​February 25th 2020
 
To my valued patients and every other Albertan resident who needs healthcare,
 
February 20th I read on social media the government dissolved the master agreement they had with the physicians of Alberta. They announced huge cuts to physician payments, especially in primary care. These cuts will have dramatic consequences for every patient in Alberta. I wrote this letter from my heart and explain why I am so concerned and feel deeply hurt. I’ll give some background first.
 
How are doctors paid and where does the money go to?
The government pays doctors on a fee for service basis. The money is pre-expense and pre-tax business income, not a salary. This money pays for the overhead, which is for most physicians around 30-40% and pays for rental, our staff, office and medical supplies. It also pays for annual dues for regulatory bodies, certifications, bookkeeping, continuing medical education and malpractice insurance. It pays for 10 years of university training. Like any other small business owner physicians needs to budget for their own insurance, health expenses, time off, vacation time and retirement savings. It pays for the time I cannot bill for. This includes the management of the clinic and my business, my paperwork and lab reviews during after office hours. It allows me to allot time for activities in the community to educate and promote health.
 
I feel deeply hurt and nauseated by the government’s new compensation plan, why?
In October 2019 the government implemented Bill 21, which gave them the power to dissolve the current agreement with doctors. It gave them and give authority to unilaterally dictate physician compensation. November 29th we received an email from the Alberta Medical Association the government came forward with proposals to adjust the agreement. The AMA had 3 weeks to reply. Meanwhile Minister Shandro and several government health agencies began a social media campaign to ‘inform’ the public with misleading and suggestive information. A lot of finger pointing was done and doctors were not presented in a very positive way. January 31st mediation was agreed upon by government and the AMA. The government stated ‘the AMA refused to present alternatives’, which is not the case. Mid February mediation was declared a failure. Again there were a lot of posts on Twitter, sometimes up to 20 a day from Minister Shandro! Not sure where he found the time to spend on social media, or who he paid from taxpayers money to do this. February 20th I (as well as the president of the AMA and all doctors) had to read on social media that the government ripped up the existing contract and announced their initial proposals would go into effect April 1st, without being able to give all details. Imagine how that would feel if that happened to you! The order of events does not show any ‘good faith’ and ‘willingness to work together’ that the government talks about. President Kenny talked about ‘we honour and respect physicians’, ‘our great doctors’. These actions showed the opposite however. And I could give more examples of actions that showed enormous disrespect.
 
I fear for your healthcare, why?
The biggest impact will come from the elimination of the complex time modifier, which allows us to bill extra if 15 min or more are spent. This fee in the future is only going to be billable after 25 min or more. So every time you go to your doctor and say “I have got a few things for you’, or ‘I brought my list” ( and I am sure you will because I hear that all the time!) I will have to reply with “Sorry, I have got 7 min to listen to your story, do an exam, make a diagnosis, explain it to you and agree on a plan how we are going to manage your issue, 3 min to do charting, review your chart and write your referral, so please book other appointments to address your other concerns’. Currently the most commonly positive feedback we get is “Thank you for listening to me, being thorough and taking the time for me”. The most common reason for people to be dissatisfied is if they feel brushed off. I don’t want to practice 10 min medicine, but it is what I have to do to keep the doors of our clinic open. ER wait times will go up and more referrals will be done, because we don’t have time in our clinics anymore to address issues properly. And you will receive that same kind of care wherever you go. The government pushes for privatization, which could be lovely I am sure if you can afford it. But lots of people cannot and I fear for those patients. I fear for good quality publicly funded healthcare, accessible for every Albertan.
 
I fear for the future of Care in the Creek Medical Centre, why?
Time has proven it has been challenging to get doctors to come to Bragg Creek and to keep them. A lot of people invested their time and money to get a clinic here. We are putting a lot of effort in recruiting locums or getting somebody interested to join our clinic for the longterm. Dr Cunning and myself have been as flexible as possible by working extra, in evenings and weekends as well, to provide a medical home to our local residents. Our staff works hard to keep our preventative care standards high. With these changes it will even be harder to recruit a new doctor. Dr Cunning and I cannot do more than we have done for years already. With just the 2 of us the clinic will not be sustainable. These changes were a slap in our face and incredibly discouraging.
 
I fear for all clinics in Alberta, why?
All family doctors and specialists are facing the same challenges. There will be clinics closing, there will be doctors leaving. Rural locations will lose services because doctors will leave. Waiting times will get longer, more ER visits will lead to higher healthcare expenses. Young doctors will be forced to work in certain locations to be able to start practising in Alberta. But not everybody is made for that kind of work and they will choose to work in other provinces. The government argues this is fear mongering. I don’t think so. It is what I hear from my colleagues.
 
I fear for myself and my family, why?
A revenue loss of 30-35% will hit me hard. Business expenses will continue to go up as they do everywhere. So it translates to a 45-50% reduction in my income. That is not sustainable. Things will need to change drastically in my private and business life. I will have to practice in a way I don’t agree with to be able to keep the clinic open. My family and I have to make big personal sacrifices.
So yes, I am upset, shocked and furious. I cry for the losses so many people will feel. The attitude and lack of ethics the government has shown makes me very worried about the future.
 
What can you do?
Please stand with your doctors and let the government know this is not acceptable. Please contact our MLA Miranda Rosin, phone 403 949 5090 or 403 609 4509, email [email protected]. Please contact Health Minister Tyler Shandro, phone 780 427 3665, email [email protected]. Or Premier Jason Kenney, phone 780 427 2251, email [email protected].
Thank you for your support.
Dr. Annelies Noordman

Care in the Creek will be closed for Family Day Monday Feb 17th, 2020.
Enjoy the lovely day with family & friends :)
​We will reopen on Tuesday Feb 18th. 

To register for any of the workshops listed below, go to:
community.hmhc.ca/sessions/

Taming Anxiety Gremlins
​Feb 20, 2020 @ 6:30 PM - 8:30 PM
Bishop Pinkham School
​Anxiety is at epidemic levels among children and teens. This workshop will promote parent and teachers' understanding of anxiety and teach them how traditional ways of offering help may unwittingly feed into the child's worries and associated behaviours. Participants will learn effective tools to help children manage their anxiety to promote their resilience and overall well-being.

Teen Mental Health: Depression
Feb 24, 2020 @ 6:30 PM - 8:00 PM
Dr. E. P. Scarlett High School
Adolescent Depression will present parents/caregivers with an overview and trajectory of depressive symptoms, guidance in helping teens identify and manage them, and resources and interventions designed to have a mitigating effect.

Taming Anxiety Gremlins
March 5, 2020 @ 6:30 PM - 8:30 PM
Marion Carson School
Anxiety is at epidemic levels among children and teens. This workshop will promote parent and teachers' understanding of anxiety and teach them how traditional ways of offering help may unwittingly feed into the child's worries and associated behaviours. Participants will learn effective tools to help children manage their anxiety to promote their resilience and overall well-being.

Teen Mental Health: Anxiety & depression
March 9, 2020 @ 7:00 PM - 9:00 PM
Western Canada High School 
TBA

ADHD & Executive Functioning *also available via webinar*
March 10, 2020 @ 6:30 PM - 8:30 PM
East Lake School
This session will be an overview of ADHD and how issues with impulsivity and/or inattention impact children's ability to manage their environments. The session will also explore the impact ADHD has on Executive Functioning and how it relates to managing everyday tasks, and meeting daily expectations at home and at school, including social, emotional, behavioural and academic demands.