‘Nothing has improved’: Physicians see no impact from Alberta’s Healthcare Action Plan

During a late-February press conference, Alberta Premier Danielle Smith said the province’s healthcare system is “not in crisis.” To her right were seated Minister of Health Jason Copping and Dr. John Cowell, the official administrator of Alberta Health Services (AHS). Smith had appointed Cowell about three months prior, after firing the entire AHS board, to oversee AHS’ then-newly-launched Healthcare Action Plan. The media event coincided with the release of AHS’ 90-Day Report, which touts the progress that’s been made since Cowell’s appointment, from November 2022 to January 2023, in the four key areas of AHS’ plan: emergency medical services (EMS) response times; emergency room wait times; surgical wait times; and “patient flow throughout the healthcare continuum,” which the report defined as “the flow of patients from the emergency department into acute care, and from acute care back into appropriate care in the community.” Read: Alberta premier commits to medicare; NDP points to past musings on private options AHS cites metrics like shorter EMS response times (17 minutes in metro areas, down from 21.8 minutes); a 10% reduction in emergency department wait times, to 6.4 hours; the opening of 55 new long-term care beds; and about 800 fewer Albertans on surgical waitlists. (These measures are based on the 90th percentile, meaning they account for 90% of all activity.) According to two physicians who serve on the executive teams of physician advocacy groups, these priorities have not resulted in alleviated pressures either in their own practices or in the province’s healthcare system more broadly. “I would say no, immediately, nothing has improved,” said Dr. Rithesh Ram, a family physician and rural generalist based in Drumheller, in an interview with the Medical Post. He is also the president-elect of the AMA’s Section of Rural Medicine, the director of the University of Calgary Longitudinal Integrated Clerkship program, and the representative for Alberta at the Society of Rural Physicians of Canada. Read: Alberta announces funding slated to expand healthcare workers education “I haven’t seen any improvements in the grassroots, like in the patient-to-patient scenarios when they’re in the hospital. I haven’t seen any improvements with regards to patient transport for EMS, when we have to send them for things. I haven’t seen any improvements with regards to patients getting any kind of, say, CT scan in our facility when we do have the facility but yet we transport people out to get them,” he said. “There’s still very much a crisis as far as the help that’s being provided in rural communities, and that hasn’t changed at all.” Dr. Ram’s observations were echoed by Dr. Fredrykka Rinaldi, president of the Alberta Medical Association (AMA) and a family doctor based in Medicine Hat. “Members are seeing unchanged pressures in the ER and ER closures continue at various rural sites. In my own practice, I have noticed no change in the lengthy wait to see a specialist and many Albertans are still unable to find a family physician,” Dr. Rinaldi wrote in one of her public letters, published on the AMA website, in early March. What's the disconnect between AHS and primary care providers? In an interview with the Medical Post, Dr. Rinaldi said the four priorities outlined in AHS’ 90-Day Report, which mostly pertain to emergency and hospital services, are not wrong in and of themselves. “You certainly are not advantaging any patient’s health by having ER overcrowding and lack of resources to see people in a timely matter,” she said. The problem, however, is the lack of alternatives to going to the ER. “What you need to do is to reduce the number of people coming to the ER, who do not need to be there, but are there because they don’t know where else to go,” Dr. Rinaldi said. She noted that she’s spoken to Dr. Cowell, AHS’ official administrator, about decreasing the ingress into emergency rooms and supporting the capacity of family and community practices. “I said to him, physicians are burnt out. So you tell me what you’re doing to resource this, because Alberta Health Services always seems to be on the, ‘We’re hiring X number of new people.’ But, you know, we haven’t ever seen any increase to community resources.” She added that it’s nearly impossible to patients without one to find a family doctor in Alberta today. The number of family doctors accepting new patients in Alberta declined by half from May 2020 to January 2022, as reported by the CBC. Between May 2022 and mid-January of this year, the number of doctors accepting patients went from 390 to 250, according to an article published on the province’s online portal for finding a doctor. Part of the problem is that there is a huge disconnect between the province and primary care providers, according to Dr. Ram. “Alberta Health actually doesn’t have any real knowledge or idea of what happens as far as the primary care setting, whether that’s in the city, or whether that’s rural, they don’t really have any knowledge of what communities need,” he said. That disconnect, Dr. Ram explained, is because primary care is by and large not within the scope of AHS. “The report is based on Alberta Health Services, which takes care of everything that really isn’t primary care. So everything that essentially we would call it tertiary care, or in the hospitals or maybe some outpatient-focused clinics,” he said. “There might be nuance, there might be a clinic here and there attached to Alberta Health Services. But in general, greater than 95% of what we consider primary care or family medicine is not Alberta Health Services related.” This neglect of primary healthcare, decade over decade, is why the system is under strain, Dr. Ram said. “The reason that things are usually at a crisis mode or as bad in the hospital, is because for the most part, we allowed patients to actually get to the hospital. When we focus on primary care, we focus on preventative medicine, focus on good health, we will prevent a lot of people from ever getting to that stage where they need to have that urgent care,” Dr. Ram said. “The problem is, primary care only receives less than 10% of what the budget is. So if over 90% has been focused on hospital acute care plus ancillary services, and less than 10% is focused on this preventative care, what would you expect to happen? We expect the delayed surgeries, we expect the high ER times, we expect all the things that they’re trying to fix, we expect the delay in EMS, because we’ve allowed patients to not have the ability to have primary preventative care.” Addressing the physician shortage In its report, AHS lists “building the workforce” as one of its other priorities. It notes that in 2022 they added 800 registered nurses, licensed practical nurses, and healthcare aides and since 2019, it’s added 5,800 front-line staff including 1,800 registered nurses and 300 paramedics. It also says it recruited 28 physicians to rural Alberta between November 2022 and January 2023. Those numbers are “a bit of a misdirection,” according to Dr. Ram. “When they say they managed to hire physicians to communities, it’s not necessarily they hired them; they allowed them to practice in their hospitals. And it doesn’t mean that that is the number of physicians that were needed in those communities. That was the number that Alberta Health Services allowed them to have,” he explained. There needs to be a more streamlined recruitment process with less red tape, and less of that disconnect between AHS and community healthcare providers, according to Dr. Ram. “Let’s say a community in rural Alberta, they know they need three or four new physicians, because one or two of the old ones are retiring. Now, they can go out and they can recruit three or four physicians on their own. But in order for those physicians to do that full scope of practice (as a rural generalist), Alberta Health has to say, ‘Yep, that is okay, you can have privileges in the hospital,’” he explained. “The community knows it needs three or four, let’s say four doctors. Alberta Health, because they have zero understanding of what the community needs . . . they’ll say, ‘Oh, you only have one doctor retiring, therefore you only need one.’ Versus the community saying, ‘No, actually, family physicians are overrun, there’s no way to see anyone in the community clinics, we need four.” International medical graduates have to apply through AHS to have privileges in AHS hospitals, explained Dr. Ram. And those privileges are crucial to working as a rural generalist in Alberta. International medical graduates make up 34% of all Alberta physicians and 70% of the medical workforce in rural areas, according to the AHS report. “It’s Alberta Health Services that will allow them to do all of their assessments to be able to be in their hospital, but then that physician still has to figure out and actually see if they fit in the community themselves,” Dr. Ram said. “So it’s very disconnected. It’s really not a good process.” According to Dr. Rinaldi, to ensure there are enough doctors working in the province, physicians and their teams need to be better compensated and given more capacity. “We have a human health and resources crisis. . . . It doesn’t matter what other resources you have, if you don’t have anybody to administer them, or monitor or deliver them, it really doesn’t solve the problem,” she said. “I think they [the province] have to provide a stable environment with reasonable remuneration and capacity for physicians to practise to their maximum. So in communities eventually that will probably look something like an expanded team-type approach, but that’s not going to happen overnight.”

‘Nothing has improved’: Physicians see no impact from Alberta’s Healthcare Action Plan

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