Doctors Depart

By Tadzio Richards

Alberta physicians are closing family clinics, withdrawing from hospital services and even leaving the province. Since the start of 2020, according to the Alberta Medical Association (AMA), physicians at some 400 clinics have announced they’re closing, considering closing or laying off staff in municipalities as disparate as Ponoka, Pincher Creek, Lac La Biche, Calgary, Edmonton and Cold Lake. It’s an exodus of medical expertise, in part the result of a breakdown in negotiations over doctor pay and compensation, but more, as one BC-bound Drayton Valley doctor put it in an August 9 letter to patients, it’s about UCP legislation that allows for more privatization of the public health system and has created “a continual stream of fear and uncertainty for us working in healthcare.”

The relationship breakdown started shortly after the UCP formed government. In September 2019 the Blue Ribbon Panel on Alberta’s Finances recommended that the government consider legislating doctors away from the traditional fee-for-service model, which would make Alberta the only province to do so by fiat. In October the UCP introduced and later passed Bill 21, which gave Health Minister Tyler Shandro the power to kill the compensation agreement with the AMA.

In February 2020, citing an impasse in mediation, he did just that—Shandro cancelled the existing contract and gave his office full authority to set doctor’s fees, stripping the AMA of the power to veto fee changes. A new fee structure was announced, including a cap on the number of patient visits per day and a reduction in fees for visits over 15 minutes with complex patients. In response, the AMA filed a lawsuit against the ministry of health.

The UCP argues Alberta physicians are among the highest paid in Canada and “the $5.4-billion budget for physicians represents about 10 per cent of the entire government’s expenditures. Given the economic crisis the province is in, it is not unreasonable to seek a greater ability to control future increases in the physician compensation budget.” Further, “there is no need for a formal agreement to allow government to compensate physicians.” 

Immediately following Shandro’s decision to rip up the contract, some doctors felt they were in an untenable position. On February 24, Dr. Cathryn Zapf, a family doctor in Canmore told The Bow Valley Crag & Canyon that she would have to close her clinic. “Overheads are high in Alberta,” she said. “We have to pay for leases, staff and equipment. A large proportion of our fees go to pay for this, so with an income cut between 30 and 40 per cent it is not feasible to continue working in Canmore.”

Doctors in Fort McMurray, Claresholm, Grande Prairie and elsewhere also made plans to close their clinics. In April, in response to public outcry, Shandro announced that the fee changes would be permanently reversed in rural areas and paused in urban centres during the COVID-19 pandemic. The meaning of “pause” was clarified in May, when Premier Jason Kenney said doctors’ pay would be addressed again when the pandemic is over. Neither Kenney nor Shandro agreed to return to the negotiating table with doctors.

Physicians at 400 clinics said they’re closing, considering closing or laying off staff.

CTV News reported in July that Dr. Annelies Noordman had left the 2,200 patients in her Bragg Creek practice, uprooted her family and moved back to the Netherlands, saying government policies made her concerned about the future. She said her only option was to leave: “Go somewhere else and provide care in a way I think it should be provided… or I sacrifice my own values and give lower quality of care because that’s going to be the only way to keep the clinic open,” she said.

In July the UCP introduced Bill 30. It was aimed at overhauling the healthcare system by making it easier for private companies to offer medical services and allowing the government to contract directly with physicians. In late July an AMA survey found that 42 per cent of Alberta doctors are so unhappy with the government’s approach to physician funding that they “are considering uprooting their practices and homes to another province or country.” The loss of trust was expressed by one of those departing physicians, Dr. Don Wilson, an obstetrician-gynecologist at the South Health Campus in Calgary, in his resignation letter posted online in August: “I feel the conflict between the current government and the medical profession in Alberta has become too toxic and too unstable for me to remain here,” he wrote. “Pursuing profits over patients is simply a terrible recipe for bad medicine, and I cannot support this drastic change and the dismantling of the public healthcare system in Alberta.” 

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