Tag: Associate Clinic

Group of people, mostly seniors, seated at a meeting

Recent Pincher Creek hospital closures worry residents

Written by Dave Lueneberg on August 25, 2023. Posted in Dave Lueneberg, Health/Wellness, Local News. No Comments on Recent Pincher Creek hospital closures worry residents

Following three recent emergency department closures at Pincher Creek Health Centre, area residents are concerned over the facility’s future, something very apparent at an Aug. 15 engagement session with Alberta Health Services.

“It is not our intent to close the hospital,” Dr. Sandra Stover, associate zone medical director for AHS and a palliative care physician from the Beaver Mines area, told the audience of nearly 200.

“It’s our goal (as doctors) to keep the emergency department open,” added Dr. Bev Burton, the community’s acting medical director, when asked to speak to the large gathering.

Acknowledging there have been challenges in the past, Burton said she is hopeful that things will improve.

At the centre of the recent closures: the continuing struggle to recruit new physicians and the challenge to keep them, once here. The lengthy process, which can take up to nine months, even after an agreement is reached, doesn’t help either.

Right now, Pincher Creek is served by five doctors, plus one on maternity leave. In the past, the town has had up to 11.

“Some of the delay is the recruitment process but some of it is through the College of Physicians. It’s simply a lack of people who can mentor or sponsor,” Stover said.

Staffing shortages and ER closures aren’t isolated to just the southwest, or even Alberta. This can create hardship for families in rural communities where the next hospital is an hour or more away and, for some, the additional challenge of getting there is very real.

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“What happened? We came out of Covid and all of sudden there are no doctors,” said Edna Fairbrother, a member of Piikani Nation.

Getting in to see a doctor, for Fairbrother, was never a problem until recently.

“We need to find some solutions because it’s not just Pincher Creek. It’s my community as well,” she said.

“Retaining physicians is even more important than recruiting them,” Dr. Stover said, following the meeting.

“We can always recruit a physician but it’s harder retaining one. People want to have a long relationship with their doctor,” Stover said.

“We have a great relationship with the town and MD. They’ve even set up their own committee.”

With an aging population, good health care is a big pillar of any community and several times during the course of the evening, AHS officials recognized the large turnout.

“We can see the community here is very concerned about their health care and rightly so,” Stover said. “After all, they have a big stake in it.”

While obstacles remain in recruiting and retaining physicians, the news on the evening wasn’t all bad. In fact, there might be some promise.

A new physician assistant is set to begin in September to fill a small part of the current gap. Negotiations are also underway with three international medical graduates, one of whom could be practising in the community by the spring of next year.

Dr. Akarakiri, a young black man with short hair, moustache and trimmed beard, outside Pincher Creek's Associate Clinic

New doctor joins staff at Pincher Creek hospital, clinic

Written by Laurie Tritschler on July 6, 2023. Posted in Health/Wellness, Laurie Tritschler, Local News. No Comments on New doctor joins staff at Pincher Creek hospital, clinic

Pincher Creek has a new doctor, and he plans to stay for years to come.

Dr. Kunmi Akarakiri, a Nigerian expat with over 10 years’ experience in rural medicine, is a welcome addition to Pincher Creek Health Centre’s ER and neighbouring Associate Clinic, where a handful of GPs have held the fort for years.

His arrival in mid May brought the number of full-time docs at the centre and clinic from five to six, according to the clinic’s executive director, Jeff Brockmann.

Another doctor had joined both rosters in the new year, but is no longer practising at the clinic.

“The adaptation for me has been very easy,” Akarakiri told Shootin’ the Breeze.

It took him a little over a year after landing in Canada in December 2020 to clear most of the regulatory hurdles set by Alberta’s College of Physicians & Surgeons.

“I was lucky,” he said, noting that the process can take two to three years for many foreign-trained GPs.

He’d never seen snow before passing his first winter in Kamloops, B.C.

“When I got there, I thought to myself, ‘The snow is bad. But it’s not that bad.’ Then I moved to Calgary,” he said with a laugh.

If the white stuff was bad west of the Rockies, it wasn’t long before he suffered a minor case of frostbite in Cowtown.

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When he toured Pincher Creek with ER chief Dr. Gavin Parker last August, the only concern he left with had to do with the town’s notorious chinooks.

“I was told that, sometimes, the wind can blow against you,” he told the Breeze in what has to be the understatement of the year.

It remains for him to wrap up the college’s supervised practical experience, which Brockman explained will be monitored by a doctor from outside the community, in order to avoid any conflict of interest.

Akarakiri said he then hopes to sign a five-year contract with Alberta Health Services.

In the meantime, he plans to settle into his new rental — a rare find in a small town that’s up against a housing crunch — and then welcome his wife, Hephzibah, and their young daughter, Megan.

“It’s a nice community,” he said, complimenting Canadians’ friendliness and easy-going nature.

Akarakiri graduated medical school in Nigeria in 2012. He practised rural medicine for seven years in the southwestern town of Ile-Ife before moving to Canada, he told the Breeze.

Learn more about Dr. Akarakiri in this episode of The Innovative Practitioner.

Woman with shoulder-length dark brown curly hair speaks into a microphone as one other woman and two men look on

Pincher Creek health-care forum draws large audience

Written by Laurie Tritschler on May 3, 2023. Posted in Health/Wellness, Livingstone-Macleod, Local News, MD of Pincher Creek, Municipality of Crowsnest Pass, Town of Pincher Creek. No Comments on Pincher Creek health-care forum draws large audience

Alberta’s rural health-care system needs more public funding, more efficiency and much more local autonomy, residents and esteemed panellists said at Pincher Creek’s health-care forum in late April.

Upwards of 150 people came for a one-hour discussion that saw residents, politicians and one riding candidate engage local doctors and public health policy researchers from the University of Calgary.

Between panellists who said the status quo isn’t holding and residents who said they felt ignored by the province, the conversation registered an uneasy mix of frustration and hope for the future.

‘If you want to find someone who can fix this, find a mirror’

Drs. Gavin Parker and Kristy Penner, both of whom practise family and emergency medicine in Pincher Creek and neighbouring Crowsnest Pass, repeatedly called for more community involvement.

“If anybody can help solve this, or at least start to work on this, it’s the people in this room,” Parker started off.

“I do think there is hope,” he continued, qualifying in the next breath that “Clearly, what I’m doing and what we’re doing isn’t working.”

Penner’s prognosis was no less sparing.

“If we keep doing the same thing, we’re only going to be waiting longer” for routine medical services, she told the packed forum, painting graver implications for women and the elderly.

“You’re going to have to leave [home] to have a baby — you won’t be able to get surgery in Pincher Creek or Crowsnest Pass. You won’t be able to get home care or long-term care in your community. And as a senior, you’ll have to move out of your community to access long-term geriatric care.”

The College of Physicians and Surgeons of Alberta is working to fast-track foreign-trained doctors’ credentials, while licensed practical nurses are picking up the slack at Pincher Creek’s medical clinic, according to Parker.

But the system can’t build capacity when there aren’t enough doctors to train med school graduates, much less foreign doctors.

“Our voice is stronger when it’s collective,” Parker said, acknowledging the residents on Pincher Creek’s Attraction and Retention Committee, the citizen/council body that helps settle incoming doctors within the community, among other functions.

Parker also noted that Albertans who work outside of medicine make up a significant proportion of the CPSA’s board of directors.

“So, if you want to find someone who can fix this, find a mirror. That’s who,” he said.

It’s Friday night: Do you know where your MLA is?

Audience speakers questioned how civic participation could reverse the Government of Alberta’s concentration of authority in a sclerotic Alberta Health Services, the provincial health authority that executes government policy.

“I’ll vote for any party that starts taking that system apart and returning power to the community so that we can make a difference with some of the things you’re asking us to make a difference on,” one speaker said.

Another speaker noted that United Conservative MLA Roger Reid, who represents Livingstone-Macleod, was conspicuously absent.

“Where’s our MLA?” the speaker asked, drawing groans from the crowd.

“Is anybody from the Alberta government here?” another speaker asked. “Maybe that’s part of the problem,” the speaker suggested, drawing thunderous applause.

In the crowd were town Coun. Sahra Nodge, MD Coun. Dave Cox and Reeve Rick Lemire, and a host of doctors and nurses from Pincher Creek Health Centre.

The NDP’s Kevin Van Tighem, the only riding candidate to show, suggested that Pincher Creek has the talent and the grit to restore the health centre to a model of rural health care.

“Do we have to change ourselves? Or can we change medicine so it fits into our community without the community changing?” he asked from the mic.

The UCP’s 2023 provincial budget funds public health care to the tune of $24.5 billion, a roughly four per cent annual increase. This year’s budget includes $105 million for capital projects under the UCP’s Rural Health Facilities Revitalization Program.

Don’t expect a quick fix

Funding and educational programs need to deliver a robust, “team-based” rural health-care model that empowers Indigenous and rural learners to practise medicine, Dr. Penner explained.

More immediately, Penner said, doctors-in-training have complained about a lack of affordable housing and limited child-care options in Crowsnest Pass.

Melissa Fredette, a registered nurse at the health centre, vice-chair of the town’s Attraction and Retention Committee and mother of three, implored the community to promote Pincher Creek as a career destination for young health-care providers. But Fredette and her colleagues need more local support.

“We’ve just come out of a pandemic. We’re tired in health care,” she said. “We would love to have more help from the people here.”

Once it’s gone, it may never come back

Aaron Johnston, associate dean of rural medicine at the U of C, warned after the forum that many rural health-care teams are on the verge of collapse.

An under-resourced team “works until it doesn’t work — until there’s the loss of that last one person,” he said. “Lose a rural anesthetist and say goodbye to that town’s surgical team. Lose a team, and good luck restoring the services it was designed to provide.”

“Imagine how difficult it is to recruit 10 highly-trained medical staff at the exact same time,” he suggested, “because that’s what it takes to reboot these services once they’re gone.”

Opinion: Alberta hates rural maternity care

Written by Shannon Peace on January 20, 2023. Posted in Columns/Opinions, Health/Wellness, Local News, Rural Life. No Comments on Opinion: Alberta hates rural maternity care

Alberta hates rural maternity care

I have been working as a rural physician for 16 years. My focus and my expertise has been surrounding maternity care and, to that end, I have worked as a low-risk maternity provider and a provider of rural surgery primarily to provide access to rural maternity care. I’ve been on numerous boards and committees to try to address access to labour and delivery services close to home.

Unfortunately, none of these have been successful to prevent the ongoing death of rural labour and delivery services.

Most heartbreaking to me, I no longer can support ongoing labour and delivery in my own community of Pincher Creek beyond May 31.

Perhaps this is just the sentiment of modern thought – we can no longer as a society accept the risk inherent in providing medical assistance to people who live outside of city limits. In order to access that quality of care you deserve you must live in communities where mail is delivered to street addresses instead of box numbers.

I don’t know for sure whether all Albertans despise rural maternity care, there seem to be quite a few that prefer the personal nature of it. I don’t even know whether it is purely a maternity care thing, or if we really hate all rural medical care.

I don’t want to generalize, but this could even be a Canadian thing: rural care appears to be disappearing across the country. What is clear to me, is that when there is a question on whether to support rural maternity care, they always decide against.

The barriers to excellent rural maternity care are many:

Due to risk, or lack of role-models, many family physicians have decided that maternity care, labour and delivery is an optional skill. There was a time when we counted it as a required skill to work here. It is not trained well in many programs, and low-risk maternity groups are often poorly supported.

Rurally, there is no on-call funding to be available for delivery services. When advanced skills are needed for c-section and for neonatal resuscitation, the team size expands to at least four physicians and an army of allied health workers, such as RNs, LPNs and respiratory therapists, as well as the many lab and imaging technicians, EMS and other support staff working in the background.

We are down to six physicians from 11 to serve a patient population of 10,000, and our emergency department has only become more busy.

I have had the joy of working with many dedicated caregivers who attend when they are needed, even when not on-call. This care costs significantly.

However, often forgotten is that when these services are not in place, the costs increase greatly due to emergency transportation, delivery en-route, increased NICU admissions, and emergency deliveries at a rural facility not set up for labour management in training or equipment.

We already have managed high risk maternity patients beyond the scope of our site who were unable to get to a higher level hospital and we could no longer transport. This will continue to happen with even fewer resources. These harms are borne unevenly by those who don’t have the resources to access care.

Gaps in the availability of this team impacts maternity before and after care as decisions are made based on when services may not be available.

As a cost saving method, our hospital site manager will not provide OR or maternity nursing coverage when anesthesia or surgery is scheduled to be away. This creates further gaps as it blocks partial days or a day that later could be covered by changes to vacation plans or finding last-minute locum coverage.

There is no dedicated maternity nurse, which means each time a maternity patient arrives there is a scramble to see who is available, and a sense of frustration at the lack of staff availability, and that maternity coverage is considered additional work instead of being appropriately planned for with adequate staffing.

More distressing, where I used to look forward to labour and delivery, now I have apprehension about whether I have the time or support to provide good care.

Despite all these challenges, our goal has always been to provide as much coverage as possible to ensure the best care for our maternity patients.

As the lone surgeon in Pincher Creek for the last five years, I have been on surgical call 24/7, barring scheduled time off.

Management at AHS has noticed, and for reasons of well-being and safety have indicated they will cease paying me for on-call days past a certain number each year. I agree with the sentiment, this isn’t a reasonable call burden, and there are times I suffer more burnout than I care to admit.

I hear about how much they are spending to pay for the many locum obstetricians in Lethbridge, when we have been asking for support the last six years. They have not, instead, found additional coverage for surgery in Pincher Creek, or encouraged physicians to work here who have undergone my level of training, or even called to see how I’m coping with the call demands.

These steps might have a real impact on physician well-being. I don’t count my call by number of days, but by my kids’ volleyball games I’ve missed, family events I’ve not attended, robotics teams I haven’t coached, and the number of maternity patients transferred on my wife’s birthday when I was out of town.

Alberta does not have a training program for advanced skills for family physicians. Once we have been trained to perform various procedures and surgeries, specialist physicians in the cities decide which of our procedures they don’t want us to do. This is called privileging.

Being declined privileges has a real impact on applying to work in other regions. There has not been a surgeon privileged in Pincher Creek to provide all the skills they trained for in the last 12 years, myself included, and this may have impacted other surgeons choosing not to stay.

Despite decisions being made in regional centres, there is not a reciprocal responsibility to provide support for the rural sites. Many models of creating a network of care have been suggested over the last several years.

At its best this would create a seamless transition between rural sites and the referral centres, and a cohesive team of professionals from both rural and central facilities who could support at-risk rural sites with education, training, and perhaps even call coverage. All of them have collapsed without funding.

So where is the leadership? Well, it changes frequently. Some new manager in a new role, with no memory of the prior issues, is surprised I’m not ecstatic when they have a new “Pathway Through Privileging.”

I’ve continued to ask for a statement from AHS – “We support rural maternity care.” It has never come from any level of its bloated bureaucracy.

There is no doubt that government has a role to play, and I won’t lessen the negative impact the last four years have had on rural physician supply. However, this is not a partisan issue. The reality is, rural health care does not matter to politicians. Rural votes are counted as won before the polls open and no one feels they need to pay anything except lip service to improvement of rural medical care.

It’s not just that labour and delivery is special to me in particular, it is emblematic of how we care for vulnerable people in our society. It should be an equalizer, we all were once born; but the care women get is divided sharply along socioeconomic lines. In order to provide this care well, you need a dedicated team of people working within a well-supported system.

Despite our dedication, we do not have that support. Most times, a rural maternity program collapses after a bad outcome where the lack of support results in finger-pointing to deliver blame. Often providers leave the profession. I can shoulder the work, and the call, but I can’t face the injury to my colleagues if I keep it going when I don’t believe any help is coming.

Each person who could have some positive impact doesn’t feel it is their responsibility to help.

If I were a younger man, I might be looking for greener pastures. I may yet look for other rural programs I can support for a little longer, but I intend to remain planted in Pincher Creek for now and I still have many other surgical skills that will remain useful.

I know what happens to communities who end their maternity programs though, as they lose the need for a cohesive team to come together to celebrate new life and in doing so gain a little joy in a job well done.

Jared Van Bussel MD CCFP ESS FRRMS
Pincher Creek, AB

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.

Maternity care on the ropes in Pincher Creek

Written by Shannon Peace on January 20, 2023. Posted in Community, Health/Wellness, Laurie Tritschler, Local News, Rural Life. No Comments on Maternity care on the ropes in Pincher Creek

Dr. Jared Van Bussel, who specializes in obstetrics, will stay on as a general physician and trauma surgeon at the Pincher Creek Health Centre and will continue his practice at the attached Associate Clinic, he told Shootin’ the Breeze on Thursday.

“If I were a younger man, I might be looking for greener pastures. I may yet look for other rural programs I can support for a little longer, but I intend to remain planted in Pincher Creek for now,” he wrote in an open letter.

“If my colleagues call me, I’ll always show up,” he said.

But it’s unlikely that the health centre can handle scheduled births, especially routine C-sections, without a dedicated obstetric surgeon.

The man has been on call for 70 per cent of his waking life for years, apart from his scheduled time off. The burnout is real, but Van Bussel repeatedly stressed that he’s scaling back his practice because of what he considers an acute and profoundly systemic lack of provincial support.

“Alberta hates rural maternity care,” he wrote, telling the Breeze that in his 16 years in rural family medicine, he’d seen too many gaps in patient care and professional training for new doctors, and too many shortsighted cost-saving measures he said were untenable.

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Things came to a head on his birthday, Jan. 16, when he received a letter from Alberta Health Services reminding him of the funding limits for on-call services paid for by an Alberta Health grant program.

“Please be advised AHS is unable to compensate you for (physician on-call) services in GP Surgery after you have reached 255.5 days of service,” the letter states.

AHS South Zone declined an interview for this story, but explained in a written statement that Van Bussel would continue to be paid, including for his on-call services.

“The South Zone recently sent a courtesy letter to physicians who were approaching the limited days paid for on-call time under the provincial Physician On Call Program,” the statement reads.

“We do not believe that any physicians (in Alberta) will go over their 255.5 days of on-call coverage,” AHS said in a followup statement.

The South Zone added that these courtesy letters “go out each year,” while other doctors at the health centre also received letters in the new year.

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Van Bussel said he’d never received any such letter before Jan.16, especially not in his six years as the town surgeon.

“They’ll always pay me for coming in, but they won’t pay to support physicians or the community in general,” he said.

As heartbreaking as it was for him to write his letter, he said he’d been crafting it for a long time. He’d told his Pincher Creek colleagues it was coming about a month ago.

“I’m willing to reconsider, but I just don’t see it,” he said.

The Government of Alberta is plainly not about to prioritize rural health care, he explained, and “when it feels like everything is pushing against it, it feels to me that we’re approaching a breaking point.”

Setting aside AHS’s “tone-deaf” letter, Van Bussel reiterated that he wasn’t concerned about his take-home pay.

“I want to pull attention away from any one event and draw that attention to rural maternity care.”

With AHS insisting that “Physicians are a cornerstone of our health-care system,” Van Bussel said he’d made it known for years that it wasn’t sustainable for him to live on call while resources dwindled at the health centre.

The health centre serves around 10,000 patients over a broad swath of southwestern Alberta.

Its team of doctors is down from 11 to six and, instead of asking how the province could do more to help, AHS sent Van Bussel a letter that seemed to say no help was coming.

“I hope this will become a discussion point in the community. I hope that people will start asking their decision-makers why this is the case,” he said.

Read Dr. Van Bussel’s open letter

Read AHS letter to Dr. Van Bussel