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Tag: Alberta health care

Torsos of three medical staff with crossed arms. One in a white coat and two in blue scrubs.

Alberta’s health-care future front and centre at engagement sessions

The Alberta government is looking at changing the province’s health care, a system many describe as broken.

A series of in-person engagements began last week, hearing from health-care providers and community members on what the government called some of the challenges Albertans are facing.

Two of those gatherings were held Jan. 24 in Crowsnest Pass and Pincher Creek. Unlike a packed town hall meeting in August 2023 at Pincher Creek Community Hall, last week’s sessions can be best described as roundtable discussions.

“I think any time that there’s change there’s an opportunity, and with opportunity a chance for folks to participate, to contribute,” said Sarah Murrant, speaking on behalf of the province.

“What I understand, and why we’re running this entire process, is not every answer is there.”

Discussion during the two-hour event centred around topics including experiences and outcomes, but also on a proposed unified health-care system the current government says will enhance local decision-making and lead to early detection and intervention. Just what that might look like is yet to be determined.

Chelsae Petrovic, MLA for Livingstone-Macleod, feels any conversation must include patient care outside of the larger centres.

“It’s extremely important that we look at rural health. That we start to see the unique challenges and some of the unique solutions that, maybe, can be brought forward,” she said.

 

Table setting of wedding venue — the Cowley Lions Campground Stockade near Pincher Creek in southwestern Alberta.

 

A former nurse with 13 years in the field, Petrovic knows all too well about the challenges.

“I think it’s great to meet with front-liners, coming from that experience and understanding where they’re coming from. Being able to, I guess, sympathize,” she said. “And it was only seven months ago that I was in those same positions, so I really do understand.”

Some health-care providers at the Pincher Creek event, who didn’t wish to go on record, felt the agenda items lacked details and “weren’t sure what they were signing up for” in any future plan.

Dr. Gavin Parker, a local physician, agreed engagement is important, however.

“I think we have a system that has long failed Albertans, in particular the lack of investment in primary care and rural services. But if these conversations lead towards improving that, then it was time well spent,” he said.

One of the talking points zeroed in on Alberta’s burgeoning population and the added stress it’s putting on the health-care system.

Parker acknowledged there’s more at play.

“I think what you’ve seen in the last few years is not only an exodus of family physicians in the province or people going into early retirement, but also changing the scope of their practice.”

 

 

He said the end result is less focus on primary comprehensive care and more doctors working toward a niche practice.

“Until we train, pay and support rural family physicians better, the situation won’t change,” he said. “The problem is we’re running into a dearth of physicians who are trained as rural comprehensive physicians, and when they are trained they aren’t compensated adequately.”

Parker also noted a drop in specialty practices, like maternity, declining to less than 50 per cent in the south zone compared to when he started his training.

“So, these young doctors that want to provide comprehensive rural care, including maternity, feel utterly unsupported to do that right now because of the current situation,” he said.

The sessions in Crowsnest Pass and Pincher Creek were the second and third of more than 40 visits scheduled to communities across Alberta.

Although there aren’t further meetings scheduled for the southwest region, a complete list of the remaining sessions can be found online and you can have your say here.

 

Red and black angus bulls on poster for Blades Angus Bull Sale

 

Map showing Pincher Creek, Alberta, and the number of hours the ER was closed in 2023.

Alberta ERs closed for 38,000 hours in 2023

Emergency departments 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 practising 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 health-care 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.”

 

Tires on ad for safe winter travel with winter tires from Fountain Tire in Pincher Creek

 

Total length of emergency department closures in 2023

David Shepard, Alberta NDP rural health critic, said it’s troubling how access to care in rural parts of the province has been impacted, and called it “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 ERs 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 health-care system. Communities like Lac La Biche, Consort, Boyle and Swan Hills all 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.

 

We got your bumps and bruises covered advertisement for Osa Remedy'sRx in Pincher Creek

 

“There are people who rely on that emergency department for every other gap in the health-care 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,” he said.

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 front-line professionals. The cheapest fix would be to take care of staff that are already hired who 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.”

 

Shelves of bottled liquor in an ad for Town & Country Liquor Store in Pincher Creek

 

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 health-care 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,” he said.

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 environment and in a province where health-care professionals know they cannot trust their government.”

 

Text over a glass of beer and bingo cards on ad for Lions TV Bingo at Oldman River Brewing in Lundbreck

 

What the data doesn’t show

The AHS data used to map ER closures gives some indication of the health-care crisis in Alberta. Missing from these statistics, however, is the dire situation faced by staff and patients in the ERs that have stayed open.

Alberta Medical Association president Paul Parks has said ERs 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,” he said.

“I challenge you to go into any emergency department in any facility or find any Albertan waiting for any aspect of health care. 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.”

 

Display of fall clothing at at Emerald & Ash Clothing in Crowsnest Pass.

 

View of women's clothing store, at Emerald & Ash Clothing in Crowsnest Pass.
Heading for My Little Corner and editorial by Shannon Peace

‘It’s crumbling around us as we speak’

Should there be public consultation when changes affecting health care are proposed? Should there be an opportunity to ask questions? Should we be concerned when budget cuts could drastically affect our community?

I asked these questions in a March 2020 article after Pincher Creek physicians voiced concerns about budget changes at a community town hall.

A key point, one I hadn’t considered before, was that rural family medicine practices are small businesses with fixed costs. And when cost outweighs income, changes must be made for a practice to remain viable.

Financial costs aren’t the only consideration. At the time, Dr. Jared Van Bussel referred specifically to potential changes to maternity care and the cost of losing it. His concerns have not changed.

He also noted that disruptions to maternity care and individual health services impact the viability of the community.

A month later, Associate Clinic physicians announced a planned withdrawal of hospital-based services to come in 90 days. The move was prompted by a continuing lack of trust between doctors and Alberta Health, and ongoing uncertainty for the future. The uncertainty was not just for the physicians themselves but for their staff, patients and community.

 

Pincher Creek Chamber of Commerce notice of annual general meeting on brightly coloured background

 

The point hit home, and Pincher Creek rallied around its doctors. Letters were sent to government officials and a drive-by rally was held in June.

At the same time, Covid-19 was moving in, stretching local, provincial, national and global medical care to its limit.

Negotiating a master plan between the Alberta Medical Association and the provincial government piled even more pressure on Alberta’s medical professionals.

In October, local physicians chose to continue working in the emergency room and hospital rather than withdrawing those services. The community gave a collective sigh of relief, but problems remained unsolved.

By April 2021, a tentative master plan from Alberta Health had been brought forward and voted down by AMA members. Tyler Shandro, then minister of health, had also been to Pincher Creek to meet with Associate Clinic doctors, who were cautiously optimistic that agreement could be found.

It was September 2022 before a new funding contract was agreed to between AMA and the province.

The number of doctors at the clinic began to decline. Some retired while others chose to pursue careers elsewhere.

Finding replacements continues to be a challenge. Meanwhile, the cost of operating the clinic remains.

As we have all seen the cost of living rise dramatically, the cost of running any kind of business has increased as well.

To put this in perspective, as with any business, the financial burden on each partner increases substantially when the number of partners declines.

Speaking from personal experience, the stress and workload also increase significantly when staffing changes occur.

 

 

Let’s take stock of what we have in Pincher Creek.

We have a clinic and hospital providing continuity of care under one roof, personal relationships with physicians, an anesthetist and a surgeon, and even a CT scanner. Most importantly, we have a team of family doctors providing comprehensive care.

We also have our medical community working in difficult circumstances and likely losing hope for positive change. The emergency department was closed overnight twice in July due to a shortage of physician coverage.

About 800,000 Albertans do not have a family doctor, a situation especially dire in rural areas.

Our community has amazing medical resources, which are easy to take for granted, but a lack of stability under the very foundation of our health care system leaves it in danger of caving in.

“It’s crumbling around us as we speak.”

Dr. Paul Parks, president of the Alberta Medical Association, spoke those words Tuesday morning while sharing the results of a family and rural generalist physician survey conducted last week.

Asked to put the current state of affairs into medical terms, he likened it to a mass casualty that is bleeding out. The bleeding needs to be stopped and the patient stabilized.

Only then, once the chaos has passed, can treatment proceed.

 

Wedding banquet view of wedding venue — the Cowley Lions Campground Stockade near Pincher Creek in southwestern Alberta.

 

About 30 per cent of Alberta doctors participated in the AMA survey. Most have been practising for 11 or more years and 43 per cent are dealing with 1,000 or more patients.

Of respondents, 21 per cent feel their finances can sustain their practices for up to a year, while 20 per cent say they are unlikely to be viable beyond six months and eight per cent say only three months.

While $100 million of federal assistance earmarked for stabilization was announced in December, Parks says “not one cent has flowed to family physicians yet.”

He also noted that financial assistance is available immediately when there are wildfires and other emergencies. The health-care crisis, which physicians and their association have been red-flagging for over a decade, has yet to trigger the same response.

The old model needs to evolve because physicians are leaving Alberta for greener pastures where governments are responding to the crisis. Actions must match promises so health-care workers and all of us can look forward with hope.

If we sit quietly and say nothing, the system will continue to crumble, with disastrous consequences.

At a town hall last May, Dr. Gavin Parker said, “If you want to find someone who can fix this, find a mirror.”

On its website, Alberta Health says, “The future of health care is in your hands.”

Alberta Health is holding public engagement sessions in Crowsnest Pass at 10 a.m. today and in Pincher Creek at 5 p.m. Registration is required.

TODAY!

This long backstory leads to a strong call to action.

If you are concerned about a crumbling health-care system, please register for a session.

Have your say — your life may depend on it.

 

 

Beauty products on ad for Providence Salon & Spa in Pincher Creek

 

 

Three white envelopes blow in the wind in front of an open grey mailbox

Health-care planning needs drastic changes

Concerned about the coming changes to health care? Worried about the current state of health care in southern Alberta?

The Alberta government is giving you a chance to express yourself this Wednesday evening at the Heritage Inn. Not that many of us likely knew about this. Indeed, most Pincher Creek readers of Shootin’ will have to rush to register for this event, since it is at 5 p.m. Wednesday (that is, today). Readers in the Pass have probably missed their chance, since that meeting is set for 10 a.m.

The discussion seems to be focused on the upcoming changes to the structure and function of what is currently known as AHS. We are to get that behemoth chopped up into four pieces. Which might be fine if our problem was just the way that management is structured.

But, it is not.

As a retired physician with 26 years of practice in Crowsnest Pass, I lived through multiple reorganizations (or, more accurately, redisorganization). Each created its own special kind of chaos for at least a couple of years. The system, if you can call it that, kept functioning due to the goodwill of the front-line troops.

After years of being overworked and being told that they are not worth whatever their wage might be, there is very little goodwill left. If chaos follows a management shuffle, there will not be goodwill to pull function out of the chaos.

 

Camille Kalveram, young professional woman with long blonde hair, on Vision Credit Union ad

 

Anyone who has contact with health-care workers knows that what is lacking is not managers. What we need are workers and “stuff.” In case our politicians have not noticed, health-care workers are in short supply across Canada and indeed throughout the world.  You do not get them by tearing up contracts, offering lower salaries than the competition, and promising to make huge but unspecified changes to how the system is run.

Similarly, the system needs “stuff,” starting with long-term and acute-care beds, plus the technical equipment to support them.

None of those people and things will come to be just because a politician is unhappy with the current state of affairs. Training a doctor takes at least nine years after high school. A nurse requires at least four years. Lab and X-ray techs need two years for the basics, and more for extra skills.

Building hospitals is a 10-year process, from idea through planning, construction, staffing, commissioning, and receiving patients. The new long-term care building in Crowsnest Pass took a couple of years to plan, and another couple to build. Not to mention the years of asking that preceded approval to build.

 

 

Alberta is growing rapidly, with nearly 200,000 new residents moving here last year. Not to mention the babies that were born here. Since every thousand folks require about two doctors of varying types, the province needs close to a net of 500 new doctors each year, just to stand still. And, that 500 does not account for retirements and other losses. We are not building any giant new hospitals in the near future, and not many smaller ones.

Unless we make drastic changes to how we plan for our health-care system — from training, recruiting and retaining staff to planning and building infrastructure — our health-care system cannot improve. Splitting up the management team will not do that, at least not for a few years.

Hopefully, many locals will come out Wednesday evening to tell the government to make changes that will actually improve our health care.

Allan Garbutt
Resident of Cowley, Alberta

 

Sara Hawthorn, woman with long brown hair and glasses on ad for EXP Realty in Pincher Creek and Crowsnest Pass

 

Shootin’ the Breeze welcomes submissions about local issues and activities. Personal views expressed in Mailbox articles are those of the writers and do not necessarily reflect views of Shootin’ the Breeze management and staff. 

white and red megaphone on green background announcing weekend closure of Pincher Creek Emergency Department

Pincher Creek ED closed Saturday and Sunday

The emergency department of Pincher Creek Health Centre will close Saturday, July 1, at 8 a.m. and reopen Monday, July 3, at 8 a.m.

The temporary closure is the result of a physician shortage to cover the department over the weekend, and regular 24-hour service will resume Monday morning.

Inpatient care will be provided by nursing staff, who will have access to physician support by phone.

In the event of a medical emergency, Alberta Health Services advises residents and visitors to the community to call 911. Pincher Creek Emergency Services will respond as usual and facilitate transfers to neighbouring sites as necessary.

Emergency services are also available at the health centres in Crowsnest Pass, Fort Macleod and Cardston, as well as at Chinook Regional Hospital in Lethbridge.

Non-emergency support is also available by calling Health Link at 811, and AHS advises that “individuals requiring non-emergency medical care are also encouraged to call their family physician.”

 

Reader opposes Sovereignty Act

 

If adopted, the Sovereignty Act will forever change how Alberta functions inside or outside of Canada.

There has been a lot of press coverage of the Sovereignty Act over the past few months. It was a major plank in Danielle Smith’s campaign to become leader of the UCP.

As we all know, Danielle won with just over 60,000 votes, in a province with more than four million citizens. With that as a mandate, she took over as premier, and has embarked on a program that will fundamentally alter the relationship of Alberta with the rest of Canada.

The premier had repeatedly asked that the Sovereignty Act not be judged until it had been tabled in the legislature. That happened last week, and there were some surprises in the package the government submitted.

Taking the premier at her word, I read the act carefully, and was surprised. I am not a lawyer, but I cannot help but think most members of the cabinet must have skipped the high school classes on how our democracy works.

The first and most important point is that you rarely get everything you want. You have to be gracious when you win, and accept it when there are outcomes you are unhappy with.

Canada and its laws are not a smorgasbord. You do not get to pick and choose the laws that you like, and ignore the ones you do not like.

If you believe a law, any law, is wrong, there are ways to express your views. The most serious is to take the law to court, and to abide by the ruling.

If we adopt a pick-and-choose approach, things start to fall apart. If the provincial government can ignore certain laws, why couldn’t a city do the same thing to provincial laws? Indeed, why would a private citizen be required to follow a law that disadvantaged them?

The situation gets even more complex when you note that Bill 1 would allow the provincial government to rule against things that have not even happened. The language in the bill allows government to act against any perceived intention by the federal government to do something.

A basic aspect of our laws is that we cannot be convicted for simply thinking about doing something illegal. Even talking about doing something is not usually a crime. In Bill 1, that assumption of innocence seems to have been forgotten.

Our system also requires that the legislature have an opportunity to debate changes to laws. Bill 1, as written, will allow cabinet to make laws and proclaim them, without any debate in the legislature. Those laws are in force for up to two years, and can then be renewed without legislature debate for a further two years.

There are news reports that the bill will now be amended to remove the lawmaking portions. This raises the question of why the bill was introduced with that language in it. Do the politicians not read their own legislation? Or was it a power grab that they hoped no one would notice?

Neither option is reassuring. In one reading, they are just incompetent. In the other, they are dictators-in-waiting.

So, we have a bill that will allow a small number of legislators to try and cancel a national law. It further allows cabinet to direct a large number of other bodies, including your local hospital, police force and the whole educational system, to also ignore federal law.

There appears to be no consideration of the degree to which at least some of those bodies must interact with the federal government, and that interaction requires the bodies to follow federal rules.

I find it disturbing that there does not appear to have been consideration of what the federal response to Bill 1 might be. There seems to be an assumption that the federal response will be either a legal challenge or nothing. However, that may be incorrect, as there are many actions that Ottawa could take that would have dramatic impacts on Alberta.

The premier has been loud in her demands that the Canadian government stay out of areas of provincial jurisdiction. Exactly what that might mean has not been spelled out, but there are some obvious areas where dramatic change might happen.

Health care is a provincial responsibility under our Constitution. Despite that, there are multiple shared-cost programs, where the provinces receive federal dollars to help deliver programs. If Ottawa stopped their cost-share, Alberta would lose several billion from the health budget.

The UCP government has vigorously promoted a provincial police force. They admit that would cost tens of millions of dollars more than the current arrangement. They also note that it would take several years to set up a completely new force. But, the current contract allows either party to cancel on two years’ notice. If Ottawa simply exercised that option, Alberta might have a very hard time replacing the RCMP by 2025.

Many students receive scholarships and similar support from federal bodies, especially at the university level. The universities and such also receive large sums from the federal government. If Ottawa decided that since education is a provincial responsibility they would stop their financial contributions, many students and institutions would be in serious trouble.

There will also be economic impacts. No large company is likely to start or expand operations where two levels of government are in a fierce battle. If there is an alternative place to invest, they will likely avoid Alberta until things are sorted out.

In short, this bill, if adopted, will forever change how Alberta functions inside or outside of Canada. If Ms. Smith really wants to make such sweeping changes, she should at least wait until after we have an election.

Alan Garbutt
Resident of Cowley, Alberta

 

Shootin’ the Breeze welcomes submissions about local issues and activities. Personal views expressed in Mailbox articles are those of the writers and do not necessarily reflect views of Shootin’ the Breeze management and staff.