Day procedure room at CRH -- LNN

By Dori Modney

A letter from local doctors

Alberta health care system is intact – But, doctors ask “For how long?”

Apr 17, 2020 | 3:42 PM

LETHBRIDGE, AB — Physicians across the province continue to work under a heightened sense of awareness and urgency because of a one-in-one-hundred-year pandemic. They are doing it at a time when some would question “Why is the provincial government adding to their burden, at a time when they have enough to worry about?”

Dr. Ian Mitchell, a clinical professor of pediatrics and University of Calgary professor, has said it is unethical for the Alberta government to bring in changes to how doctors bill for service during the COVID-19 pandemic.

The province went ahead with changes to the physicians’ funding framework on April 1 – ignoring pleas from doctors and the Alberta Medical Association (AMA) to delay them so physicians could focus on the pandemic.

In Lethbridge, Dr. Samuel deWalle, previously told LNN that the biggest problem is that doctors are being asked to figure out how to restructure how they function under new rules, at a time when the medical system is dealing with the pandemic.

It’s been just over two weeks since the new framework was instituted and cracks are already showing in the health care system. Just this week, ten of eleven doctors in Lac La Biche have decided not to cover emergency and obstetrics services at the community’s hospital. Other physicians across the province are already looking to relocate to other provinces.

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With that in mind, LethbridgeNewsNOW has offered this space to Lethbridge and area doctors, so they can speak directly to you. The letter, below, is presented verbatim:

Dear Lethbridge and surrounding Community,

We are in troubling times. Both you as a community and we as Physicians, are feeling uncertain, unsettled and considerably frightened. One thrust of this fear for Physicians has been our current government’s plan for sweeping Health Care cuts, announced abruptly with the termination in February of the Physician Master Agreement and the implementation April 1st of a new Physician Funding Framework, purposely crafted without expert Physician involvement. This has been referred to in social media circles as a ‘Shandemic’.

A concerned group of Lethbridge Physicians had planned to have a factual and honest face to face with the public about the impact this imposed, and possibly illegal, government maneuver was going to have on your health care. We believe that a very large audience of concerned and engaged public had planned to be in attendance.

An overwhelming public health crisis has taken precedence 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 in light of rapidly evolving concerns that a public gathering would erroneously risk exposing our community to COVID-19.

Instead, every physician in this community, from clinic to hospital, has mobilized their skills and focused them on flattening the COVID-19 transmission curve, in an attempt to soften the dramatic morbidity and mortality effect being experienced elsewhere in the world. We will ease the burden of public concern and risk by employing our skills in advance of this illness and in doing so maintain the health and well-being of our patient public.

The COVID-19 Pandemic is ominous and worrying and epic in scale, and your Medical Professionals are up to the task on your behalf. As I write this, safe protocols have been developed and implemented to safeguard you and prepare our system for the frightening possibility that our isolation and social distancing guidelines prove inadequate.

But let’s be honest, Pandemic aside, placing ourselves in advance of health risks of varying scale and severity is our daily work. It is woven into the very essence of our livelihood, and deeply embedded in the personal reflection and motivation required for pursuing a career in medicine.

A simple example is your Family Physician guiding you on the intricacies of managing the sugar in your blood and the pressure in your blood vessels to reduce the risk of kidney failure and heart attack, while simultaneously recognizing and managing the risk your emotional state has on your overall balance of health.

Similarly, your Emergency Physician considers the severity of your abdominal pain in the context of your health history, gauges your physical wellness with their expert exam, and weighs this against lab and imaging evidence to calculate the risk that your symptoms are dangerous and thereby guide on safe intervention and 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 few examples highlight how Physicians champion your health care; through an almost incalculable daily collection of expertly executed risk-reducing medical decisions that place your Physician as the first and last line of defense against the intricate combination of variables that would potentially compromise you or your communities’ health. Such as is occurring in the current Pandemic.

In Alberta’s advanced health care system however, these decisions are routine for you. So common as to be mundane – taken for granted even. And this is a good thing, because in an organized, thoughtful and professional model of health care such as ours, the appropriate supports are in place to allow these risk reducing and life sustaining interventions to occur as implicit properties of the system.

They occur without you even realizing the professional expertise and collaboration underlying them and are implemented so smoothly that you simply assume this is the norm.

This is not the norm. In fact Alberta has, over the last 20 years or so, set itself up as the exception; an enviable model of integrated health care, with partnerships, alliances and expert consultations on your health occurring at every stage of your care pathway from rural to regional, clinic to hospital. The concept of the Family Medical Home emerged to capture this complex care integration, 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 the hard work and vision of the Alberta Medical Association -representing the expertise of the bulk of Physicians licensed in Alberta, a productive 15 year 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, as of the publishing of this letter, Alberta’s health care system is no longer likely to be a source of envy. It may eventually be regarded as an example of how to carelessly implode an innovative partnership, but what is clear at the moment is that your current comprehensive model of health care beyond the COVID-19 crisis is not guaranteed, as the system you take for granted is dismantled.

On February 20, the UCP government, citing provincial debt and an expensive and cumbersome health care system, terminated with little discussion or warning the Physician Master Agreement. Statements were made presenting Physicians as unwilling to negotiate or adapt, misinterpreting the distribution of costs in the system and placing an unfair burden of blame on claims of Physician overbilling, and suggesting that Physicians were not capable or 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 advisement on health care system implementation, and overwhelming evidence that fiscal awareness and system efficiency factored into each collaborative provincial discussion.

In a similar move of bad faith, on March 13th the Minister of Health announced a 1 year notice of termination of a newly renewed contract with provincial Radiologists; first accepting a retro-active cutback on fees related to imaging, then making the announcement once the recall money was in hand. The intention is apparently to award future contracts to the lowest bidder, wherever these Radiologists might be located.

Finally, our government, despite the desperate ongoing medical scramble to stave off the tide of COVID-19, has proceeded to implement the Physician Funding Framework April 1st, making the small concession to temporarily suspend the cancellation of complex care time modifiers for Primary Care. 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.

— Time modifiers are temporarily allowed, so during the Pandemic appropriate time can be allotted to manage complex patients. Afterwards, the reduction and loss of complex care modifiers will significantly shorten your Family Physician visit time. Complex integrated care will be a distant memory. Complex patients experiencing health crises will require multiple clinic visits to treat, 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 in-hospital General Surgeon coverage for trauma team activations. This 7-year program has decreased adult and pediatric trauma death in Lethbridge by 65%. Time is critical in these instances, and an increase in preventable traumatic deaths is highly likely with the loss of this program

— Similarly Palliative care has lost the stipend needed to cover the travel cost of home visits to vulnerable and dying patients. 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. Expect 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, the passing of which allowed the government 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-healthcare/

Realize you have a voice and your opinion is important. Please make your concerns known.

premier@gov.ab.ca – 307 Legislature Building, 10800 – 97 Avenue, Edmonton, Alberta , T5K 2B6, Toll free: 310-0000

health.minister@gov.ab.ca – 423 Legislature Building, 10800 – 97 Avenue, Edmonton, AB, T5K 2B6, 780 427-3665

Sincerely,

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