When Elizabeth Fox moved from Athabasca to the central Alberta hamlet of Elnora in 2013, finding a family doctor close to home was a breeze. “I was pregnant,” she says, “so they’ll all take you.”
But seven or eight years later, her clinic emailed Fox to tell her she was being de-rostered—removed from her doctor’s list of patients—and would have to find a new doctor. She didn’t come in very much, and they needed the doctor for other patients.
“Don’t you just shift your patients around?” Fox recalls asking. They didn’t, and it was up to her to find someone new. With three kids and a declining number of doctors accepting new patients, that proved easier said than done. Her family joined the 650,000 other Albertans the Alberta Medical Association says lacks access to regular primary care.
Fox’s eldest has since moved out and is living on her own, but her two younger kids are still at home. Her middle child is almost through high school and has autism and social anxiety; her youngest has ADHD. Fox is a single parent and expects to apply for income assistance for her daughter once she graduates, but to do so she needs medical reports. Without a regular family doctor, she relies on walk-in clinics for these reports, but she says even some of those clinics now only see “overflow” patients—those people already registered to the clinic but who needed an appointment urgently. And it’s endlessly frustrating dealing with different clinics and their various policies and out-of-pocket charges, not to mention starting again from scratch with each new doctor she and her daughter see.
Fox thinks she might be able to find a doctor in Sylvan Lake or Olds, both about an hour away. But that’s not so simple either. “That’s a long drive, and being a single mom on a low income, it’s a struggle,” she says. “Sometimes we’ve got to move our appointments because I don’t have gas money.”
Her family joined the 650,000 other Albertans that lack access to regular primary care.
Fox has tried virtual options but doesn’t feel they offer the same quality of interaction as in-person visits, especially for her neurodiverse kids. Instead, she relies on pharmacists. (She paid one $45 recently to test her kid for strep throat.) Or the hospital. “It doesn’t matter what it is,” she says, “if it’s the littlest thing, I take them to emerg.” Wait times are long, but what else can she do?
“We,” she says, “are not getting the care we need.”
Fox is far from alone in her struggle to find regular care. In May 2024 the primary care networks of Alberta announced that visits to albertafindadoctor.ca had topped a million for the first time since the website launched in 2019. That represented an increase of 28 per cent over the previous year. Only 163 doctors were accepting new patients province-wide, down from 887 in 2020. This, at a time when the number of registered family doctors (and doctors overall) is increasing in the province. The College of Physicians and Surgeons of Alberta’s website reports 4,374 family physicians in the first quarter of 2024, which is 215 more than the same period the previous year.
How can there be a shortage, then? The explanation is that when family doctors are unsatisfied with longitudinal care (seeing the same patients, often proactively, over a long period), they have plenty of other options. Following medical school, they complete a two-year residency training program that prepares them for generalist practice. While some continue in full-scope “cradle-to-grave” longitudinal care, others choose narrower practices in sports medicine or labour and delivery or cosmetic medicine. In other words, doctors are not leaving. They’re narrowing their practice.
Michelle Hart can tell you why that happens. She trained as a general practitioner in South Africa before moving to Canada in 2004. For the first seven years she worked in Daysland, a central Alberta community of 800 people southeast of Edmonton. The hospital there served a large catchment area and had an emergency department; you could have your baby there and even be admitted for awhile after you were discharged from your knee replacement in Edmonton. Sometimes people drove from the capital to Daysland for urgent care because wait times were shorter there than in the big city.
Hart was one of three to five doctors who kept the doors open 24 hours a day. Together the doctors saw patients in clinics, did shifts in emerg, delivered babies, did rounds of inpatients and even did outreach clinics in two neighbouring towns. “There were no Canadians doing these jobs. We were all immigrants, so you keep your head down and mind your own business and do the work.”
Eventually, though, being on call for days at a time and working 90-hour weeks with young kids got the better of her. “[My husband] said he was done with super-rural life,” Hart says, “and if he was never going to see me, he was going to raise the kids in the city and I could come visit him.” She resigned her Daysland practice and the family moved to Calgary.
For the next six years she worked at a couple of different clinics—both of which closed due to financial issues—before starting Hart Family Medical in the southwest neighbourhood of Signal Hill in 2017. Now her clinic is also being squeezed.
Hart’s overhead is around 40 per cent. For something like a quick blood pressure check and medication refill, the government pays her $39.49. About $16 of that goes to supplies and to pay the electricity bill and to keep good people at the front desk. “You can’t pay [your staff] peanuts,” she says. “It’s very, very difficult.”
Hart has had a few doctors join her over the years—many of whom worked with her as trainees who then wanted to stay on as colleagues—but she says it’s hard to keep them. Money is only part of it. There’s also the paperwork, which she describes as “horrible” since the COVID-19 pandemic. Before the pandemic she says she might have done two disability tax credit forms; last year she did 20. And wait times are longer, which means family doctors have more letters to write and answer trying to get their sick patients seen somewhere. She had breakfast recently with two former trainees who are now several years out of residency. One was completely burnt out and the other, after having a baby, doesn’t want to come back to family medicine. “None of that generation wants to do it,” Hart says.
This is only a slight exaggeration. Michelle Morros works as a family doctor and directs the family medicine residency program at the University of Alberta. Last year she interviewed each of the 75 graduating residents and asked them what kind of practice they intended to pursue; only four saw themselves ever pursuing the kind of “cradle-to-grave” care people generally associate with family medicine. Very soon, Morros says, her heart started to sink. Many were going to leave the province—not unexpected, since doctors don’t always stay where they trained. It was when she heard that many who were planning to stay in the province were going to do a year of extra training in “enhanced skills” that she became especially worried. Enhanced skills training can be in emergency medicine, geriatrics, palliative care—a large array of skills considered part of a general scope of practice. All necessary, says Morros, “but my job is to create that comprehensive longitudinal doc. Once you do [enhanced skills], you don’t return to comprehensive care. They actually just become mini-specialists.”
Their reasons for not pursuing the kind of generalist care they trained for…? Morros says they don’t want to have to run a business. If family doctors’ compensation is going to be the lowest of all physicians, they at least want to rein in their hours and responsibilities. And they want to be able to take a vacation. Morros frames this as “moral injury.” Residents tell her that if they can’t get time away from their patients when they need to, then they’d rather not take on regular patients.
“They see some [doctors] who haven’t had a vacation in five years. They see others retiring, and their patients have nowhere to go. They don’t want that burden. It’s the burden of responsibility rather [than a desire for] a capricious flexibility,” Morros says.
Even new medical students seem to be feeling this pressure. Sana Samadi is a first-year medical student at the University of Alberta. She’s had people ask her to provide them with medical care—before she’s even a doctor. “That’s how desperate the situation is,” Samadi says. “People are just trying to find anyone they can. As learners, when we see a struggling system first-hand, why would we choose it?”
Back in Calgary, Michelle Hart doesn’t fault people for leaving or avoiding full-scope care. “All of them are lovely, smart, amazing human beings,” she says. “But they [want a] work–life balance, and I think we missed the lecture on that in school a long time ago.”
With the doctors who have joined and left her clinic in the last year or so, Hart estimates that about a thousand patients have been “orphaned,” meaning that when their doctor left there was no one to take over their care. Her own 1,500 patients might soon join them. The lease on her office runs out in October and she’s giving serious consideration to letting it all go then.
“Have you got an hour or two?” Paul Parks laughs when I ask him why it’s so hard for people to find a family doctor in Alberta right now. Parks is an emergency physician in Medicine Hat and the president of the Alberta Medical Association. While he doesn’t think it’s been malicious, he feels comprehensive family medicine has been neglected by governments for a long time, with fee schedules not keeping pace with increased demands on family doctors. Patients are living longer and have more medical conditions than in the past. They see more specialists, who all require communication.
Parks says the cracks were beginning to show even back in 2020, before the COVID-19 pandemic heated up. In February of that year then-health-minister Tyler Shandro made the unilateral decision to reduce or eliminate fees for complexity and additional time modifiers (extra amounts doctors can bill for a patient whose needs are not straightforward, say, heart failure with poor kidney function and a new infection). Shandro famously stated, “We don’t think that the population of Alberta is that complex.”
The announcement led to confrontations with physicians. The AMA called the clawback a disproportionate attack on family doctors, and shortly after released survey data indicating that 40 per cent of all doctors in the province were considering leaving—just as the healthcare system faced unprecedented challenges from a virus the likes of which the world had never seen. Shandro left the complexity modifiers alone and deferred further conversation for sometime in the future.
Most doctors ended up staying. But Parks says it was more a question of duty. “Physicians just sucked it up and took care of the pandemic,” he says. “I’m proud of my profession for that, because we didn’t carry on the war with government. We just took care of it.”
Four years later, though, the cracks are spreading again. Already people are not being seen at clinics. It means that while Parks still treats the usual accident victims and heart attacks, he also sees all the folks such as Elizabeth Fox who bring their kids to ERs for things that might otherwise be dealt with more cheaply in a family doctor’s office.
And survey data suggest things will only get worse. In January 2024 the AMA released results of a survey of family physicians in the province. Over a quarter responded. Of those, 61 per cent were considering leaving healthcare in Alberta altogether, while 54 per cent were at least considering leaving comprehensive care.
In Alberta only 163 doctors are accepting new patients, down from 887 in 2020.
Don Wilson is an obstetrician/gynecologist who formerly worked in Calgary but left for BC in 2020. “I sort of had this flash about how things were going to go with the healthcare system,” Wilson says, “and that’s why I decided to leave. I can’t stay and support this kind of a system that’s going to do this.”
By “this” he means the province’s unilateral changes to billing in 2020. Beyond what it might have meant for his own bank account and the stability of his practice, Wilson was concerned about what it might mean for primary care. Problems left untended upstream—preventive care missed, initial investigations not done, treatments untried—can lead to bigger problems downstream, where he works. Abnormal uterine bleeding not addressed by a family doctor, for example, can eventually land a patient in the emergency department with severe anemia waiting for the gynecologist.
Wilson was especially concerned about what it could mean for marginalized people. A member of the Heiltsuk First Nation, Wilson says he was particularly concerned about Indigenous patients, many of whom live in rural areas and have already been marginalized in the healthcare system. “The province has hemorrhaged family doctors, and Indigenous people have been disproportionately impacted.”
I spoke to Wilson in February 2024, more than a year after doctors and Alberta had agreed on a new physician agreement. He doesn’t regret leaving. His concerns with the UCP have now drifted toward the governing party’s stance on healthcare for trans people and to whether it might even defund abortion. “I didn’t have much of a political conscience until the UCP started what I would call an ideological war against the profession of medicine and public healthcare in the province,” Wilson says. “It really woke me up.”
If Wilson and the data are correct, and the province has hemorrhaged family doctors—or at least access to traditional family medicine—then what will stanch the flow?
It’s a problem the entire country is having. The Canadian Medical Association reports that more than 6.5 million of Canada’s 41 million people lack access to regular primary care, and that a third of people who do have a family doctor wait too long for an appointment. And adding training spots in residency programs isn’t a solution on its own if those positions go unfilled, as 22 did last year in Alberta, and a further 12 did this year.
All medical associations in the country are advocating for more team-based care to help ease the burden on GPs and to keep people healthier, and in 2023 health minister Adriana LaGrange announced that nurse practitioners (NPs) would soon be able to run independent clinics. Critics say that while the change may open more appointment slots in the short term, on its own it does nothing to make any clinic—whether staffed by MDs or NPs—more viable.
If family doctors’ compensation is going to be so low, they at least want to work fewer hours.
AMA president Parks is no Pollyanna, but recent progress on so-called stabilization funding gives him some hope. In December 2023 the province announced it would spend $200-million over two years to help pay doctors for work that currently goes unpaid: reviewing lab results and other documents, filling out forms. In addition there would be a new Physician Comprehensive Care Model that would give doctors an option other than fee-for-service, where much of the work has no applicable fee. That model is set to roll out this fall, though details at press time were sketchy. BC announced something similar in 2023, and Parks says it resulted in the recruitment of 600 new physicians to longitudinal primary care in that province.
Michelle Morros in Edmonton loves the work of primary care. She recognizes that her academic salary shields her from the vagaries of running a private clinic, so she can focus on the rewards of doing the work. “When I am in the room with a patient, I love it, the medicine,” she says. “I absolutely believe that if someone has a proper primary care provider, their health outcomes are so much better. I think that’s the difference I can make.”
But what of the fee-for-service doctors distracted from the medicine by trying to keep the lights on? If you ask Michelle Hart, she’ll tell you family medicine is dying.
You’ll get no argument from Rob Graham. When he was a kid growing up near Trochu, his whole family of six—two parents and four brothers—went to see the same family doctor in Innisfail. When Graham married, his wife started going there, and when they had a daughter, the baby went there too.
All that changed last year when Graham, who now lives near Pine Lake, turned 41. “[My doctor] retired after the last UCP government got in,” he says,” and her clinic closed down after that.”
His first thought was for his daughter. “She’s got asthma and allergies, so there were medications we needed, and it was, like, ‘How do we get these anymore?’” Graham himself has epilepsy.
He was told they could transfer their files to a new clinic in Innisfail, which he did, assuming they’d be guaranteed a new doctor. But no. While they’re able to access a walk-in clinic 14 km away in Penhold, like Elizabeth Fox in Elnora he’s unlikely to see the same doctor twice. And it’s beginning to matter.
After a long seizure-free period, Graham had two back-to-back episodes in January 2021. He works as a millwright and pipefitter. Besides a seizure being “a pretty rough experience to go through,” Graham also can’t work or drive for three months after he has had one, so it’s important to stay on top of things to avoid having more. When he can’t get a walk-in appointment, he uses an online medical service called Maple, which offers a membership subscription for $79.99 per month (plus applicable taxes), which fortunately his work benefits cover.
“Everyone screams about free healthcare in Canada,” Graham says. “If you can’t talk to anyone, it doesn’t matter if it’s free or not. It’s kind of useless. The way things are going, I’d almost rather just pay for it.”
Still, he holds none of this against his childhood doctor—or any doctor for that matter. “If people are going through charts until 11 o’clock at night,” he says, “and you see the stress on our doctors from trying to get everybody through, I mean, it’s a thankless system.”
The health minister declined to be interviewed for this story, but her office provided a statement: “Alberta’s government is committed to making sure Albertans can access primary care when and where they need it. We want to ensure Alberta can attract the best and brightest to our province.”
It’s possible the future compensation model will start to turn things around. For now, though, Rob Graham wonders why, if he himself wouldn’t put up with poor working conditions, Alberta’s family doctors should have to. “Those guys are working flat out,” Graham says. “I think our medical system is failing.”
Monica Kidd is a journalist and family physician in Calgary who writes about health and the environment. Her previous Alberta Views story (March 2023) is “A Mountain of Medical Waste.”
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