When it comes to battling the provincial government, the new president of the Alberta Medical Association is something of an expert.
In the Royal Alexandra Hospitalâ€™s intensive care unit, Dr. Richard Johnston regularly goes toe-to-toe with failing hearts, kidneys and lungs. Yet he is also a veteran of boardroom battles with provincial bureaucrats, having served as the chairman of the AMAâ€™s negotiating committee for more than 15 years.
The last of those battles was a bitter pay dispute in 2012-13 that ultimately ended in a seven-year deal for doctors.
Now Johnston is hoping to work constructively with the government to reform how physicians get compensated, which he believes can lead to better care for people with complex and chronic conditions.
â€œThere is a lot of work that has to be done in terms of coordinating their care,â€� he said Sunday in an interview. â€œAnd right now, the family doctors who take that on, they really suffer financially because there is ton of things they need to do and time they need to take that isnâ€™t recompensed.â€�
The care of patients with incurable, long-term illnesses such as heart disease, diabetes and asthma was the focus of a special report from provincial Auditor General Merwan Saher last month. Saher called for immediate action to bolster the primary care such patients receive, which he said would improve their lives and potentially save the health system billions in costs.
Johnston said he believes changes to the compensation system could help form part of the solution Saher is looking for.
Currently, the primary vehicle for paying doctors in Alberta is called fee-for-service, in which physicians bill the government a pre-determined fee every time they perform a service for a patient. But the system tends to reward specialists far above doctors practising in family medicine.
â€œFor the complex patient, we need to work on some mixed payment models that will include payment on a fee-for-service basis but probably also on a per-patient basis,â€� Johnston said. â€œWe need to do some work that will allow us to use payment models to essentially reward people for moving into those other operational models.â€�
He said those discussions are already taking place within the physician compensation committee, a new joint effort of the province and the AMA. In addition to reviewing how doctors get paid, the committee is also examining 22 specific procedures to determine if their associated fees still reflect the time and skill it takes to perform them.
Johnston said another of his top priorities is to improve the use of information technology to better share medical records. The idea is to eventually create an integrated system for the whole province that would give health professionals a common platform to view tests results, X-rays, discharge summaries and other relevant information about a patient.
Johnston said he spoke to new Health Minister Stephen Mandel earlier this month, and was impressed the minister identified hospital bed overcrowding as a major priority. Evidence indicates some of the backlog is being caused by a shortage of continuing care spaces.