Alberta Health Minister Tyler Shandro is wading into deep water with his current confrontation with the province's general practitioners over pay.

Armed with volumes of graphs and figures showing the province's doctors are overpaid, Shandro is proposing a fairly major overhaul of physician compensation.  A first attempt at voluntary mediation on a new deal between the AMA and the government ended with no joy and the AMA president already mentioning "legal options".

Doctors on the front line are fighting back too, and they're mobilizing patients and public sentiment to undercut the province's assertion that Alberta's doctors are paid too much.

Patients are faced with pleas in doctors offices to sign petitions.  Articulate doctors are popping up on open line radio shows and all over social media making their case.

The assumption on which the government's case rests is that Alberta doctors are paid more than doctors in other provinces.  The AMA does not agree, either in terms of how much general practitioners make or on whether it is more than in other provinces.

The government argues Alberta doctors make $90,000 more than docs in Ontario.

The AMA pleads the bigger picture: "The amount that Alberta spends on its physicians (just under 23 per cent of total health care budget) is consistent with what other provinces spend on physicians."

The province is proposing a detailed plan for wrestling down the doctors' compensation.  On fee-for-service billing, they want to pare back the complex modifier, which pays doctors more for dealing with patients who require more time in their GP's office.

Under the new plan doctors would have to spend 25 minutes with a patient before billing for extra time.  They now can start that extra billing at 15 minutes.

Health care advocates argue that could prompt doctors to avoid complex patients, such as seniors and those with chronic conditions.

Another proposal eliminates clinical stipends, a bump up for on-call physicians which is particularly used in rural areas.

Implementation of a couple of the government cost cutting provisions, which actually seemed a bit mean spirited, have already been delayed  â€” a requirement for seniors over 74.5 years of age to pay for their drivers licence physical exam and denial of payments to doctors who don't ensure the patients they are seeing are covered by the provincial health care insurance plan.

Shandro's favoured position on restructuring compensation involves changing the actual payment method.  Alberta has a large percentage of doctors using fee for service compensation, being paid for each medical service they perform, which Shandro argues is paperwork heavy and makes budgeting tough for the government.

He wants to up the percentage of physicians on various alternate payment arrangements, such as hourly or annual salaries, fixed per-patient payments or a hybrid of per patients and fee for service.

While some of what he suggests may have merit, the government is outclassed in terms of having an appealing message.  The doctors are far better at bringing it down to the grassroots.

An official government Twitter feed tweets out about basic pay for doctors being "a base rate of $38.03 (plus $2.95 from the Business Cost Program) for a total of $40.98.  This is the highest rate across main comparator provinces."

The replies, many from doctors, point out that dentists base rates are much higher, that an auto lube job costs way more.  One points out that two of the "comparator provinces" cited are having difficulties with doctor shortages.

AMA President Christine Molnar has shown a flair for drama as well.

"It will be physicians who will be up in the middle of the night at 2 a.m. trying to save someone like when the (novel) Coronavirus comes," she told reporters after the latest negotiations broke down.

"It will be us risking our lives on the front lines for any of those things.  That's what we signed up for and we're willing to do it but I think that requires a certain level of valuing and respect and acknowledgment.  I would like to see the relationship reflect those values."

The way doctors are paid in Alberta is probably overdue for an overhaul.  But the government has approached the doctors with a very detailed playbook with little consultation, a pattern that has become the hallmark of provincial budget cuts.

Despite a bit of sabre rattling on both sides, there will be more time spent at negotiation tables on these issues.  But general practitioners and their close relationship with their patients shouldn't be underestimated by the government.