Every villain is a hero in his own mind
Late last fall Health Minister Tyler Shandro, under direction from Premier Jason Kenney, set fire to Alberta’s health care system by pitching a host of draconian changes to the physician funding framework—changes conceived without any input from doctors.
He was warned repeatedly—by the Alberta Medical Association, by individual doctors, and by patients—of the destructive impact of those poorly-thought-out proposals.
He was strenuously and repeatedly advised to solicit input from doctors before moving forward with significant alterations to our complex, finely calibrated system. The idea that someone with only the barest understanding of how the medical world functions would unilaterally attempt wholesale changes—without any consultation with those who work within it—is incomprehensible.
Ignoring all the warnings, Minister Shandro pushed recklessly forward. After engaging in half-hearted talks with the AMA, after paying lip service to the principles of collaboration and fair negotiation, he used his government’s Bill 21 to rip up the government’s Master Agreement with doctors in February and decreed that his changes would proceed.
All hell broke loose, predictably, as the destructive impacts quickly made themselves felt.
On Friday Minister Shandro, no doubt faced with mutiny from UCP MLAs under siege from angry constituents, held a press conference to announce the rollback of every single change for rural doctors and the suspension—until October—of those changes for urban physicians (with the exception, for urban doctors, of a hike in malpractice costs).
After all the weeks of bureaucratic busywork that went into accommodating the Minister’s decrees; after all the acrimony; after all the energy expended on unnecessary distraction at a time when all of our energies should have been harnessed in a united fight against COVID-19; after all that, we are almost back to square one—but minus a contract and minus every shred of trust between the minister and doctors.
One might have expected to witness a chastened Minister of Health on Friday—perhaps even to hear an apology or two.
But there was no hint of humility, nary a shred of remorse, not a scintilla of shame. None of that. Instead he portrayed his reversals as the measured, careful, wise response of his ministry to the concerns of physicians.
Mr. Shandro is like a pyromaniac fireman who torches a home, then rides to the “rescue” armed with a couple of water pistols, trying vainly to douse the fire he set in the first place—and expecting to be celebrated as a hero.
Incredibly, in a spectacular example of victim blaming, after months of disseminating disinformation and fomenting dissent, and after reaping the bitter harvest of his actions, the Minister pointed the finger at the Alberta Medical Association.
He blamed us.
The doctors of Alberta, collectively, are the AMA.
For the past 114 years we’ve elected dedicated, talented physicians from all sectors of our profession and from all regions of the province to serve us in our dealings with government, to uphold our constitutional right to organization and representation, and to help us maintain laser focus on patient-centered, quality care.
The AMA is us.
When Minister Shandro attacks the AMA, he attacks us.
When he drips contempt for the AMA, he drips contempt for us.
If, as seems evident, his goal is to get rid of the AMA, then his goal is to get rid of us.
But we will not be divided. The AMA executive has always been and always will be our voice.
We will always stand together—for ourselves, for our profession, and for the patients of Alberta.
Mr. Shandro never tires of portraying us as overpaid physicians selfishly focused on our personal financial interests.
It’s a portrayal that has taken hold in the minds of some of the public, unfortunately, particularly in the context of the pandemic that has so many Albertans suffering grievous economic injury.
“We’re all hurting. Perhaps you guys should take a hit, too,” a friend of mine said to me upon learning that the AMA had filed suit against the government of Alberta earlier this month.
Set aside the fact that we had already accepted significant cuts to physician remuneration, in collaboration with the previous Rachel Notley administration.
Set aside the fact that we were—and are—prepared to sacrifice much more, and that we made multiple proposals in that vein to Minister Shandro via the AMA: thoughtful proposals that recognized the sacrifices that all Albertans have been making, proposals that weighed carefully the impacts on patient care.
Set all that aside and consider this: most fee-for-service physicians (which is the bulk of us) have taken a giant pay cut as we work the front lines during the pandemic. With elective surgeries and non-urgent services cancelled, and with less trauma and less spread of infectious disease as people shelter at home, patient volumes are down significantly.
Yet doctors still go to work—for reduced pay but at increased risk to themselves due to COVID-19 exposure—to attend to those who continue to get seriously ill or injured, to deliver pregnant patients, to care for cancer victims, to resuscitate those with COVID-19, and so on.
And if physicians test positive or become sick with COVID-19 in the line of duty, they are sent home to isolate—without any pay whatsoever. No sick benefits, zero financial support.
And if COVID-19 ends their lives, no death benefit either. Zip.
The risk is not insignificant: in other jurisdictions up to ten percent of those who die from the virus are health care workers. In Italy more than 150 doctors are dead.
I think it’s fair to say we’re “taking a hit” as we do our bit, to put it mildly. Which is in stark contrast, I might add, to the Minister and his political colleagues, whose substantial pay packets are untouched as they toil in safety, even as the remuneration for front line doctors working in the face of heightened risk is reduced by 50 to 75 percent.
Whether it is moral or ethical that the pay of front line physicians is severely reduced during a pandemic is a question I will leave for others to debate. (In a more normal situation, one in which doctors and the health minister were working together instead of at cross purposes, I expect that this situation would be addressed.)
The spectacle of this government fighting with its doctors in the teeth of COVID-19 is unspeakably sad. But it’s not awfully difficult to sort the villains from the heroes in this battle.
Mr. Shandro may well look in the mirror and see a conquering hero. But the only thing he has vanquished is any chance of a cordial relationship between himself and doctors.
It is tragic that we’ve endured such ham-fisted “leadership” from the person at the helm of the health portfolio at the time of the greatest health crisis this province has ever seen.
All trust is gone. We have no contract. We have no stability. We have no expectation of honour in our dealings with this minister.
The thing about pyromaniacs is that they always start another fire. They can’t help themselves.
So it shall be with Mr. Shandro.
He must go.
We need a minister of health who is skilled at putting fires out, rather them starting them; someone skilled at building medical homes, rather than burning them down.
For the sake of all Albertans, Tyler Shandro must resign. Immediately. Before he ignites another inferno.