Lethbridge doctors say emergency department staffing “in a crisis”

He explained that, typically, the CRH emergency department has seven physicians working within a 24-hour period.

“Come July, we’re going to be in a position where we will, every day, be at least short of one shift, and there’s going to be other times were we have to cut out a second shift, so from seven throughout the day down to five shifts in total,” said Martin.

“What that’s going to result in is longer times where there is single physician coverage.”

The lack of adequate staffing levels, he adds, has a direct impact on both staff and patients.

Martin said that wait times at CRH have typically been under two hours, whereas other facilities in Alberta can see patients waiting anywhere from six to 12 hours for emergency care. Over the next few months, however, he expects the numbers in Lethbridge to creep up closer to the other hospitals.

“[Patients] are having a bad day to begin with, something is going wrong and that’s why they’re there. They’re afraid or they’re in pain or they have a significant medical problem that they’re very anxious about, so they need help with it,” said Martin. “Then, they’re faced with long wait times, which increases the tension. By the time they get to see our staff, they’re frequently a little less able to cope with staff than they normally would be.”

As the hospital staff are trying to do their best to deal with all of their patients, Martin said they often end up having to spend less time with each person.

He believes that this is an extremely complex issue and that it will not be easy for any government or organization to resolve fully. However, Martin said there are several ways in which improvements can be made.

He said that the Government of Alberta and Alberta Health Services have made numerous cuts to salaries and bonuses for recruitment and retention in recent years.

The physician told LNN that the next provincial government should take a serious effort to approve its relationships with doctors and come forward with a strong plan for recruitment and retention.

“The biggest problem is just a lack of bodies,” said Martin. “We need more providers, and rather than just stealing them from elsewhere and creating further shortages where they came from, the plan is going to have to allow more to enter into our training facilities, although that is going to take, in terms of physicians, a minimum of six-to-eight years before that new applicant comes through and is able to provide services.”

Both the United Conservative Party and New Democratic Party have pledged funding for a doctor training clinic in Lethbridge if elected in the May 2023 provincial election.

In the meantime, Martin said no one will be turned away at the CRH emergency department, but he asks people to be patient as the staff are doing their best to care for everyone.

If you are unsure if your medical situation constitutes a visit to the emergency room, Martin advises checking with your family doctor or phoning Health Link at 811 first.

The full letter from the group of local emergency department physicians can be read below:

May 2023,

A message to the people of the city of Lethbridge and area from Lethbridge Emergency Medical Services:

We are the physician group contracted to work in the Chinook Regional Hospital emergency department. We wish to make you aware of the risk of increasing delays and wait times in the coming months due to a shortage of local emergency physicians.

Our emergency department is a busy center serving both the city and southwestern Alberta, an area with over 100,000 people. In 2022 our department saw over 60,000 patient visits. Over the last 3 years our visit volumes have increased significantly every year. Our patient count is usually between 150 and 210 people per day in a department with 28 beds. We currently see more patients per day than other comparably sized departments in our province, while our wait times per visit have historically been the shortest in the province. The number of days when those wait times are reaching new highs have been increasing over the past year. There are many different factors that affect wait times. One factor we have managed well in the past is making sure we have enough doctors working to see new patients. Over the last two decades as visit volumes increased, we added new physicians to our group and expanded the number of hours scheduled per day. For the first time in the memory of our group’s members, we find ourselves unable to recruit and retain enough physicians locally to meet service demands.

Emergency medicine is our passion, but it is physically, mentally and emotionally demanding work that requires around the clock coverage from rotating providers. Fatigue and overstretching are dangerous to our patients. Years of increasing visits coupled with challenges in recruiting new doctors has reached a crisis point. We have lost physicians due to retirement, relocation and burn out. Turn-over is normal and is usually managed by recruiting new grads or other doctors looking for a change, both of whom are now harder to find. We currently rely on visiting locums to provide the work of about 4 full time doctors. We have about 1/3 fewer fulltime physicians to schedule this summer than in previous years.

Our department currently has a rotating schedule of 7 physicians each day, overlapping to provide anywhere from 1 to 3 available doctors depending on the time of day. Instead of increasing coverage to meet rising demand, we find ourselves unable to fill all the shifts in the coming months and are starting to reduce coverage hours. This means fewer hours with two or three doctors working. We will not be able to see as many patients as quickly as we usually do. It may mean a risk of delays in care to critically ill people, and much longer wait times for walkin patients with minor issues. We currently have several days in May and June with reduced coverage, and by July we anticipate a severe staff shortage with reductions possible every day moving forward.

We are doing everything we can as a physician group, and in association with provincial health authorities to prevent this from happening, including ongoing recruitment, efforts to increase out of town locum coverage, and exploring new coverage options. None of the efforts underway are simple or ideal fixes, so we wish for our patients and their families to be aware why you may be waiting longer. This is not the only challenge facing our department; local managers are currently struggling to fill several vacant nursing lines and staff current positions without burning out our highly trained and experienced nurses- many of whom have already moved to less stressful or more flexible jobs. With a high percentage of new and junior nurses there are necessary supervision and learning curves that can further delay care to make sure it is provided safely. Provincial initiatives have added positions for other health related professionals to assist in care, but many of these remain unfilled locally. Historic and sustained patient volumes in our hospital as a whole stress the entire system, and that stress often manifests as emergency department crowding and delays. We are not the only city or province facing such challenges, so solutions will not be quick or simple.

We recognize that with the current shortage of family physicians and lack of other urgent care options, many of you come to see us because you have no other option. We understand and will continue to do our best to provide care where other branches of our healthcare system are deficient. We ask for your patience and understanding as we try to do this in an environment of increased demand and decreased resources. Please do not delay seeking care if you are worried you may be experiencing a medical emergency.

We invite local and provincial leaders and political candidates to work WITH us and other local health experts to inform themselves of local health care challenges and work collaboratively towards local solutions. One size fits all provincial initiatives are rarely as helpful for local needs. We want our healthcare system to work well and are eager to engage in practical solutions.

Sincerely,

Dr Richard Buck

Dr Stephanie Brass

Dr Nathan Coxford

Dr Ryan Derman

Dr Nic Hamilton

Dr Matthew Kriese

Dr Magdalena Lisztwan

Dr Kevin Martin

Dr Nick McPhail

Dr Bilal Mir

Dr Wes Orr

Dr Alan Wilde

Dr Sean Wilde

by David Opinko

Lethbridge doctors say emergency department staffing “in a crisis”

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