Emergency departments (ED) in Alberta were forced to close for more than 38,000 hours, or about 4.3 years, in 2023.
Disruptions ranged from a few hours without a physician to communities losing ER services for months on end. Of the 26 emergency departments that shut their doors in 2023, more than half had closures lasting 20 days or longer.
In almost all cases, these service disruptions were caused by staffing shortages, and the communities left without access to emergency care were in rural Alberta.
This data comes from biweekly hospital service disruption updates published by AHS, which were collected, analyzed, and mapped by Great West Media.
Compiling and quantifying the extent of emergency care disruptions shows it is more than a random event, said Dr. Warren Thirsk, president of the emergency medicine section of the Alberta Medical Association and a practicing emergency physician.
“It is evidence of the resource gap between what Albertans need from an emergency health care system and what is being provided,” Thirsk said.
“I think that is important to understand that there have been cuts throughout the healthcare system – in terms of personnel, in terms of training of personnel, in terms of facilities and infrastructure building – that have been going on for a long time.”
As the cuts go deeper, and the gap between the population and available resources widens, emergency rooms close as a last resort, Thirsk said. “Then it just becomes more obvious that the system is not doing well. And it's not funded adequately or resourced adequately to meet the needs of Albertans.”
Total length of emergency department disruptions in 2023
David Shepard, Alberta NDP rural health critic, said its troubling how access to care in rural parts of the province has been impacted, and it is “a direct result of a lot of decisions that were made by the UCP government, going back to the war on doctors in 2020.”
Since then, Alberta has lost not only clinic staff but those providing training as well, Shepard said, creating deficits in the professionals needed to keep EDs open.
"People should be able to expect that their emergency department is going to be there when they need. It should not be running like a fast-food restaurant where it closes in the evening," he said.
Cost borne by rural Albertans
People in rural Alberta are often far more likely to turn to the emergency department for care, and the temporary loss of these care centres is a sign of deeper problems in the healthcare system. Communities like Lac La Biche, Consort, Boyle, and Swan Hills all of went several weeks, or even months, without an ER last year. The local populations also have emergency visit rates for semi-urgent or non-urgent problems between 2.8 and 6.5 times the provincial average, according to government of Alberta data released in 2022.
“There are people who rely on that emergency department for every other gap in the healthcare system,” Thirsk said. If their family doctor or specialist is unavailable, the ER is often the only alternative.
“I think that is a cost borne more by the rural communities in terms of time. Because it'll take them a lot longer to get to the next care facility that might be open.”
Researchers from the University of Alberta’s Faculty of Rehabilitation Medicine have estimated that rural patients pay an extra $450 out of pocket every time they have to travel to Edmonton to see a specialist.
Taking a patient out of their community also removes them from their support network and puts additional pressure on already strained hospitals in larger centres, said Mike Parker, president of the Health Sciences Association of Alberta.
During COVID when hospitals in Calgary and Edmonton were overrun, they were overrun with Albertans, not just Calgarians are Edmontonians, Parker said, because the high-level resources and intensive care required didn’t exist anywhere else.
“It all started right back where there was no community care in the areas that needed it most, that are hours and hours away,” he said.
Every year, Parker said he sees a loss of frontline professionals. The cheapest fix would be to take care of what staff are already hired, that are “the experts in the system.”
“COVID devastated our health care system to the point where people cannot come back to work anymore. And the response from government is that we're going to reduce hours, we're going to reduce people, and we're going to privatize services.”
Promises to recruit – promises to cut
“Work is currently underway to attract more doctors to rural communities, this includes increasing the number of physicians educated and trained in the province, strengthening programs to attract and retain physicians, conducting targeted recruitment campaigns, streamlining registration processes for international medical graduates to work in Alberta,” Alberta’s Ministry of Health said in a statement.
The province is also establishing regional training centres for physicians in Lethbridge and Grande Prairie, which will serve as hubs for the surrounding communities, the statement said.
“Once developed, the training centres will include interprofessional teaching clinics and the ability for medical students to complete most of their medical education outside the metropolitan regions.”
Thirsk said that healthcare professionals are highly skilled and the time-frame to train and subspecialize new workers is measured in years. “And we make decisions, and budget cuts are made, on a very short-term basis. And that's where the gap is happening. It's happening to our nursing colleagues right now.”
A recent AHS memo, obtained by the United Nurses of Alberta, asks management to cut nurse overtime by 10 per cent and reduce the use of private agency relief staff. A move the union has said could put additional strains on remaining workers and worsen patient care.
Shepard said it is almost a universal truth that if you train people in a rural area, they are far more likely to return to work in a rural area. But the rural physician recruitment incentives and new training programs “mean nothing in an in an environment and in a province where healthcare professionals know they cannot trust their government.”
What the data doesn't show
The AHS data used to map ED closures gives some indication of the healthcare crisis in Alberta. Missing from these statistics, however, is the dire situation faced by staff and patients in the EDs that have stayed open.
Alberta Medical Association president Paul Parks has said EDs are critically overcrowded, with patient wait times hitting record lengths this winter.
Last year, 190 Calgary doctors signed an open letter calling for the government to respond to "collapsing" emergency departments, which they blamed on a combination of pandemic aftermath and government policy that destabilized primary care and caused critical labour shortages.
"It is now common to have 40 to 50 people waiting to be seen by a doctor at any given time in any of our emergency waiting rooms. Frail, elderly patients languish on stretchers in hospital hallways. Patients with mental health crises are housed in the emergency room, often for several days, while awaiting inpatient beds," the letter reads.
Hidden behind the number of hours each department was closed is also a personal cost that data can't capture, Thirsk said.
“It's the cost borne by every patient who's suffering in a waiting room anywhere or driving another two hours in pain down the road.
“I challenge you to go into any emergency department in any facility or find any Albertan waiting for any aspect of healthcare. And to actually ask them how much they're suffering as they wait.
“That's where the real cost is. Because it's not really dollars. It's humans and human suffering that we're missing.”
