The Rise of Babylon — And The Fall of Shandro?

Babylon

In 1978 Boney M captured in song the agony of Israelites languishing in captivity almost twenty-six millenia ago:

By the rivers of Babylon

There we sat down

Ye-eah we wept

When we remembered Zion

Substitute Shandro for Zion, and that stanza becomes an apt lament for the doctors of Alberta.

The Israelites of yore were yearning for the good old days.  But Alberta’s physicians will not be yearning for the days of Health Minister Tyler Shandro once this current turbulent period has entered the history books.

In the teeth of an unprecedented pandemic one might have reasonably expected to find Mr. Shandro boldly leading a cavalry of doctors united and laser-focused on battling COVID-19.

Instead, at a time when Albertans desperately need all of their doctors pulling together—at a time when those doctors are putting themselves and their families at risk to serve Albertans— Mr. Shandro is battling those physicians.

The mind boggles.

In fairness to the minister, he initiated his adversarial stance with the province’s doctors last fall, well before anyone had any inkling that this pandemic was going to visit devastation upon the world.

On November 14— without consulting doctors and in open contradiction to the “Public Health Guarantee” publicly signed by Premier Jason Kenney when he was campaigning for office—Mr. Shandro introduced a suite of sweeping changes, chief among them deep cuts to compensation to family doctors for delivery of complex care.

Alarmed by the certain negative consequences for patients, concerned doctors from all corners of the profession rallied to support family doctors.  Hundreds and hundreds of emergency physicians added their names to joint open letters to the Minister, imploring him to change course.

The intense lobbying was successful, it seemed.  Mr. Shandro finally agreed to delay the changes, set to kick in February 1, 2020, and to engage in meaningful consultation with the Alberta Medical Association.

Then, when those talks stalled, he agreed to a period of mediation.

But on February 20 he abruptly pulled out of mediation, ripped up the master agreement between Alberta Health and doctors, and decreed that the cuts would proceed as initially proposed, effective March 31, 2020.

It was like throwing gasoline onto glowing embers of animosity—just as the malignant beast of COVID-19 was lumbering into full view in Alberta.

Amidst the frantic (and remarkable) efforts of Alberta’s medical community to prepare for the pandemic, thousands of physicians have been needlessly distracted by worries about the viability of their practices.

Twelve days ago, again under intense pressure from doctors, Mr. Shandro suspended his planned cuts to complex care remuneration.

The timing was darkly ironic: the contested fee for complex care was restored just as family doctors could no longer use it.  Acting proactively to protect their patients and themselves from COVID-19 contagion, they turned as much as possible to the delivery of virtual care, and the Minister didn’t permit the “restored” fee to apply to virtual care.  Instead he implemented a scheme that paid physicians twenty measly bucks per virtual visit.

That rate was revised upward after further outcry from doctors, but physicians are still being paid substantially less to deliver virtual care than for care delivered in their offices—for many patients these encounters require significantly more time to complete.

Unbelievably, the rest of the suite of changes to doctor pay which Mr. Shandro originally announced in November will launch on the first of next month.  How deep those cuts will be we don’t know:  with April 1 two days away, the minister still hasn’t bothered to tell us.

Paying doctors less to work more—in an environment of dramatically heightened personal risk, to boot—is perhaps not the best way to rally the troops.  April Fool’s Day is a fitting launch date.

Family doctors are floundering.  Many are barely breaking even, or worse.  It simply isn’t possible for doctors to deliver competent care to all of their patients virtually: many must still be seen and examined in person.  That means family doctors must keep their clinic doors open to physically see some of their patients—part-time hours, with full-time overhead.

Doctors are grimly soldiering on, trying to survive, paring staff to a skeleton crew and cutting other expenses to the bone.  But clinics are shuttering, and more will follow, leaving patients stranded at a time when they need their medical homes more than ever.

Then on March 19 the Minster showered a tanker load of rocket fuel on top of the aformentioned gasoline.  He announced—in partnership with Telus—the rollout of Babylon, a service that gives people the option of connecting with a physician using an app on their phone.

Babylon seems like a great initiative, on the surface—an innovative way to relieve stress on the system by providing additional capacity for Albertans to access virtual care.

Virtual health care delivery is long overdue.  The fact that this pandemic is forcing its widespread adoption is a solitary silver lining to this crisis.  Without question, once the crisis has passed and the dust has settled, virtual care will be here to stay.

Introduced properly and thoughtfully, as part and parcel of patients’ medical homes, it will enhance the patient experience immeasurably.  Virtual care must be complementary to hands-on care; it cannot stand alone.

Unfortunately Babylon doesn’t meet that bar.  Not even close.

One cannot use Babylon to access his or her own doctor.  The app supplies a limp imitation of the turnstile walk-in clinic model that serve no one very well.

That Babylon was chosen by the Alberta government to deliver services to Albertans is dumbfounding.  It’s owned by a multinational conglomerate, a corporation funded by foreign countries—most notably, Saudi Arabia owns a large portion of the app.

That’s right:  the Saudis, who in the midst of this pandemic are destroying world oil markets and shoving Alberta down the road to utter financial ruin, now have their greedy paws in our health care system.

I browsed through the fine print of Babylon’s virtual delivery service: it made my hair stand on end.  Customers are informed that each video consultation— your most personal confidential information—is recorded and saved on company servers.

Furthermore, one consents to allowing Babylon software developers to use your “medical records, “transcripts” and “recordings of your consultations”—however they see fit—for developing and “improving” their for-profit application.  The company may dole out your personal health information to the members of their corporate group and to other partners: “We may share your personal data with companies we have hired to provide services on our behalf, including those who act as data processors.”

If that isn’t scary enough, your personal data can be transferred out of Canada and “notwithstanding… safeguards, while outside of Canada, personal data may be accessible by foreign government agencies.”

Why the Alberta government wouldn’t at least select a Canadian alternative, one which has proper respect for patient privacy and isn’t funded by the Saudis, is mystifying.

To top it all off, Babylon cherry-picks the simple, easy cases and directs everything else to family doctors or to the emergency department; and for this inferior and fragmented care, Babylon’s “doctors” (who have no overhead) are paid more than Alberta’s hardworking family physicians.

It’s little wonder that Babylon’s rollout sparked an inferno amongst doctors on social media, abetted by the revelation that Mr. Shandro’s wife, Andrea, runs a business—Vital Care—that delivers private health care solutions to businesses.  Whether or not a conflict exists is almost immaterial—the perception alone was enough.

Things were said, memes were shared, emails were sent—some of them to the Minister’s wife.  Suffice it to say that none of them were flattering.

It culminated last week, unbelievably, in the spectacle of Mr. Shandro, a Minister of the Crown, tracking down a private citizen—a physician who had reposted a derogatory meme—and publicly berating him at length in his driveway in front of his wife and kids and in full view of his neighbours.

Yup.  He did that.

Someone alerted the CBC, which picked up the story and promptly added in jawdropping details about email exchanges between Mr. Shandro and private citizens, one of which threatened discipline to a citizen via the legislature’s security services; another called a citizen “crazy” for raising concerns about his alleged conflict.

Again, all of this in the teeth of a pandemic that requires every inch of physicians’ attention: Farce, meet tragedy.

For the sake of Alberta, it needs to stop.

It is unacceptable, clearly, for citizens to defame our political leaders, let alone their spouses.  Absolutely.  I can understand Mr. Shandro’s impulse to defend his wife.

But politics is a rough game, unfortunately.  It’s not for the faint of heart, or the thin-skinned.

Rachel Notley, when she was premier, endured more than her fair share of hateful, sexist, misogynistic comments.  But she never stooped to going to the houses of her constituents to rant at them; she never threatened them by email with the legislature’s security apparatus.  Nor did her husband.  The very notion is outlandish.

This fracas with doctors may revolve around money, in the Minister’s mind.  But it’s certainly not about money for physicians—it’s about being able to keep their doors open to properly serve the people of Alberta.

It’s worth pointing out that the value of a pre-pandemic dollar will bear no resemblance to a post-pandemic dollar.  We are hurtling toward a world of economic pain that may make the Great Depression look as shallow as a finger bowl (a simile Premier Kenney will appreciate).

Fighting about dollars today that will be worth a fraction of what they will be worth in the post-pandemic tomorrow is like squabbling over pennies and nickels.

But physicians need today’s dollars in order to keep their clinics open today.

Times have been extraordinarily tough for many Albertans in recent years due to the downturn in our energy sector.  Doctors understand that.

Tens of thousands of Albertans now find themselves suddenly unemployed with no sure source of income amidst the biggest catastrophe any of us will ever experience.  Doctors empathize with that, too.

But crumbling the foundation of our health care system won’t make things better; forcing doctors to shut down medical clinics isn’t part of the solution.

Minister Shandro should be working double-time to equip us, not to hamstring us.

Enabling us to properly care for Albertans in the face of COVID-19 is absolutely critical.

This viral pandemic will kill some of Alberta’s doctors, if the experience of other jurisdictions is any guide.  Others will step forward to stand in the breech.

That’s the way we operate.

We’re not complaining or looking for sympathy.  We signed up for this.

But we didn’t sign up for disrespect.

We didn’t sign up to be painted as greedy, grasping, self-interested charlatans.

Every major crisis spawns a collection of heroes and villains.  Many of the heroes of Pandemic 2020 will be doctors steadfastly defending their patients to the last against the ravages of this virus.

Minister Shandro, alas, is busily painting himself into the villain’s corner.

But it’s not too late for him to change that narrative.

It’s not too late for him to come to his senses.

It’s not too late for him to suspend all changes to the physician funding framework for the duration of this pandemic.  We can sort all this stuff out later, once the COVID-19 battle has been won.

For now, we need all hands on deck.

We must stand united.  We must all pull in the same direction.

We must not falter.  We must not fail.  We will not fail.

I wonder, however: will Albertans be left with a functioning health care system once the battle with COVID-19 is won?

Or will they be left with a system decimated by a mass exodus of embittered, battered family doctors fleeing our province for jurisdictions that will afford them some respect?

Who will take proper care of the Babylonians then?

I took a good deal of flack in December when I admitted, in an essay criticizing the government’s actions on health care, to voting for the UCP.  I didn’t apologize for my ballot-box choice then; nor do I do apologize for it now.

The landscape can be rather barren for those of us wandering the political middle.  Election day decisions often come down to holding one’s nose and voting for the least objectionable option.  To adapt a phrase uttered by Al Pacino’s character in The Hunters, “In a world of constipation and diarrhea there’s not much room for normal turds.”

I’m just a normal turd—a turd that used to be a friend of the UCP, sort of.  But the party is turning normal turds like me into enemies.

Not only that, it’s driving us further away with each passing day.  The party would do well to remember former American President Lyndon Johnson’s sage advice about keeping one’s enemies close—it’s better to have them “inside the tent pissing out than outside the tent pissing in.”

That’s a pile of excrement with which to end this essay.  Unprofessional, even.

But it’s entirely appropriate, given the crappy way Alberta’s doctors have been treated by this government.

7 Replies to “The Rise of Babylon — And The Fall of Shandro?”

  1. Thank you for documenting the timeline, and editorializing the egregious decisions and inappropriate conduct of our Health Minister. His contempt for our profession is unprecedented, and is beneath the dignity of any elected official. His attacks on primary care are ideological, and demonstrate an unwillingness to understand the short and long term consequences of his decisions–for which there will be many. His attacks are also unsettlingly personal, revealed in his choice to use social media to launch his own bullying tactics. This govt has a fiduciary responsibility, of course, to the citizens of Alberta. We stand at a crossroads–an opportunity to build into existing systems, even with a difficult economic forecast. It all rests on this government to restart negotiations and to look to collaboration–before disillusioned physicians close their doors on Alberta.

  2. You’ve glossed over some very important details:

    Health Care funding in Alberta far outpaces that in other provinces, much more growth than in population+inflation over the past few years. Where are doctors going to go to, and how much less are they willing to take to live elsewhere?

    Where are the solution from the AMA as to how to solve the billions in dollars of overspending? Why is the answer always to tax the private sector, already reeling from unemployment and lack of growth before the COVID-19 shock, even more?

    There’s only so much blood you can squeeze from a stone, and the AMA has only been interested in protecting their members thus far. It would be nice to see some real solutions on how to cut 2 billion in compensation offered instead of the constant one-sided attacks.

    1. Thanks for the comment. I’ll copy here what I wrote in December in “Good Doctors Plan Before They Cut”:

      “The MacKinnon Report claims that physicians in Alberta are compensated at a rate 35% higher than the average of comparator provinces, but neglects to take into account higher payments physicians in those provinces receive via Alternate Remuneration Plans. With these properly included, the difference between Alberta and elsewhere shrinks to roughly 11%. Thirty-five percent makes for a splashy headline, but it’s a 200% error.

      Add in the unique economic environment in Alberta, including higher overhead costs, and the remaining 11% gap melts away faster than snow in a Calgary chinook. And it’s worth emphasizing that remuneration in Alberta has consistently tracked below the province’s Consumer Price Index, going all the way back to 1971.”

      And again, to emphasize: Shandro/Kenney are needlessly antagonizing doctors at a time when we are operating at great personal risk, over dollars that will amount to pennies and nickels when the catastrophic effects of the pandemic are fully priced in over the next few years. Completely, unforgivably, unbelievably stupid.

      Ten percent of health care workers will be sickened by this virus, if the experience of other jurisdictions is any guide. Some will die. And let me remind you: we have no government provided safety net – no sick pay, no disability leave, no compensation for dying in the line of fire. We don’t work because we get sick on the front lines, we don’t get paid – we live off our savings, until whatever disability we have arranged for ourselves kicks in , and if we die we rely on life insurance we have arranged for ourselves.

      A little respect and compassion for soldiers serving on the front during this horrific time would be much appreciated.

  3. Hi Ed. Thanks for your eloquent articulation of the state of health care in Alberta, and in particular how unjustly physicians are being treated. I hope your article gets shared far and wide! You do us proud!

  4. I wrote shandro 3 weeks ago. I told him our daughter works in emergency in lethbridge and the good new doctors there are stressed and talkng of moving. Our own gp’s clinic is having a miserable time making ends meet. They even sold off their patient parking lot to help meet expenses. Now we as patients have to park a block or more away on the street and plug meters. I told shandro to pay up, not down. I read in the news where he was not implementing his program. That is what he said he would do. But that is not what he did. He cut away anyway.
    Well 2 elections back i dropped the pc because of their arrogance and voted 1st time ever for ndp.
    I thought ok they worked hard and did ok, but I wasnt sure if they were thrifty. So I went upc. They are more arrogant and uncaring than the pc were when i turfed them. Never UPC again. They are even selling off parks. Jerks.

  5. I hope that you get it that we MUST have the NDP back in power in Alberta. Stop wishing we were back in 1970. Rachel Notley was by far our best premier. Truly concerned about our welfare. I challenge anyone to point any glaring missteps the NDP made. We were healthy, safe, fed, watered, clothed and housed. To entertain voting otherwise is suicide. Unless, Kenney starts restructuring our electoral structure. Oh and please don’t forget that the NDP had broke ground for a superlab, that is much needed. That the UCP immediately halted.

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