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Tag: Rural Health Care

Chelsae Petrovic

Petrovic ‘eager to collaborate’ with front lines through health-care appointment

Livingstone-Macleod MLA Chelsae Petrovic will use a new government role to continue advocating for front-line health-care workers, she said on social media last week.

Named by Premier Danielle Smith as the parliamentary secretary for health workforce engagement, Petrovic is “eager to collaborate with heath-care professionals across the province, engaging directly with those on the front lines to understand their needs and concerns,” she posted on Instagram.

“Together, we will work towards building a health-care system that prioritizes the well-being of both patients and providers.”

Just before her successful run last year to represent Livingstone-Macleod, the UCP candidate was accused of victim-blaming and made cross-country headlines. She suggested in a podcast that some heart patients could be held accountable for their condition because of health and lifestyle decisions.

Petrovic, who spent more than 13 years working in Livingstone-Macleod as a licensed practical nurse, admitted then that she could have chosen her words more carefully. But she did not apologize, saying comments pulled from a full-length podcast failed to capture nuance and context.

Petrovic’s appointment comes as the UCP government prepares to restructure Alberta Health Services into four specializations: primary care, acute care, continuing care, and mental health and addiction.

 

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

 

 

After attending public-engagement sessions on the restructuring in Livingstone-Macleod earlier this year, the former Claresholm mayor said she was continuing to take a deep dive into the local situation before returning to Edmonton for the post-Christmas resumption of the legislative assembly.

Petrovic said then that she had confidence in Health Minister Adriana LaGrange

“I was probably her biggest critic when it comes to this,” Petrovic said.

But after Petrovic shared problems and scenarios from the front lines, LaGrange won her over. “She gave me hope for the future of health care,” Petrovic said in February.

A provincial news release on Petrovic’s appointment said that consultation with health-care workers is vital.

“Alberta’s government has been clear that throughout this refocusing process and as the system changes, health-care workers must be empowered in their roles,” the release said, adding that Petrovic will help in that work.

 

 

“Albertans deserve a better, stronger health-care system,” said Premier Smith, the member for Brooks-Medicine Hat, in the release.

“Addressing issues that have been allowed to grow for decades is a major job. Chelsae will play a pivotal role in ensuring that we continue to hear from the hard-working men and women who serve on the front lines of health care. I am confident her work will help lead to a stronger system.”

LaGrange said in the release: “I look forward to collaborating with Chelsae in the weeks and months to come. With her health-care background, she will bring a very important perspective to our refocusing work.

“The voice of every health-care worker is critical to understanding what is actually happening on the front lines and what needs improving. Chelsae will help us incorporate those voices to strengthen the health system for all Albertans.”

The Opposition NDP was not enthusiastic about the government’s choice. A release quotes NDP health critic Luanne Metz calling the appointment “incredibly poor judgment” from the premier that will “cause more chaos” in health care.

Undeterred, Petrovic posted on Instagram: “Our government has emphasized the pivotal role of front-line health-care workers in our health-care system’s refocusing from the onset. In my new capacity, I am committed to ensuring this principle is not only upheld but actively put into practice.”

 

 

Aerial view of the Cowley Lions Campground on the Castle River in southwestern Alberta
Three white envelopes blow in the wind in front of an open grey mailbox

With a commitment, we move forward

The health system remains under immense pressure. I am pleased that the Alberta health minister has made two commitments with the 2024 budget in response.

First, she has agreed to implement a new funding model for the comprehensive, lifelong care provided by family and rural physicians.

Second, she will ensure that Alberta can compete with our neighbouring provinces when it comes to retaining and recruiting physicians and medical learners.

Budget 2024 also provides more funding for the additional services that physicians are providing to more Albertans as our population continues to grow. We will work with the government to implement our AMA agreement.

I had a chance to speak with Minister Adriana LaGrange after the budget announcement. As you know, the AMA has been advocating loudly and ceaselessly for a commitment to a new comprehensive-care payment model and stabilization for family and rural medicine.

I am grateful to many members who lent their voices to our SOS campaign to save family and rural medicine. You were heard.

The minister has given me her word that we will implement the physician comprehensive care model as quickly as possible. She went further with a commitment to ensuring that Alberta will once again be competitive with other provinces for retention and recruitment — and make family and rural medicine viable across the province.

 

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The minister can move forward, now that there is money in the budget that can be used, to lock stabilization and the new payment model down and get the job done. We need to move expeditiously. The urgency is still very real.

This will allow us to work collaboratively on some of the other big pieces. I made a promise to physicians in acute specialty care that we would advocate strongly for their needs when family and rural medicine matters were starting to turn in the right direction.

We will need to keep pushing on primary care, but you will be seeing acute-care advocacy really coming to the fore. I hope we can count on members to continue to participate and show support for your colleagues in all specialties.

By the numbers, Budget 2024 has funding for primary care. There’s been an increase to the physician services budget that will offset some of the volume we have seen from population growth and add a partial funding top-up for inflation. It does not catch up, but because we negotiated a rate agreement, this is less of an issue.

Among line items in general, the specifics need to be worked out about where the money is going. We’ll be digging into that as we head into the busiest two-year period of our four-year agreement.

Dr. Paul Parks, President
Alberta Medical Association

 

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. 

 

 

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Province to offer sexual assault care training for doctors and nurses

Tanya Fir, parliamentary secretary for the status of women, said last week that the province will cover tuition for registered nurses, nurse practitioners, registered midwives and doctors invited to take the Rural Sexual Assault Care program, an online course offered by Grande Prairie’s Northwestern Polytechnic. 

The 12-hour self-study course is designed to familiarize health-care providers with sexual assault testing and evidence (SATE) procedures and to build on the emotional skills needed to treat survivors. The overarching aim is to make SATE testing more available in rural hospitals so that survivors don’t need to undergo the procedure in far-flung cities.

“Every person who’s been sexually assaulted deserves access to care and forensic evidence collection, regardless of where they live,” Fir said. 

“Sometimes, in certain rural areas, there may not be health-care providers that have this training or are comfortable administering it,” she added.

Dr. Gavin Parker, lead physician at Pincher Creek Health Centre’s emergency room, said he welcomes the program’s intent, but cautioned that staff crunches are the limiting factor, not training gaps. 

Parker noted that the hours-long procedures sap vital staff resources because SATE kits are designed to gather evidence of a crime. 

“There’s a very strict chain of evidence that we have to follow,” he said, explaining that SATE procedures cannot be interrupted. The necessary examination is so intimate and invasive that Parker chooses to perform the procedure alongside a nurse, which takes responding nurses off the ER floor. 

 

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Sexual assault often brings trauma that needs urgent medical attention, but Parker said evidence gathering isn’t a medical priority. 

“The more we can do on-site, the better…. But I can’t in good conscience ignore other patients in the health centre who might get hurt in the two to three hours it takes to perform the test.” 

Parker said he’s performed the procedure in small hospitals and will continue to do so when he can, qualifying that it’s not uncommon that survivors treated at the health centre are transported for SATE procedures by the nearest sexual assault response team, at Chinook Regional Hospital in Lethbridge. Sometimes, survivors have to drive themselves, he said. 

“If the province really wanted to be serious about this, they’d pay for designated physicians to be on call,” Parker said.  

The RSAC program is funded through a $1-million investment the province announced last fall. 

Participation is voluntary and the program doesn’t require a practicum, according to Fir and Michelle Wallace, Northwestern’s associate dean of continuing education. 

The program is set to launch April 3, according to Wallace.

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. 

 

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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. 

 

 

Alberta government 2022 highlights from MLA Roger Reid

Our communities have received significant levels of investment and support from the Alberta government, and I am proud of the role I have been able to play in this. Alberta is leading the nation in job growth, which means our neighbours are going back to work and providing for their families again. And with investment pouring back into our province across a variety of sectors, I anticipate more growth ahead.

Our government is committed to tackling this affordability crisis, fixing our health-care system, maintaining our economic momentum and making life better for all Albertans.

Even though our economy is strong, far too many Alberta families are struggling to pay their bills right now due to inflation. To help families cope with these costs, we have passed a landmark inflation-relief package that will make life better for all Albertans, but particularly our most vulnerable.

This package includes targeted relief payments to seniors and families with dependent children under 18 whose household incomes are under $180,000 per year, as well as to Albertans receiving AISH, PDD and Income Support.

We have also introduced inflation relief that is non-targeted and benefits a wider segment of Albertans through making fuel and electricity more affordable.

We are cutting the full 13-cent fuel tax on gas and diesel between Jan. 1 and June 30, 2023, regardless of oil prices. This will ensure Albertans continue to pay among the lowest fuel prices in Canada.

 

 

In addition, we are providing $500 in electricity rebates for 1.9 million households, farms and small businesses. This will help Alberta households cope with high electricity prices at this challenging time of year. 

We can provide this substantial relief because our budget is back in balance and our fiscal position is strong. Alberta is succeeding again, and our United Conservative government is committed to reinvesting that success into everyday Alberta families, so they can grow and thrive. Our government has continually prioritized a balanced budget and strong fiscal policy, which has led to our thriving economic position.

Additionally, we have continued to focus on our resources and the economic growth that comes from diversifying and supporting these large industries. I am proud that our government has embraced these industries that help make Alberta the wonderful and successful province we all know and love.

Another major focus of our government is health-care reform. We have heard repeatedly from people across our province that changes need to be made to our health-care system. This is one of the reasons that our government is working to take immediate action to have AHS improve EMS response times, decrease surgical backlogs and cut emergency room wait times.

Additionally, our government knows that rural health care is unique and requires a different approach. This is why we are working to address health-care staffing challenges, particularly in rural areas, through improving health workforce planning, evaluating retention policies, leveraging the scope of allied health professionals, streamlining immigration and certification processes, and further increasing the number of training seats for health-care professionals in Alberta.

 

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We are also working with municipalities, doctors and allied health providers to identify strategies to attract and retain health-care workers in rural Alberta.

These steps are just a part of the more long-term changes that will strengthen our health-care system and ensure that everyone has access to timely high-quality care.

One of the steps we are taking to do this is looking into creating more spots in post-secondary institutions for health care related fields. This will help ensure that more Albertans are able to pursue this valuable education closer to home. We are also looking into continued long-term consultation with front-line workers to improve the decision-making processes in our health-care system.

I am hopeful that these steps will be the foundation of ensuring our province and our people continue to have world-class health care for generations to come. 

 

 

These are just a few of our major government accomplishments this past year. Our government is committed to continually taking steps to improve life here in Alberta. We are doing this by introducing legislation that is beneficial to Albertans in the most valuable ways while maintaining a strong fiscal position.

These types of policies have helped to stimulate our economy, which has led to our continued economic success. I am proud to be a part of a government that prioritizes not only what is best for our province but what is best for our people.

I look forward to seeing the continued success of our wonderful province and communities over the upcoming year. I know that this success would not be possible without all the wonderful people who call our communities home, which is why I would like to extend my sincerest wishes of a happy holiday season to you and your families. 

May 2023 be a year of health, happiness and prosperity for all!

Roger Reid
MLA, Livingstone Macleod

 

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. 

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. 

 

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Maternity care on the ropes in Pincher Creek

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