CRH emergency room -- LNN

By Dori Modney

Hearing from the front line – local Doctor’s perspective on health care changes

Mar 31, 2020 | 5:16 PM

LETHBRIDGE, AB –– It spite of continued objections, the provincial government is going ahead with what the Alberta Medical Association (AMA) calls ‘irresponsible’ health care restructuring.

In the face of the COVID-19 pandemic, the AMA and Alberta Health Minister Tyler Shandro continued discussions. Association president Dr. Christine Molnar said in a letter to members that she met with the Health Minister on Friday and he committed to get back to her before the changes come into effect on April 1.

More than 800 Alberta doctors added their voices to the issue on Monday, by sending an open letter that asked the government to delay the changes and allow physicians to focus on the COVID-19 pandemic. However, on Tuesday (Mar 31), Molnar said the government is going ahead with the changes. LNN spoke with one of the 800 doctors who spoke out about the impending restructuring.

Local physician, Dr. Samuel deWalle, says the changes have created a culture of uncertainty for doctors.

“That sense of uncertainty may differ depending on what kind of medicine a physician is practicing. So, if I were working more in the hospital, I would not actually be sure what kind of resources we’re going to have available to us of April 1, because the government hasn’t explicitly said so.”

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Dr. deWalle says that he does most of his work in out-patient medicine, in a community clinic which has some night-time walk-ins. There’s been a number of changes for him.

“The government has somewhat de-incentivized seeing complicated patients who have a lot of health issues – that’s been one frustrating element. I don’t want to have to go to all my older patients who have to get driver’s medicals, and tell them that those (services) are all going to have to be paid out of pocket now. But, that’s something Alberta is mandating that we do. They’re (seniors) not going to be covering those anymore and I don’t feel great about that.”

Dr. deWalle goes on to explain other impending issues.

“The big concern that I have right now, and this is just me personally, is that we’re looking at the start of a COVID-19 crisis, and we’re in a bit of a calm-before-the-storm here – this is coming! We expect to see cases that will put a significant strain on the health care system, both in the hospital and out of it.”

“Concurrently with that,’ says deWalle, “the government has decided to institute these patient “encounter caps”, which means that, as a community-based physician, I’m not allowed to do more than a certain amount of things per day.”

“What that means, is that if the system is becoming overwhelmed, we’re no longer able to run our evening walk-in clinic in the way that we’d like to. In times without Covid-19, it’s been a popular option for people to use at night and we just wouldn’t be able to find a physician or staff for coverage to be able to do it any more.”

“In the time of COVID-19, we want the flexibility to be able to off-load pressure from the hospital and E.R. but, we’re going to be more limited in doing that.”

On the issue of a cap on how many patients a doctor is able to see, Dr. deWalle outlines how complicated it’s become.

“The problem is, it’s actually not 65-patients – it’s 65 encounters of any kind. I do a lot work in long-term care and if they send me a fax stating a patient has an issue and they ask if I can help deal with that. Well, the government counts that as an encounter – it’s not a patient I’ve seen but it’s an encounter that I’ve done – the same thing if the pharmacy asks for clarity on something we’re trying to get done for a patient, and that pharmacy interaction is an encounter.”

“The reason it makes a difference for being able to offer night time care is, I’m probably not going to get over 50 or 65 encounters in any given day, but every once in a while – every two or three weeks, I do work that night-time clinic and I would.”

” So, because they have been quite strict on that, I think the rule is designed to distance doctors from seeing 70 to 80 patients a day, which I have no problem with that , but there’s some unintended consequences here, that the service itself is going to be changing, in terms of what we’ll be able to offer.”

According to Dr. deWalle, a lot of the problem, is that doctors are being asked to figure out how to restructure how they function. He says while some of the things may make sense, some of them may not.

” But, they’e being instituted at a time when evrything is in flux, so not only are we dealing with the present changes that are coming on here, in a medical system that’s dealing with COVID-19, but we’re also trying to turn around and deal with a big change to the structure and the system, of how we operate and how we’re able to provide services to patients. It’s not proven to be something that’s taking something off of our plate, instead, it’s just proving to be something that’s overwhelming us.”

As for having any actual input, it hasn’t really happened, said deWalle.

“The AMA, which is our negotiating team of the Alberta Medical Association, had been meeting with the government for quite a while and offered a lot of cuts to our services. So, it’s not about money.”

“The government denied all of their (AMA) suggestions and they bluntly went on with their proposals, some of which will actually cost more money than they save, I’m convinced. But, they cut us out of it entirely – they tore up our master agreement, which I think, is the first time that’s been done in Canadian history, to cut us out of all decision making on this matter.”

“More recently, apparently, our health minister has been sitting down with the AMA again, but we’re not really privy to much of what’s going on, and that’s part of the issue as well – we really don’t know what to expect – we’d just really like some clarity. There’s enough uncertainty with the health care system with the health of our patients coming up and we’d like to be able to focus on that.”

“How I deal with a patient who’s coughing or maybe has influenza or do they have strep-throat or how can I see to that patient’s safely or how can we treat that patient safely in the context of COVID-19, while keeping ourselves and their fellow patients safe and there’s not a lot of extra time to focus on this extra stuff.”

There have been discussions with the government to hold off on instituting the changes for doctors, by the response from government, to this point, has been fairly silent.

Dr. deWalle says they would appreciate if they could just get some certainty, so they can focus on what they need to focus on.

Some of the changes coming to Alberta’s health care as of April 1st include:

— Albertans who are 74.5 years old or over will have to pay for their Driver Medical Exam out of pocket – seniors will need to pay at least $85.52 per year.

— Payments for referrals by non-publicly funded practitioners such as chiropractors, audiologists and physiotherapists for publicly-funded diagnostic imaging will be the responsibility of patients. Referrals by these practitioners would be deemed uninsured.

— Physicians will no longer be able to submit Good Faith Claims, preventing them from billing for the care of patients who cannot provide identification or a valid Alberta Health card, a move that will leave vulnerable populations without access to health care.

— There will be an end to clinical stipends, impacting primary care in rural areas especially.