Physician resource planning

In the early and mid-2000’s, Alberta had fewer physicians per population than the national average and efforts were made to recruit and retain more physicians in the province. These efforts, including financial incentives and amendments to legislation, resulted in an increase in Alberta medical graduates and increases in the number of physicians coming to Alberta from other countries and the rest of Canada.

In recent years, growth in the number of physicians has dramatically outpaced Alberta’s population growth and Alberta now has more physicians per population than the national average.

At the same time, the percentage of physicians practising in rural and remote areas in Alberta decreased. Despite growth in Alberta’s overall physician supply, physician access continues to be an issue in many rural and remote areas as well as in some urban areas. These trends also impact the affordability and sustainability of the health system.

The fall 2016 amending agreement between Alberta Health and the Alberta Medical Association (AMA) outlined our commitment to establish a physician resource planning committee and develop a needs-based physician resource plan. Physician resource planning is an important part of addressing these issues and meeting Alberta Health’s vision of ensuring that Albertans receive the right health care services, at the right time, in the right place, provided by the right health care providers and teams with the right information.

Physician resource planning work begins

Physician stakeholders, including future PRPC members, first met in late October 2016. Information was provided on physician resources in Alberta, including trends in physician supply, distribution of physicians in Alberta, and the costs of physician services. Alberta Health and AHS also presented a proposal for regulatory changes that would give Alberta Health the authority to issue practitioner identification numbers only to new physicians who practice in positions identified in the Physician Resource Plan.

This approach was designed to provide multi-stakeholder governance and oversight over physician resource planning in Alberta by establishing ways to better match physician resources with population health needs. It also gives government and its partners the flexibility to respond to changing health system, demographic, and economic environments. Stakeholders met five more times to review the current state of physician resource planning in Alberta and get updates about Alberta Health’s proposal for regulatory changes. In addition, a technical working group of subject matter specialists, clinician scientists, and technical experts began examining the physician workforce in Alberta, including population health needs and supply variables.

Alberta Health also held individual and small group meetings with stakeholders to further discuss physician resource planning and get feedback on the proposal.

Based on the feedback received from stakeholders during the past few months, the original proposal to place mobility conditions on new physicians’ practitioner identification numbers was withdrawn. The Government of Alberta approved the regulation amendments described below to establish physician resource planning without any new restrictions on new physicians.

Regulatory amendments

Regulatory amendments to the Alberta Health Care Insurance Regulation and the Claims for Benefits Regulation have been approved to set the direction for implementation of physician resource planning in Alberta. These regulatory amendments also set the foundation for fulfilling the commitments made in the recent Amending Agreement with the Alberta Medical Association.

The amendments will:

  • authorize the Minister to create a formal Physician Resource Planning Committee (PRPC) with representation from the Alberta government, the Alberta Medical Association, Alberta Health Services and other stakeholders to provide advice on the appropriate supply and distribution of physicians in Alberta. This work will include recommending to the Minister the number of additional physicians needed each year; and
  • formalize existing policy to require all physicians to have a practitioner identification number in order to bill the Alberta Health Care Insurance Plan for providing insured medical services.

PRPC member organizations will be responsible for implementing changes collectively, and within their individual authority, to achieve the number of additional physicians established by the Minister and other physician resource planning objectives. These objectives will include identifying where physicians are most needed in Alberta.

Proposed timeline

  • July 5 – Regulatory amendments came into force.
  • July/August – Physician Resource Planning Committee established by Ministerial Order and membership confirmed.
  • August – Committee starts developing advice on the number of additional physicians needed in Alberta for 2018–19.
  • January 2018 – Health Minister receives advice from the Physician Resource Planning Committee and issues a Ministerial Order establishing the number of additional physicians needed in Alberta for the next fiscal year.
  • January–March 2018 – Stakeholders take action within the authority of their organizations to implement physician resource planning and reach the number of additional physicians set out in the Ministerial Order for 2018–19.

What you should know

What the physician resource plan will achieve

In November 2016, the Government of Alberta and the Alberta Medical Association (AMA) publicly committed to developing a needs-based physician resource plan that will identify the supply, distribution and cost of physician resources that Albertans need.

  • The amendments to the Health Care Insurance Regulation and the Claims for Benefits Regulation will enhance physician resource planning in Alberta.
  • The amendments fulfill government’s commitments to physician resource planning in the AMA Amending Agreement by providing the authority to establish the Physician Resource Planning Committee. The committee will provide advice on supply, distribution and cost of physician resources that Albertans need. 
  • The amendments will:
    • provide the Minister of Health with the authority to establish a Physician Resource Planning Committee to advise on the supply and distribution of physicians in Alberta,
    • enable the Minister to establish the number of additional physicians required on an annual basis, and
    • require all physicians to have a practitioner identification number in order to bill the Alberta Health Care Insurance Plan for providing insured medical services.

Ministerial Order to create a Physician Resource Planning Committee

Establishing the Physician Resource Planning Committee in connection with the Alberta Health Care Insurance Plan communicates the importance of sharing physician resource planning with key stakeholders and allows the Minister to receive key advice on the issue.

Placing doctors in communities where they’re needed most

The goal of the physician resource planning amendments is for Albertans to get the care they need by ensuring physicians are practising where they are needed most. This is a goal shared by the Alberta Medical Association through the new amending agreement. The Physician Resource Planning Committee will use the best possible information to identify Alberta’s physician resource needs and recommend strategies to achieve better distribution of physicians to serve Albertans.

Determining the number for additional physicians each year

  • The Physician Resource Planning Committee will establish a technical working group of subject matter specialists, clinician scientists, and technical experts to develop methodological approaches to planning the physician workforce in Alberta, accounting for population health needs and supply variables.
  • The working group will examine the best available evidence to determine Albertans’ health needs and recommend a number of additional physicians.
  • Multi-stakeholder membership on the committee and sub-working groups will ensure a variety of perspectives are considered and engaged.

Getting the number of additional physicians needed

  • Alberta Health and the organizations represented on the Physician Resource Planning Committee will use current mechanisms at their disposal to influence the supply and distribution of physicians.
  • These mechanisms include using  Alberta Health Services appointments and privileges processes to manage physician supply and distribution, influencing physician supply and distribution through sponsorship of international medical graduates, and aligning medical school training programs with physician workforce and population health needs.

Strategies to reach the agreed upon number of additional physicians

  • Alberta Health will continue to work with stakeholders to use the current mechanisms, existing legislative mechanisms, and policy initiatives to influence the supply and distribution of physicians.
  • If existing mechanisms aren’t successful, the Minister will consider using other legislative mechanisms and policy initiatives to achieve physician resource planning goals.

Physician resource planning is necessary. Here's why –

  • Alberta is experiencing unsustainable increases in the number of physicians in our province.
    • Between 2000 and 2015, the number of physicians per 100,000 population in Alberta grew by 43%, compared to 18% growth in comparator provinces.
    • On average, Calgary and Edmonton have 35% more family medicine physicians per 100,000 population than the rest of the province. 
  • Alberta is maintaining the highest per capita spending on physician services in Canada.
    • Alberta will pay $5.2 billion this year for physician compensation and development programs.
    • This is nearly a quarter of Alberta Health’s budget at 24.3%, with the Ministry making up 39% of the entire government’s budget.
    • From 2000 to 2015, per capita spending on physician services in Alberta grew by 218%. This compares to average spending growth of 108% in British Columbia, Saskatchewan, Ontario and Quebec during the same time frame.
  • Despite the growing number of physicians, Albertans still aren’t getting access to the physician care they need. This is especially true for rural and remote areas, but certain urban populations are underserviced as well.
    • In 2011, 8.6% of physicians practiced in rural areas; in 2015 this percentage had declined to 7.3%.
    • Of the 986 net new family medicine physicians in Alberta between 2011 and 2015, only 43, or 4%, were practicing in rural areas.
  • Through the AMA Amending Agreement, both the Alberta government and physicians have committed to physician resource planning.

Questions

Check back for updates and summaries of the discussions as the consultation process and PRPC meetings take place.

If you have questions regarding physician resource planning, please email us at health.prp@gov.ab.ca