The Alberta Medical Association is reflecting on the journey the province's doctors have been on for the last three years. It was a path of uncertainty: financial issues, burnout, pandemic, working without an agreement. There were additional obstacles and challenges: the increasing numbers of patients requiring complex care, new cost pressures and limited access to longitudinal care.
Now in the first year of a new agreement, and with the commitment to support and advocate for members, the AMA continues to listen to its membership.
The AMA has had a tradition of measuring specific strategic expectations and experiences and regularly surveying members using opinion tracking surveys. The trackers have allowed the AMA to observe the profession for over 20 years. In January 2023, the AMA commissioned a revamp of the survey, and a new version was launched. Member experiences will be benchmarked bi-annually to capture collective expectations and assess progress.
On January 11, 2023, approximately 14,000 members received the new survey through an email invitation that contained a link to the TWI Surveys questionnaire. As AMA’s third-party survey provider, TWI Surveys stores the survey and the corresponding data securely on their server to ensure confidentiality and anonymity of the respondents. The survey closed on January 27, 2023.
Responses were voluntarily submitted by 1,313 members, a response rate of 13%. The data is valid 19 times out of 20 within a margin of error of +/- 2.53%. This is a typical response rate for this kind of survey and provides valid and reliable opinions of members.
Survey conclusions
In 2019, physician surveys indicated that the Alberta health system was starting to change and improve. For example, more collaborative care models emerged and new technology-based methods improved access to care. Seventy-one percent of physician respondents agreed that the AMA was able to effectively support a patient-first vision.
In January 2023, however, results from the tracker survey showed members in a more pessimistic place. Only 46% of physician respondents agreed with the AMA's ability to support a patient-first vision this time. Most did not believe the compensation model aligned with patient needs. Respondents also did not believe they have financial security or the funding to support increasing costs. Most disagreed that stress related to managing their practice was acceptable.
Responses to a few questions also indicated that current declining opinion levels may have bottomed out similar to June 2022 levels. More physicians reported that they are able to maintain quality care, that the system can maintain quality care, that they have confidence in the overall management of the system and that their issues when dealing with patients are understood. While each of these indicators has improved compared to the results of past surveys, they are far from positive progress indicators. Each measure still has most members disagreeing with these statements.
Generally, most members felt they were well informed about the activities and news from the AMA. However, these same members were also less likely to feel well informed about the news and initiatives within the Alberta health care system. A large majority of members feel that neither Alberta Health nor Alberta Health Services understood their issues as physicians caring for patients.
Members were unsure if the AMA is effectively building and managing the partnership with Alberta Health and Alberta Health Services, with 40% of member participants selecting “neutral” as a response. Comments suggest this may be due to a belief that these parties were not interested in collaborating with physicians.
What follows are a few benchmarks to point to how much work needs to be done.
- When asked to compare the current health system to the one in last few years, 41.5% of physician respondents felt it was getting much worse.
- When asked to rank the statement “I am valued as a physician within the Alberta health care system,” only 20% of respondents agreed.
- When asked to rank the statement, “I can influence decisions that impact how I provide care,” only 16% of respondents agreed.
Looking ahead
The latest tracker survey results showed some hard facts to confront. The foundations for leadership, like trust in people and information sharing, must be present for improvement. Underlying engagement measures of being valued, optimism for the future, and the ability to choose how one does their work still need to be felt by most members. Absent was a request for a compelling vision, which may indicate a loss of optimism. Members were clear about the difficulties with current clinical practice delivery.
Despite what seems a stark landscape, some building blocks are in place to facilitate progress. The AMA is still seen as understanding its members well, and the association has been able to keep members informed of their activities. With the AMA’s unique position in the health system, they can authentically advocate for improvements and share progress.
For physicians to feel a sense of agency in the health systems and in their work, a framework for resolving issues needs to be established and understood. Members will benefit from seeing evidence that their situation can improve. Patients will benefit from knowing their essential care providers are also being cared for and valued.