Transforming primary care

If you would like to read a transcript of the above podcast episode, click here: Podcast transcript

Telling Alberta’s story

Our world is in flux with emerging new societal constructs and exploding technology. Our profession too, is emerging from the shadows of old professionalism, where autonomy without accountability was the norm and the fax machine a trusted standby. 

Our province has been evolving primary care over the last decade or so. The Alberta Medical Association and Alberta’s family physician leaders have been at the forefront, leading the charge to create a better health care system through this transformation.

Over the last 12 years we have made remarkable progress, evolving from localized insular practices to organized and scalable drivers of change across the province. These coordinated and sustained improvements in primary care have created recognition that Alberta is a national leader in primary care transformation.

Specifically, the AMA is staking its leadership as a beacon of hope in Canada by challenging the status quo. As physicians, we are custodians of the health of our citizens, but we are also custodians of tax dollars. Health spending comprises approximately 47% of government operational expenses. Physician have a great deal of oversight over much of this spending by providing direct patient care, providing prescriptions, overseeing hospital admissions and stays, and other activities. With increasing demand and rising costs, there is overwhelming evidence that the best health care systems in the world, those that are of high quality, are truly integrated and have managed to bend the cost curve down. They are systems with robust resourcing and change management invested in primary health care reform. 

The backbone of this transformation is the family physician. Family physicians in Alberta have overwhelmingly embraced a new paradigm of practice called the patient’s medical home (PMH), where team-based care and accountability are the cornerstones. The genesis of the PMH was the formation of grassroots non-profit networks of family physicians, primary care networks, our own Alberta-made solution. 

Harnessing this impressive motherlode of human capital by integrating with zonal and provincial levels of health care delivery is essential to effect the system change we know is possible. Again, family physicians overwhelmingly voted to give PCN leadership the mandate to ratify a zonal and provincial framework 18 months ago. This provides governance, leadership, strategic direction and priorities for PCNs. The voter turnout for the governance framework vote was the highest in any recent AMA vote. Even more impressive is the fact that this vote was not about money. It was about system change and protecting the future of everyone’s children (not just our own) and our bottom line.

Winning the hearts and minds of our physician colleagues in order to have them embrace a bold – and sometimes uncertain – future was likely the most difficult task we faced. This kind of reform has not been done on this scale anywhere else in the world and we couldn’t be prouder of our province and our profession. 

Our leadership was invited to Vancouver last April to share the story of primary care transformation in Alberta with the BC General Practice Services Committee (GPSC) at their annual summit. I was honored to deliver the keynote address, providing what I hope were critical insights into our journey, the lessons learned, the leadership requirements and details about implementing PMHs and PCNs at the local, regional, and provincial levels. Dr. Brad Bahler and AMA staff rounded out our team. We have also been to Ontario, Manitoba and Saskatchewan on similar missions. These provinces have elements of what we have in Alberta, but what makes us unique and a leader is that we have most of the pieces in place and have striven for equity in service provision to our citizens, unlike Ontario, where more than 50% of patients have no access. There is a wind of reform blowing across our nation, which germinated as grassroots in primary care, supported by evidence, academia, professional associations and governments – regardless of political stripes. It is a wind that we will never let die down.

Primary care is the bedrock of a cost-effective health care system transformation and an investment here will pay off by transforming the entire system. We as family physician specialists thank our other specialist colleagues who have been partners on our journey and invite everyone to come on board. Moving forward as one, with mutual respect, values and equitable accountability on all fronts, we will expedite this inevitable journey and make it less painful. We should embrace change and not wait for “perfect” before moving forward. Remember, we won’t get if we don’t ask, so be bold and be cheeky! You just never know what can happen. 

If you’d like to learn more about Alberta’s primary care transformation journey, visit the Patient’s Medical Home page on the AMA’s Toward Optimized Practice website.