SUNDRE – A local physician and former president of the Alberta Medical Association says tangible, actionable steps – not more endless discussion, task forces, memorandums and special appointment committee panels – were needed yesterday to address the growing pressures in the province’s health-care system.
In fact, Dr. Michelle Warren, who co-owns Moose & Squirrel Medical Clinic alongside husband Dr. Rob Warren, said action should have been taken after the new agreement was approved in 2022.
“What we needed two years ago when we signed our master agreement, was action. Concrete plans on how are we going to make this work,” said Warren, adding that since then, there’s mostly just been words.
“I’m not seeing any real action on behalf of our government; lots of talk, but not a lot of action to actually recognize the crisis and begin to work to (address) it,” she said, later adding nothing significant has happened since the agreement was reached.
“We’ve had lots of committee meetings and task forces and everything else, but it really hasn’t translated to a change for physicians in the province and so the losses continue,” she said.
“And it’s sad, because I think there’s a lot of potential in the work the AMA and Alberta Health have been doing, but it just doesn’t seem to translate” into action, she said.
Of course much has unfolded since the new agreement was signed that contributed to hampering progress, she said.
Namely the shaky egression from a global pandemic and the internal political turmoil of a dethroned premier who was replaced by a controversial contender that just barely eked out a victory following six long rounds of votes at a tight party leadership race that ultimately lead to a new government under the same banner but with a complete shift in policy that instead of investing into front-line services as well as recruitment and retention efforts, opted to restructure the system during such an already-challenging and stressful situation.
“All of those things throw massive wrenches and delays in the process,” she said.
But action is needed.
“Action means … deadlines that are met, it means new billing structures to (incentivize) physicians to do the hardest job in medicine, which is that of a longitudinal family physician,” she said.
And the longer one delays through endless debate and shuffling around middle management positions to restructure a stressed-out system, the more costly and difficult the program will become to remedy in the long-term, she said.
Alberta-trained rural docs being headhunted
One does not have to develop and cannot be expected to deliver the perfect solution, but one has to try something. Compounding the situation, while Alberta’s government dithers, opportunities to build a more resilient and enduring foundation for future health care slip away. That’s not something our provincial neighbours from B.C., Manitoba, Saskatchewan, and the Maritimes, are blind to, she said.
“They’re all jumping into action to say, ‘Hey, we’ve got a crisis. We need to start working on this,’” she said, adding that through work and meaningful collaboration with their respective medical associations, actions are being taken.
“And it might not be perfect right off the hop, but they’re recognizing that they have to start doing something.”
That includes ramping up recruitment efforts. Warren lamented what she had seen on Jan. 19-21 at the 40th annual Emergency Medicine for Hospitals conference hosted in Banff, an event where many student residents trained in rural family medicine might discover their next career move.
“What struck me this year, was how well attended it was by physician recruiters from other provinces with amazing handouts on how much money and what quality of life you can have in Prince Rupert B.C., Terrace B.C., Prince Edward Island, Saskatchewan, Manitoba, and many others,” she said.
Meanwhile, there in stark contrast was no representation of any kind from Alberta, she said.
“There was crickets,” she said, adding the young physicians-in-making who are completing their training in Alberta were instead introduced to a variety of tempting offers elsewhere.
“And I look at what we do in Alberta, and … we’re not even in the same game anymore,” she said.
Warren spoke with the Albertan on Tuesday, Jan. 23 during a phone interview in response to questions about a statement released earlier that day by the association’s current president, Dr. Paul Parks, who described the situation in Alberta’s health-care system as “dire.”
Many docs on cusp of relocating or retiring early
In his call to action, Parks said 20 per cent of family and rural generalist physicians who were surveyed reported their practices will likely become financially unviable beyond six months, while only 21 per cent felt their finances would sustain up to a year.
And more disconcertingly, nearly two-thirds of those surveyed, 61 per cent, are mulling over plans to either practise elsewhere, 39 per cent, or retire early, 38 per cent.
“We must convince the government of the unprecedented urgency of this situation,” wrote Parks, adding the association submitted a three-phase proposal and that the minister of health has expressed a commitment to consider the document.
And while the federal government has also promised funds for immediate stabilization, he added “immediate appears to be months away” and doesn’t include “the subsequent funds that will be required to fill the gaps until a new Physician Comprehensive Care Model can be implemented.”
Amid Warren’s hectic schedule that divides her time between their clinic, the hospital and its emergency department as well as long-term care and other tasks, she had not yet read the statement in full. But after being provided a summary, she wasn’t surprised to hear so many physicians were ready to either relocate or outright toss in the towel at this point.
“It’s what I’ve seen happen in our community itself. It’s what I’m seeing and hearing happening in communities around us, both rural and urban,” she said.
At Moose & Squirrel, Warren said they changed their funding model early on in the pandemic upon recognizing the clinic was going to lose doctors it would not any time soon be able to replace until there were substantial changes not only with the pandemic itself, but also the actions of the government in 2020 that had driven away many doctors, she said.
“It was going to be an uphill slog trying to get things back,” she said, adding that to survive and continue serving the community, they had to change their approach.
Five physicians who used to work at the clinic have since found new positions in B.C. and Nova Scotia, with one transferring to emergency in Red Deer, she said, adding that when their former colleagues decided to change course in how they were practising, those who remained at the clinic also had to consider options to maintain care for patients in the community.
Digging into their own pockets
“So we made our changes and out of our own pockets, we’ve been paying the salaries of now three physician assistants who are amazing individuals (and) extremely well-trained in providing primary care,” she said.
“They have – I think – saved community care in our town,” she said, adding that not only has the clinic managed not to orphan any patients, but the team has even been able to take on some patients that had been orphaned by the loss of their physicians.
Although it’s a decision that proved costly, Warren did not express any regrets as they felt it was “the right thing to do.”
Unfortunately, as the losses continue to mount, so too does the demand on remaining rural physicians to pick up the slack, she said.
“Our remaining physicians worked to fill the gaps that were left by those who went away, and then we lost two more physicians to Invermere, B.C. after the funding models was decided,” she said, adding she did not know if the funding model played a role in their decision.
Regardless, the clinic lost two more doctors, with a third who has plans to retire before long. And the departure of one doctor generally means as many as 1,000 orphaned patients, which creates a domino effect, she said.
“And so, we’re in a downward spiral locally,” she said, adding the clinic and its patients – for now at least – remain in a decent position.
Sundre hospital suffering
“It’s the hospital that’s suffering,” she said, referring to the temporary emergency department closures over the holidays and the ongoing difficulty finding physicians to fill shifts.
“My concern is the community doesn’t see this,” she said, adding people who have a doctor shouldn’t get too comfortable.
“Those patients who currently have a practice, if this continues, you may not. I think that’s the scary part. There’s lots of patients that don’t have a physician or a primary care provider, but there’s a lot more that are going to lose theirs,” she said.
“I don’t think our community really understands how tenuous things are right now,” she said.
For her part, Warren said they’ve been working with Alberta Health Services to determine if there’s a way to bring her team’s physician assistants, who work exclusively in the clinic, onboard to help out at the hospital.
“But that’s a work in progress … and things don’t move quickly at all,” she said, adding the provincial government and even municipalities across Alberta are not doing enough to attract and recruit medical professionals.
“Nobody is out there saying: ‘We have jobs for you; we want you, we want to keep you,’” she said, adding that sends the wrong message to prospective physicians who are completing their training in Alberta.
Warren said she’s seen what she considers a promising proposal from the association pertaining to primary care that is very similar to the model in B.C. “but with some tweaks that make it more Albertan.”
Premier offers plenty of talk, no action
But she does not know where Premier Danielle Smith stands on the proposal.
“I think a lot of talk, but I’m not hearing or seeing any action. And that’s I think what doctors need to see,” she said, adding that in the past, there’s been a reliance on physicians recruiting and bringing in their own replacements.
“But I can’t compete with what’s going on in B.C., and I can’t compete with Manitoba, or even P.E.I.,” she added.
Asked if the government should be investing more in attraction, recruitment and retention rather than restructuring health-care with a big game of middle management musical chairs, she without missing a beat said, “Absolutely, absolutely. There’s going to be nothing left to restructure.”
Hospitals throughout the province have already been experiencing recurring temporary service disruptions and emergency department closures, she said.
“It’s happening across the province now. And it’s happening so much that it’s almost become accepted,” she said, expressing concerns that the next step will be to start closing down understaffed hospitals or changing their designation.
“The argument won’t be that we want to close them, it’s just we can’t staff them,” she said.
Without a major and immediate course correction – not empty platitudes or vague promises of the possibility of some undefined action months down the line – the situation will only continue to deteriorate, she said.
No immediate plan to retire, but life uncertain
Asked if she was among the 61 per cent surveyed who are considering plans to relocate or retire, she said it would certainly be a lot easier, especially with job offers regularly popping up by text or email.
But having raised a family and established such deep roots in the community over 25 years – 10 of which have been through the clinic – Warren said such a move would “break my heart.”
Yet she also recognized that she’s not getting younger and that retirement – while still a relatively distant light at the end of the tunnel – is taking greater precedence in her plans for the future.
But before giving so much as a second thought to hanging up her stethoscope, Warren said she first wants to have a transition plan in place for the team “so that I know that when it’s my time to step back – and it will happen – that I’m leaving things in good hands.”
However, even the best-laid plans can be met with unforeseen circumstances that change everything.
“In my business, I have learned you have no idea what’s waiting around the corner for you,” she said, adding life can throw curveballs and even doctors get sick, or perhaps find more appealing opportunities somewhere else.
“We look at where our physicians are going, we look at the growth in physicians doing this type of work in B.C., and that tells me they got it right,” she said.
But it again comes down to taking action. In the emergency department, doctors don’t have the luxury of taking their time pondering every possibility of what to do when a patient is hanging onto their life by a thread.
“If I sat in the emergency room needing the perfect answer doing multiple tests before I was able to start working, patients would die,” she said.
“So, you have to actually start, and the hardest part I think in anything, is making a decision and actioning something. And I think for our politicians, it’s probably the same way. It’s much easier to sit and talk and debate, but I think it’s a lot harder to say, ‘You know what, we just have to do this.’”
Additionally, politicians tend to have selective hearing, she said.
“I do think politicians don’t listen to me; they don’t listen to our association. I think they assume we’re just out there fear-mongering, is a good word. But if they look at the reality, they look at the numbers, they do listen to patients,” she said.
“And what I would say to those patients who have found a medical home, or still have their medical home, don’t assume that you’re going to have it forever, because that’s a false assumption to make,” she said.
Lines in the sand
“Can I be pushed out? Absolutely. I could be. I have my lines in the sand that would make me say ‘No. It’s time for me to go,’” said Warren, adding both she and Rob also have aging parents in Alberta that they’re trying to navigate the health-care system with.
“So we’re experiencing it on the other end. And I don’t have a family physician, because my family physicians have all left,” she said, adding her children don’t have a family physician either.
“I too am an Albertan without a family physician. We might be physicians, but we’re also patients,” she said.
Asked where her line in the sand is, she said, “I think for us – just like anybody – it’ll come down to our personal health, it’ll come down to our children and our parents.”
With the days of finding physicians who are willing to commit a lifetime of service to a community mostly gone, Warren said it’ll be a matter of having to find some who are prepared to spend at least a few years.
“I don’t expect anyone’s going to live here 25 years; I think it’s very rare nowadays,” she said.
That only amplifies the importance of “constantly mentoring (and) continuing that reputation that we have as a training site” with an amazing hospital and great support teams, she said.
Appeal to community
Warren laughed when asked about the premier’s promise to fix health care in 90 days. Recalling a time when her children were young, she would tell them she’d be home in 10 minutes only to arrive an hour and a half later.
“In our family, there’s a thing called doctor minutes; there’s the time that everybody else uses, and then there’s doctor minutes,” she said. “And I think those 90 days were doctor minutes. Even worse than that – they’re politician minutes!”
Levity aside, she said, “for every day that nothing happens, it’s going to take even longer to begin to fix.”
“I don’t want for me – and for my kids – to see Alberta hit rock bottom and implode. Because it’s going to take even longer to pick up the pieces and try to recover again,” she said.
So she appealed to patients in the community, regardless of who their physician is or whether they even have on, to talk to their MLA.
“Let them know that you want to have health care in your community … and that you don’t want to see your Alberta physicians that you’ve helped train going elsewhere,” she said.
