressures doctors to move as quickly as possible with patients so they can move on to the next one and maintain revenue. The end result is ultimately a pay cut. Doctors may want to provide the highest level of care possible, but that will become far more difficult as they speed through patients to cover the costs of keeping clinics open and staffed. Rural doctors have expressed grave concerns that these changes will hit them the hardest, with some doctors saying they may need to cut staff or services or even close their practice entirely.
Physicians have been left with no avenue to voice their discontent. The AMA is supposed to act as their voice, negotiating with the government to provide the best possible arrangement. The UCP, however, have shown their complete lack of willingness to collaborate or even sit at the bargaining table. Bill 21 and the new master agreement have proven this. In Canada, doctors are considered essential workers under the Canada Health Act and do not have the right to strike. It should go without saying that any legislation that restricts the right of workers to strike, whether considered essential workers or not, must be opposed.
Facing the unilateral imposition of the government’s contract, without the right to strike, and with no access to an arbitration process, doctors are therefore extremely limited in their options to fight the UCP’s attacks on health care. This is why there has been so much talk by doctors about leaving the province or early retirement. Many feel that these are their only courses of action now that they’ve seen the UCP has no interest in working with or listening to them.
In July of 2020 the AMA conducted a survey to discover how many physicians were truly planning to leave the province. According to their findings a whopping 42 per cent responded that they were considering leaving the province. Eighty-seven per cent told the AMA that they would have to make changes to their practices due to the constraints forced on them by the UCP. These changes would mean fewer hospitals with a functioning emergency room, childbirth services, and countless other life saving procedures. Of that 87 per cent, a further 34 per cent are considering early retirement or leaving the profession entirely rather than having to entirely restructure their practices. Thankfully, the vast majority of doctors do not plan on leaving until after the pandemic is under control so as not to put their patients at risk.
The Alberta government has attempted to downplay the current crisis. In October they published statistics from the College of Physicians and Surgeons of Alberta (CPSA) to make the case that no mass exodus of doctors was taking place. However the CPSA report on the last quarter of 2020 revealed a net loss of 30 doctors across the province. Doctors leaving the province have stated directly that their reason for leaving was the UCP’s mismanagement of the public health-care system.
The level of distrust that the province’s physicians have for Health Minister Tyler Shandro is particularly high. According to another survey done by the AMA in July 2020, an absolute majority of doctors voted overwhelmingly that they had no confidence in the health minister. A whopping 97.83 per cent voted non-confidence with 66.6 per cent of eligible physicians taking the time to submit their opinion.
The UCP has continued to repeatedly deny that doctors were leaving or planning to leave the province, but in June of 2020 Shandro directed the CPSA to make changes to its standard of practice for physicians to prevent doctors from leaving en masse. This by itself is an admission that doctors were indeed leaving, or at least that the UCP knew this was a possibility.
The UCP also brought in new policies as of Jan. 1, 2021 which include a new set of rules on how doctors may take job action or leave their practice. Job action is not forbidden entirely, but is rendered completely ineffective, as it is only allowed to be taken in “extremely controlled circumstances”. What might be considered legal job action is also ambiguous. Instead of working with doctors, the UCP has attempted to control them and force their acceptance of the UCP contract by strangling them in a web of rules and regulations.
In an attempt to reinstate some form of stability, the AMA negotiated a tentative new master agreement with the government in February 2021. However, the terms were a total concession to the UCP. Importantly, it removed doctors’ right to binding arbitration and put a hard cap on the physician services budget which would allow the government to withhold payment to doctors in the event of overspending. The UCP also demanded the AMA withdraw its current lawsuit against the government for tearing up the old master agreement.
Doctors across the province were not impressed by the tentative agreement, indicating a lack of trust in Shandro and a lack of faith in the AMA. At an online town hall on March 18 between rural and family doctors and the AMA executive, none of the dozen doctors who spoke were in favour of the agreement. A confidential source who attended the meeting disclosed to Fightback that many doctors expressed fear that the government could simply tear up the new agreement whenever they saw fit. One family doctor said “It feels to me that voting yes would be like selling my soul. So I want to vote no, but the AMA experts are saying vote yes because we are not going to get any better”.
At the same meeting, outgoing AMA president Dr. Paul Boucher stated that although the agreement was not what they wanted, they perceived it as the only vehicle for stability moving forwards. Evidently, Alberta doctors did not agree with him, as 53 per cent voted against adoption of the agreement. Voter turnout was far higher than it had been for similar agreements in recent memory, indicating the stakes. This result demonstrates that doctors have lost faith in the government and many have lost faith in the AMA. This struggle is more important than 14-plus months without a collective agreement. The future of health care in Alberta hangs in the balance.
The effects of UCP mismanagement of health care in the face of the pandemic have already acutely affected working class patients. The attacks on doctors and other health-care workers by Kenney’s UCP are compounded by his “wealth before health” approach to COVID-19. When case counts skyrocket, Kenney has implemented weak, half-measure lockdowns at the eleventh hour, in an effort to keep the economy open. The province has only recently restarted contact tracing. This has all accumulated and left Alberta with arguably the worst pandemic response in North America.
If doctors continue to leave the province, and especially if there is a mass exodus following the end of the pandemic, health care in Alberta will suffer catastrophically. Rural communities may lose their only local health-care providers, which would force them to travel further to see a doctor. Closed emergency rooms mean some people will have to drive for hours to get help. With some injuries and conditions that could mean the difference between life and death. Clinics in rural towns that manage to remain open will have to take on the influx of patients from nearby towns who end up losing their local doctors.
All over the province the already burdened health-care system will not be able to provide the same level of care. Patients are already too familiar with the long wait times to see a specialist, which would be exacerbated with fewer doctors. Less access to health-care services and longer wait times will also mean less effective preventative care. This will result in deaths that would have been entirely preventable through early care or diagnosis. The consequences of this are already terrifying. An Alberta Union of Provincial Employees (AUPE) worker who participated in the Oct. 26 wildcat strikes said that “every health-care employee [they] know has seen preventable deaths”. Albertans will suffer or even die needlessly thanks to the UCP.
Doctors are also increasingly concerned about the ongoing privatization the UCP is pursuing in the province. AMA president Dr. Boucher stated at the town hall that laws like Bill 30 which open the door to privatization “done right can provide some opportunities to innovate and bring value to the system.” UCP plans to implement privatization are no secret. At their 2020 AGM in October, the party voted to approve the creation of a privately funded and privately managed health-care system.
In the same month the UCP also announced pink slips for up to 11,000 Alberta Health Services (AHS) jobs in favour of contracting out to private companies. The cuts will be focused on those working in laboratory, linen, cleaning and in-patient food services. The government’s assertion that no jobs will be lost due to privatization is a blatant lie, as most of the laid-off workers will not be rehired by private firms and those who are will find themselves without the union protection and decent wages they had under the AHS.
We only need to look at recent laundry privatization in B.C. and Saskatchewan, where wages dropped from $18 to $13 an hour and $23 to $13 an hour, respectively. Another clear example is the government’s support for a proposal to build a new $200-million private orthopedic surgery facility in Edmonton. The plan even includes the use of non-unionized staff to cut costs. Last year a scandal broke out over the revelation that many lobbyists pushing this facility had connections to Health Minister Shandro.
Privatization of health care, whether directly impacting patient services or indirectly by impacting laundry and laboratory services, all have the effect of decreasing the quality of care patients receive. Privatization necessitates the introduction of the profit motive to otherwise non-profit services. The need for private firms to make money results in workers being paid less for more work and cutting costs at every opportunity. At bottom this results in a lower quality of care and increased rates of mortality in private health systems. One only needs to look at the recent scandal in Ontario, where private long-term care homes have double the death rate of COVID-19 compared to their public and non-profit counterparts, to see the consequences of private health care.
With no official right to strike and no access to arbitration, Alberta doctors do not seem to have many options. While there is legal and constitutional precedent from elsewhere in the country that would grant Alberta doctors the right to strike, the AMA has largely rejected the idea of a strike for professional and ethical reasons.
It is interesting to note that the UCP’s austerity has put doctors’ backs against the wall, the same as nurses and other health-care workers. Doctors are now in the same position as other health-care workers in Alberta and have been forced into a position where they have to consider strike action, including “illegal” strike action.
Health-care strikes can be difficult to navigate for the union and the workers. The government will always attack health-care workers for being “selfish” and putting the health and lives of patients at risk. Doctors and nurses are especially vulnerable to these types of attacks. These arguments of the right wing mean in practice that health-care workers should not have the right to fight for improved wages and working conditions and should have to accept whatever conditions are imposed on them.
This type of reasoning is actually very dangerous for the health-care system, and far more dangerous than any strike action by health-care workers. Striking health-care workers always ensure that the strike is not “total” and that essential services are still maintained. It is highly unlikely that doctors or nurses would remain out on the picket lines when patients required urgent procedures, for example.
The fight for improved wages and working conditions by health-care workers is directly related to maintaining or improving the condition of the health-care system overall. By not simply accepting whatever agreement governments impose on them, health-care workers can fight to maintain standards of care by ensuring proper staffing levels and decent wages.
A doctors’ strike in Alberta in this case to fight against the UCP’s austerity and gutting of the health-care system would not be like the reactionary doctors’ strike in the early 1960s in Saskatchewan against the CCF/NDP government’s plan to implement the country’s first public health-care system. In this case, the doctors were selfish and were fighting to maintain their private profits.
We’ve already seen wildcat health-care strikes in Alberta by housekeeping, food service, and maintenance and support staff workers. If doctors and nurses united with these workers and began organizing for strike action, including “illegal” strike action, they could not only reverse the UCP’s austerity and attacks, but could even bring down the Kenney government.
The UCP would naturally attack any job action by Alberta health-care workers as “selfish”, but the simple way to counter this would be to show that all health-care workers, including doctors, nurses, and all support staff have united to protect working conditions, the standard of care, and thereby the health-care system as a whole.
Doctors should not be made to fight alone. The government has made it clear that it has no interest in compromising with anyone who opposes them, which is a very long list. So far, the UCP has succeeded in keeping the disputes with various health-care associations and unions separate. Doctors must organize with other healthcare worker unions such as AUPE and the United Nurses of Alberta (UNA) and unite in common struggle against the UCP’s attacks. The major unions in the province can also play an important role and by leading the way, can start mobilizing the public sector followed by the working class as a whole. Only militant action such as walkouts or strikes can defeat the Kenney government. The working class in Alberta is seething with anger, and many would gladly join the struggle.. This government has never been less popular, and a movement in defense of doctors, other health-care workers, and public health care in general, would have enormous support from the vast majority. At this moment, it looks like the UCP will lose the next election. But there is no time to wait for the next election. People’s lives are at stake, and the UCP’s policies will only put more at risk. The time to act is now, the time to bring down the Kenney government is now.