Alberta Health Confirms Plans to Launch new AMHSP for Province's Psychiatrists by end of 2018

After more than a year of negotiations, a new Academic Medicine

1 October 2018

After more than a year of negotiations, a new Academic Medicine and Health Services Program (AMHSP) for Alberta's practicing psychiatrists is now expected to be finalized by the end of December.

Peter MacLeod, Director of the Alternative Compensation Delivery Unit at Alberta Health's Provider Compensation and Strategic Partnerships Branch, confirmed the news in a letter to Dr. Xin-Min Li, Chair of the Department of Psychiatry.

"Based on our most recent assessment of the status of the new arrangements, the goal is to have final approvals and required program funding available for the Psychiatry (AMHSP) arrangement by the end of the calendar year," he wrote.

The provincial AMHSP Strategy Committee is currently formulating a remuneration framework and methodology before finalizing compensation levels for psychiatrists who wish to apply for the program.

"As part of that exercise they are referencing AMHSP remuneration levels in other provinces. Although details of the Alberta compensation plan are not yet finalized, the target date is to release this information before Christmas," says Dr. Li.

"Whatever the final numbers are, remuneration levels will be consistent for Edmonton and Calgary. It is important that we remain competitive for recruitment purposes, for the sustainability of the AMHSP program, and to ensure that those who participate enjoy their careers and don't feel financially penalized."

Pursuant to the terms of the 2016 Amending Agreement - which reset the relationship between the province's 10,000 physicians and Alberta's NDP government, as part of a plan to stabilize rising health care costs - negotiators began discussing how to design AMHSPs for psychiatry professionals last year.

In addition to the University of Alberta's Department of Psychiatry, the multi-party AMHSP talks involved representatives from Alberta Health, Alberta Health Services (AHS), the Alberta Medical Association (AMA) and the Department of Psychiatry at the University of Calgary.

The objective with AMHSPs - traditionally referred to as Academic Alternative Relationship Plans (AARPs) - is to ensure that physicians who teach, do research, or assume leadership and administrative roles at Alberta's faculties of medicine are not financially penalized for taking on such activities, compared to traditional fee-for-service work.

"Now that the letter (from Alberta Health) has given us the green light to go ahead with the AMHSP by December, we're hoping the first AMHSP position will be filled sometime early in the new year," says Dr. Alberto Choy, Associate Chair, Academic Affairs in the Department of Psychiatry, and one of the participants in the negotiations.

"We've already notified all of our clinical academic colleagues and various people at the University of Alberta. The next steps include following what the provincial AMHSP Operations Committee - which oversees this, through Alberta Health and AHS ¬- lays out for us in order to make this happen."

The process includes an AMHSP Arrangement Management Committee, centered in the Department of Psychiatry. Committee members will include Dr. Li and Mark Snaterse, AHS's Executive Director - Addiction and Mental Health, Edmonton Zone, along with other senior Faculty members from the Department.

"This all has to be coordinated with Calgary because we need to have parallel systems," says Dr. Choy. "So there is a committee for the northern part of the province and a committee for the south, and the application process for an AMHSP will include both AHS and the university. The committee will work with physicians to develop the contracts."

The contracts - or Individual Service Agreements (ISAs) - will be reviewed annually, and outline in detail the tasks and duties for which an individual psychiatrist is remunerated.

"The ISAs are truly that - they're designed on an individual basis. In the old system you could teach and also perform leadership or administration roles, but that was time you weren't spending with patients and earning income from that. Now, rather than being penalized, we can build those activities into an ISA that works for the clinician and for the university," says Dr. Choy.

To that end, negotiators created five distinct physician profiles that stipulate the average amount of time individual physicians are expected to spend on clinical work, research, education, and administration and leadership functions. The profile types fall under the following categories: Clinician Teacher, Clinician Educator, Clinician Investigator, Clinician Primary Research, and Clinician Leader.

"Generally speaking every AMHSP position slots into one of those five categories or physician profiles, and in broad strokes, each one of them stipulates what a particular job within the AMHSP structure is going to look like from year to year," says Dr. Choy.

"Now that we've got a target date in mind to roll this out, a key priority over the next little while is to strategize on how best to get the message out about this, so we can start offering these AMHSP positions for physicians. Then those who are interested can start thinking in more detail about what their AMHSP job profile might look like."

Dr. Choy says it's too early to predict with any accuracy how much demand there will be among psychiatrists to apply for an AMHSP position.

"Since we began sharing the letter (from Alberta Health) I've already had people contact me to say they're very interested in something like this. So clearly there are people who want to be able to work within the AMHSP and want to see their careers moving forward with this strong connection both with the university and with AHS. A number of individuals, some of them educators and also researchers, have expressed interest," he says.

"But I don't think we'll see a stampede. I think the AMHSP concept appeals to a specific set of individuals. It's not the same as billing on a fee-for-service basis. This is something that may appeal to some based on their career aspirations or perhaps lifestyle issues. We'll soon see how it unfolds."