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Tag: Physician Shortage

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.

 

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

 

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.

 

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

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.

 

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

 

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.

 

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

 

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.

 

 

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

 

 

Portion of red emergency sign on hospital building

Fort Macleod Emergency Department to temporarily close Tuesday

The emergency department of Fort Macleod Health Centre will temporarily be closed from 8 a.m. to 5 p.m. on Tuesday, Sept. 19.

The temporary closure is the result of a physician shortage and regular 24-hour service will resume Friday morning.

Nursing staff will remain on-site during the closure to provide care for long-term care residents.

In the event of a medical emergency, Alberta Health Services advises residents and visitors to the community to call 911. EMS calls will be re-routed to Chinook Regional Hospital in Lethbridge (49 kilometres away).

Emergency services are also available at the health centres in Pincher Creek and Cardston, or 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.”

 

Related stories:

Fort Macleod Emergency Department to temporarily close

Recent Pincher Creek hospital closures worry residents

 

Portion of red emergency sign on hospital building

Fort Macleod Emergency Department to temporarily close

The emergency department of Fort Macleod Health Centre will temporarily be closed at 8 a.m. on Thursday, Sept. 7, and reopen at 8 a.m. on Friday, Sept. 8.

The temporary closure is the result of a physician shortage and regular 24-hour service will resume Friday morning.

Nursing staff will remain on-site during the closure to provide care for long-term care residents.

In the event of a medical emergency, Alberta Health Services advises residents and visitors to the community to call 911. EMS calls will be re-routed to Chinook Regional Hospital in Lethbridge (49 kilometres away).

Emergency services are also available at the health centres in Pincher Creek and Cardston, or 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.”

The Pincher Creek emergency department has been closed a number of times this summer, causing concern in the community.

Group of people, mostly seniors, seated at a meeting

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.

 

Pig roast at wedding venue — the Cowley Lions Campground Stockade near Pincher Creek in southwestern Alberta.

 

“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.

Note asking "who cares?" pinned to a cork board

Who cares?

On the heels of recent temporary closures of emergency services at the Pincher Creek hospital, Alberta Health Services hosted an information session at the Community Hall on the evening of Aug. 15. The meeting was intended to update local residents on what is being done to improve the health-care situation and to give us the opportunity to voice our concerns and suggestions directly with AHS officials.

The hall was pretty much full, a clear indicator that there are many in the community who care and are concerned about the state of, and future of, health care in Pincher Creek.

One got a sense that the AHS officials and hospital administration leading the meeting have the same understanding of the issues as the audience and legitimately care about implementing solutions. They seem to be struggling for answers; their hands are somewhat tied by regulation and funding, but they care and are trying to improve things.

The meeting was attended by the MD reeve and at least one councillor. (I’m unsure of town council attendance as I don’t really know them.) It seems our local government cares.

Local doctors (even one on maternity leave) were in attendance. They care.

Many were there in EMS uniform. They care.

Many hospital staff and retirees were there. They care.

 

Downhill skier catches air on ad inviting skiers to stop at Miner's Mercantile in Beaver Mines on their way to the Castle Mountain ski hill.

 

The Piikani care. An elder spoke eloquently about their issues and how much they value the Pincher Creek hospital and clinic.

However, a key person, someone who might be able to actually do something, was not in attendance. Not unlike what we had come to expect from her predecessor, our MLA was MIA when we needed her support. During the election campaign she missed a similar engagement because of more pressing matters. I wonder what kept her away this time. I wonder if she cares.

I personally don’t have any answers around improving the health-care system but can offer AHS one suggestion: choose your dates carefully. If you would have held the meeting on Saturday instead of Tuesday, there’s a good chance the MLA might have attended. It seems it takes the smell of pancakes or the noise of a parade to bring a Livingstone-Macleod MLA out of hiding.

Cornell Van Ryk

MD of Pincher Creek Resident

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

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.

 

 

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.

 

 

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.”

 

Male with short, dark hair and woman with dark dark hair and cap, stand in front of an ambulance. Both are dressed in navy blue uniforms. Pat Neumann is the Pincher Creek fire chief and Sariah Brasnett is deputy-chief.

Wait times at urban hospitals tying up Pincher Creek ambulances

Increasing wait times at urban hospitals are delaying treatments for patients transferred by Pincher Creek Emergency Services’ ambulance crews and tying up paramedics, PCES Chief Pat Neumann told Shootin’ the Breeze.

Neumann said PCES crews have long experienced these delays at Calgary hospitals, especially at Foothills Medical Centre, which Neumann said handles most of the cardiac emergencies, advanced heart treatments and diagnostics, and complex traumas within Alberta Health Services’ south zone.

But similar bottlenecks have hit the Chinook Regional Hospital in Lethbridge, which also takes routine and emergency patients from Pincher Creek and surrounding areas, and where Neumann said PCES crews have consistently reported emergency room delays since last summer. 

“Lethbridge is terrible now” for wait times, Neumann said.

“It’s to a point where, unless they actually are admitting the patient to the ER right away, (PCES crews) are typically waiting every time they go now.”

 

 

A return trip to Calgary will tie up a PCES ambulance crew for at least five hours, with crews spending at least three hours on trips to and from Lethbridge, the chief explained.

The department has two ambulances. When one has to travel to and from Calgary or Lethbridge, “That only leaves one ambulance in this community to do any other urgent transfers going out of this area, or to respond to any other emergency call,” Neumann said. 

Longer waits are the norm when urban hospitals increasingly provide routine treatment and diagnostics for rural patients. At the same time, Neumann said his crews now attend calls from town residents struggling to access primary care.

“We’re picking people up that are going to the (Pincher Creek) Health Centre because they don’t have a doctor. They don’t know what else to do to get the services they need.” 

 

 

 

Patients are showing up at the health centre sicker than they might have been if they’d had regular care from a family doctor, and the problem “compounds itself” as the hospital’s doctors and nurses scramble to fill the gap, Neumann explained. 

Six doctors now work at the health centre and its attached medical clinic, down from 11 several years ago, according to the clinic’s executive director, Jeff Brockmann. (Dr. Gavin Parker manages the health centre’s ER.)

Local ambulance calls have more than doubled since Neumann started at PCES roughly 20 years ago, with hospital transfers up by a similar margin. Crews that responded to just under 750 calls in 2005 were handling over 1,500 in 2018. Transfers meanwhile climbed from around 350 to just over 600 in the same period, according to PCES statistics. 

 

Aerial view of the Cowley Lions Campground on the Castle River in southwestern Alberta

 

The town’s population held at around 3,700 for much of that time, but shrank to around 3,400 by 2021, according to the Government of Alberta’s online regional dashboard. 

Just over 25 per cent of residents are 65 or older — a slight proportional increase over 2016, according to Statistics Canada’s 2021 census. As Neumann suggested, the town isn’t getting bigger — it’s getting older.

In response, Health Minister Jason Copping said the Alberta government is investing in rural health care. 

Copping said at a media roundtable Monday that the province had put up $1 million to explore options to train doctors at the University of Lethbridge and nearby Northwestern Polytechnic. 

 

 

“We recognize that we need to train and hire locally, and by getting those seats out in rural Alberta, the more likely that (graduating doctors) are going to stay,” he said.

Copping stressed that Alberta’s United Conservative Party provided many more millions in budget 2022, including the UCP’s new collective agreement with Alberta’s doctors. 

The province further hopes to attract foreign doctors by “leveraging immigration.” Seventeen doctors from outside Canada have agreed to work in Lethbridge, with some already working there. 

“I can tell you more is coming.… So, stay tuned,” Copping said.