Family medicine in crisis in Lethbridge, SACPA told

By Alejandra Pulido-Guzman - Lethbridge Herald on March 2, 2022.

LETHBRIDGE HERALDapulido@lethbridgeherald.com

The Southern Alberta Council on Public Affairs (SACPA) welcomed Dr. Samuel deWalle to their Thursday virtual meeting to discuss the family medicine crisis in Lethbridge.
Congruent with the COVID-19 pandemic has been a gradual but persistent loss of family physicians in the city of Lethbridge, and with them the loss of access to primary care.
Dr. Samuel deWalle is a family physician living and working in Lethbridge since 2013. He graduated from Calvin University in Grand Rapids Michigan, and then the University of Calgary Medical School, before completing his residency in Rural Family Medicine in southern Alberta.
He is the outgoing president of a family medicine clinic in Lethbridge, a board member of the Chinook Primary Care Network, a Civil Aviation Medical Examiner, and a Medical School Clinical Lecturer.
“I talked to many different individuals and organizations trying to get opinions and data but if I made an error with that with anything I tell you today that error is mine,” said deWalle.
By the end of 2021, approximately 45 per cent of Lethbridge citizens found themselves without a family physician.
“I’m getting asked daily by several people to take them on, to take their family members on, the hospitals are discharging babies to nobody. There are long term care organizations trying to find someone to watch your grandma and struggling to do so,” said deWalle.
He said the numbers of physicians doing primary care has dropped recently. At the end of 2020 there were about 88 doctors who do more or less what he does here in Lethbridge. By the end of 2021 that number was 69 and is dropping further.
“Somewhere between 2014 and 2016 we were in a place in Lethbridge where if you wanted to have a family doctor you could have one, there were consistently people accepting new patients and so much so that people would move from one position to another because that clinic was closer to their house or some other cause,” said deWalle.
He said back then his clinic had the ability to run 10 evening or urgent care clinics in a week in two different locations.
“We had about 20 to 23 physicians at any given time so at that point we were at 88 positions,” said deWalle.
He said that from a systemic standpoint a robust primary care is important as it is associated with improved access to healthcare, and more broadly associated with improved health outcomes, decreased illness, increased mortality across population, and is also associated with fewer hospitalizations and fewer emergency room visits. In 2018-2019 they were able to offer that type of care.
“But then in October of 2019 the government tables Bill 21. The government gave itself the right to unilaterally terminate an agreement or contract with physicians,” said deWalle.
He said the government also gave themselves rights regarding any theoretical future contract that was signed, and the government would have the right to extricate itself from it unilaterally. And around that time, they were also talking about controlling where physicians could practice medicine.
“Meanwhile the contract between Alberta physicians and the government was expiring and there was negotiations between the Alberta Medical Association which represents physicians and the government. In February of 2020 mediation to create a new agreement had failed at that point,” said deWalle.
He said that on Feb. 20, 2020, the government used their newly-acquired powers and terminated that agreement.
“We didn’t get any notice of that, we learned about it through the media and this kind of thing hasn’t been done before in Canada,” said deWalle.
At that point doctors were capped at 50 encounters per day, and things like talking to a pharmacist, answering a fax or talking to a specialist for advice, counted towards those encounters.
“That basically stopped us from being able to do evening clinics. There are too many physicians that said ‘well I did too much today, I can’t do more’ and we couldn’t ask the remaining physicians to run as many walk-ins as we were doing and COVID had an effect on that too,” said deWalle.
He said around April 2020, it felt like they were living in a bizarro world. Physicians started to create Twitter accounts to follow the health minister at that time to know what the terms of employment were going to be.
“We would hear Thursday evening there’d be something on Minister Shandro’s Twitter page that would say this is how things are now, and then we hear about it through official channels the next week or two weeks later,” said deWalle.
He then explained Bill 30 where the government wanted to take over the College of Physicians and surgeons, which was happening in July 2020.
DeWalle said that in October 2020 the College of Physicians and surgeons reported the amount of positions was nearly stable, but it was not accurate because that was just counting who had an active license and not who was practicing.
By the summer of 2021 clinics started to shut down due to lack of physicians and by the end of 2021 Minister Shandro was replaced.
“Where we are now which is maybe more of a stable place compared to the last two years, roughly I hope, but not out of the woods by any means and I think a lot of what’s going to happen next will make a big difference in how we go from here,” said deWalle.

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