October 26th, 2020

Battling a pandemic, ‘Shandemic’


By Lethbridge Herald Opinon on April 22, 2020.

By Southern Alberta Physicians

Dear Lethbridge and surrounding community,

We are in troubling times. Physicians and the community are feeling uncertain and frightened. One aspect. of this fear is the government’s health-care cuts, which have included terminating the Physician Master Agreement and implementing a new Physician Funding Framework without expert physician involvement. This has been referred to in social media circles as a “Shandemic.”

Lethbridge physicians had planned to have a factual face-to-face with the public about the impact these changes are going to have on health care, and a large audience was expected to attend. An overwhelming public health crisis has taken precedent, however, placing the funding crisis appropriately in the background.

The COVID?19 pandemic now carries the weight of our concern, and the Lethbridge Physician Town Hall on Health Care: Public Education Forum was postponed to prevent COVID?19 transmission. Instead, every physician in this community has focused their skills on flattening the COVID?19 transmission curve to maintain the health and well?being of our patient public.

The COVID?19 pandemic is ominous and epic in scale, and your medical professionals are up to the task. As I write this, protocols have been implemented to safeguard you and prepare for the frightening possibility that our isolation guidelines prove inadequate. But let’s be honest, pandemic aside, placing ourselves in advance of risks to your health is our daily work, and is woven into the very essence of our livelihood. Your family physician treating your blood sugar and blood pressure to minimize the risk of kidney failure and heart attack is an example. As is your emergency physician examining you for abdominal pain, using imaging, labs and expert clinical acumen to assess the risk that your symptoms are dangerous and guide on safe treatment.

The same risk management skills are expertly applied by your obstetrician delivering your children, your pediatrician in the neonatal intensive care unit, your surgeon in the OR, your radiologist reviewing your mammogram, your geriatrician testing your cognitive function, your palliative-care physician attending you at home, and many more.

These examples highlight how physicians champion your health care through numerous expertly executed risk-reducing medical decisions. In this manner, your physician defends you against the complex variables that would potentially harm your health; such as is occurring in the current pandemic. In Alberta’s advanced health-care system, however, these decisions are routine for you, even taken for granted. And this is a good thing, because in an organized and professional model of health care such as ours, the appropriate supports are in place to allow these risk-reducing interventions to occur as implicit properties of the system. They occur with professional expertise and collaboration, and are implemented so smoothly that you simply assume this is the norm.

This is not the norm. In fact, Alberta has an enviable model of integrated health care, with partnerships, alliances and expert consultations on your health occurring at every stage of your care pathway. Alberta can claim the concept of the Family Medical Home, the foundation of which encompasses health-care philosophies such as patient?focused, comprehensive and accessible. Intelligently applied and smoothly integrated, your routine health-care visit is exactly that, routine. For this you have to thank 15-plus years of hard work by the Alberta Medical Association, which represents the expertise of the bulk of physicians licensed in Alberta, a partnership with the Primary Care Network, a Department of Health-funded health-care initiative launched in 2005, and a legally binding Master Agreement with Alberta Health/Alberta Health Services that frames the ongoing professional dialogue driving these innovations. These collaborative partnerships have established Alberta as a Canadian leader in primary-care performance, such that our model is being adopted in many other provinces and regions.

Unfortunately, Alberta’s current health-care system is in trouble. Beyond the COVID?19 crisis, the current comprehensive model is not guaranteed, as the system you take for granted is being dismantled. On Feb. 20, citing provincial debt and an expensive and cumbersome health-care system, the government terminated the Physician Master Agreement. Physicians were presented as unwilling to negotiate, the distribution of costs in the system misrepresented and an unfair burden of blame placed on physician billing, and physicians told they were not welcome to participate in problem solving the health?care system portion of our provincial debt. This is simply untrue, and in direct contrast to the productive history of expert physician guidance on our health-care system, and overwhelming evidence that fiscal responsibility factored into each collaborative provincial discussion.

Instead our government, despite the current medical scramble to stave off the tide of COVID?19, has proceeded to implement the Physician Funding Framework and restructure the health-care system. A concession was made to temporarily suspend the cancellation of complex care time modifiers for primary care, but all other health-care cuts outlined in this document will proceed as planned. Attempts by the AMA to re?initiate negotiations have been declined.

So where does that leave you and your physicians? Uncertain and in total chaos, that’s where. In the midst of the current pandemic, it is hard to envision the long-term implications, but here are some immediate repercussions of these dictated cuts:

– Limits have been placed on total number of daily patient visits. After-hours walk-in clinics are now closed, possibly permanently. Your after-hours care option will be limited to Emergency.

– The eventual reduction and loss of complex-care modifiers will shorten your family physician visit time. Complex patients will require multiple clinic visits, spend more time in Emergency and suffer increased hospital admissions.

– Key palliative care, on-call trauma surgery and other critical programs have lost clinical stipends. Many of these programs will be cancelled including two vital ones below:

– The Acute Trauma on-call service, which provides general surgeon coverage for trauma. Time is critical in these instances, and an increase in preventable traumatic deaths is highly likely with the loss of this program.

– The palliative care travel stipend. Home visits may no longer be possible, and palliative patients will experience increased hospital admissions for care.

– In-hospital consultation fees are being cut, which will make hospital work unsustainable for some specialists and rural physicians.

– Emergency will experience challenges with increased volume and increased wait times.

– Diagnostic imaging fee rules and codes have been altered. Wait times will be longer. Possibly, when the provincial radiology contract is terminated, your imaging may be contracted out of province.

– If you are 74.5 or older, your drivers medical visit is no longer covered.

– “Good Faith” claims are no longer accepted. Individuals without proof of residency or Alberta health coverage, as can occur in certain challenged populations, will not receive care coverage.

– Bill 21, used to cancel the Physician Master Agreement, also stipulates that the Minister of Health can restrict new physician practitioner identification numbers, and dictate where they are allowed to work. Along with a possible exodus of current physicians, new graduates will seek practice opportunities outside of Alberta.

So, if you are finding the current pandemic frightening, then what comes next should have you petrified. Your physicians are working hard to protect you from COVID?19, but we are no longer part of the team guiding our health-care system. Instead, tax dollars are being spent to promote virtual health-care platforms such as Telus Babylon to fill the void these cuts will leave. These platforms are not supported by the AMA and have not had Alberta physician input.

Please stay informed, speak with your physician. The following links are helpful for comparison.

https://www.alberta.ca/physician?funding?framework.aspx

https://wildeandrandom.ca/2020/02/22/incompetence?and?consequence?albertas?new?framework?for?health?care/

Realize you have a voice and your opinion is important. Please make your concerns known by emailing: premier@gov.ab.ca or health.minister@gov.ab.ca.

Dr. Garland Jonker, Campbell Clinic South

Dr. Samuel deWalle, Bigelow Fowler Clinic South

Dr. Eadaoin Ni Choileain, Bigelow Fowler South

Dr. Michael Cunningham, Bigelow Fowler Clinic West

Dr. Jessica van der Sloot, Campbell Clinic South

Dr. Fred Rinaldi, Family Medicine, Medicine Hat

Haig Clinic Family Physicians

Dr. Erin Appleton, The Lethbridge Breastfeeding Medicine clinic

Lethbridge GI & Surgical Associates

Dr. Sean Wilde, Emergency Medicine

Dr. Bilal Mir, Emergency Medicine

Dr. Kevin Martin, Emergency Medicine

Dr. Peter Kwan, Emergency Medicine

Dr. Dionne Walsh, Lethbridge Palliative Care Physician

Dr. Elvira Smuts, Lethbridge Palliative Care Physician

Dr. Hollis Roth, Lethbridge Palliative Care Physician

Dr. Abdul Shukkoor, Lethbridge Palliative Care Physician

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Resolute

Take it up with AHS or suck it up. Money does not grow on trees and if it did our governments would cut them down for some reason. Are not Alberta doctors and medical staff the highest paid in Canada? I do not want to hear more hysteria from ndp doctors. My doctor does not share these “concerns”. Health care aids are getting raises at this time. Not sure where that tax money is coming from.

Southern Albertan

While it is true that Alberta’s physicians are the highest paid in Canada, they are not “ndp doctors.’ Even when the AB NDP was in government, they had “targeted doctor pay as one of three major areas of the health system where the province must bend the cost curve.” Perhaps, it is more, on how, the Kenney UCP dealt with the doctors in their authoritarian manner. After all, one can attract more ‘flies’ with honey than with vinegar. It remains as to decreased available health services due to cutbacks.
When the Klein health care cutbacks happened, one doctor in Lethbridge said, “people have to decide what they want,” and another one said, “health care in Alberta had been Nirvana.” Lethbridge lost 200 acute care beds then, and an expanding city and surrounding area is expected to cope with half the beds? Albertans then, may have to be prepared to not have their expectations met if they become ill or injured.
The other 2 areas of troublesome health care expense in Alberta are: rural health care because of the distances, and, pharmaceuticals. The rural health care issue is a bit dicey for the UCP because most of their votes came from rural Alberta. And pharmaceuticals? Are the Kenney UCP prepared to force ‘Big Pharma’ to do more cost-effective medication deals?
I do not believe we need to suffer any illusions that more health care cutbacks are coming. So again, Albertans will need to decide ‘what they want.’ Sometimes realizations are learned the hard way, unfortunately. It may be helpful to know that Alberta still, has not recovered from the Klein era health care cutbacks. Many fantastic Alberta health care professionals then, went over the border to the USA resulting in a shortage of physicians and Registered Nurses to this day. And speaking of cutbacks to postsecondary institutions, spaces for enrollment in med schools at the U of C and U of A during the Klein years, were cut….again, contributing to the shortage of physicians in Alberta, to this day. Penny wiseness and pound foolishness, and all the while, we get to pay $billions for a pipeline that might not ever get built, a $4.7 billion corporate handout, decreasing $billion dollar corporate tax rates….courtesy of us pleibian taxpayers. And, a Kenney UCP authoritarian government who is not tending to economic diversification or other avenues of revenue.

Les Landry

You call them “NDP Doctors” and the reality is most Doctors supported the Cons.
And while you say that Alberta Doctors are the highest paid in the country, you will never hear the UCP government tell people, Alberta also has the highest paid MLAs in the country.
I have to question where we get the most value for our “tax-dollar?”
I wonder what one will be there to deliver someone’s baby, or be there to tell a parent their child “didn’t make it.” It is the Doctor that tells a child their mother will never be going home and then go home and have survivors’ guilt because their children are healthy and happy. I wonder what one will be sewing up the guts of a child after the car crash.
It is our medical professional that have to survive the living Hell of PTSD for the rest of their lives after seeing the horrors of death that would make most people vomit.
So Mr. Resolute, I wonder a lot of things, but what I wonder the most is how you and people with your attitude can write off our medical professionals as if they’re not contributing to society. Because they contribute the most in ways nobody can understand and thank God most people will never have to take home the memories our Doctors and nurses live with every day.
On April 17, 1998, it wasn’t any politician that sat me down and told me my wife of 17 years was never going to recover and it was time to disconnect life support, it was a Doctor and while you may honour the self-serving politician, “my hero wears a white coat.”
And in closing, I will say, “at least I can sign my name to my words.”

phlushie

thank you les. truer facts were never brought forward as eloquintly as you have.

biff

the letter does well to share a very complicated matter in limited space. the nut of the issue is the current govt is undermining the health and safety of albertans, and, likely, is looking to create a premeditated and false pretense for private health care.
res, your comments are both simplistic and concerning. your entry comes off as one that cares only about number one, and little about others or the bigger picture.
as so.ab notes, the the problem is more about where the money keeps being given away, and where and why shortfalls are being created.

Dennis Bremner

I would prefer to have Doctors address the issue that the Alberta Government has with the medical system. But you notice they do not, why? Why not look at the Alberta Spending on Health Care and confront Kenney with the fact that he is wrong and Alberta does get “the same bang for the buck or better” than comparable provinces?
It would seem to me if the Medical Association was so sure of itself and its services it would be embarking on the comparison immediately! So why not do this rather than write letters attempting to quantify what you do, how you do it, and not show costs that are either cheaper, or equal to other provinces for the same service? Uttering pending doom scenarios where I pay more is not only obvious, but it should not be used to create fear. Alberta has far less money, PERIOD, or are you not aware of that? So now, what is your roll in this? Nothing?

Not addressing it makes one believe something is hidden? Are the UCP pulling a fast one or are you? So stop with the outrage, and start proving them wrong and compare actual costs vs service.

I realize that during COVID you will raise more sympathy, in fact I am more sympathetic to the issue, however I am not sympathetic to the problem. The problem is, Alberta will likely have 1/5th of the revenue it had 5 years ago when you argued the same argument!
So, show us all, you understand that! Do a formal analysis and comparison to other provinces, so the UCP cannot pull that card any longer! It makes one suspect you choose not to do it because you really do not want to see the answers?
Also, do not use your professional title to scare Albertans into believing because were broke, you deserve more or “the right” to continue, as if we weren’t broke!
Show us you really do understand at least that, so far I see ZERO understanding of the term “broke”!