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February 28, 2020: Dozens of Calgary emergency room doctors speak out against cuts

Alberta government terminating master agreement and introducing new rules

Emergency room doctors in Calgary, like Shawn Dowling, left, and Stettler physician J.B. Lombaard, right, are speaking out against the Alberta government's changes to the health-care system. (Monty Kruger/CBC/J.B. Lombaard)


Last week's move by the provincial government to end its master agreement has prompted dozens of Calgary emergency room doctors to speak out, voicing their "deep and urgent concerns" with the resulting changes.

In a letter addressed to Health Minister Tyler Shandro, 85 Calgary emergency room doctors write that the changes will have "significant" negative short- and long-term effects on Albertans.

Shawn Dowling, an emergency physician at the Foothills Hospital and Alberta Children's Hospital, was one of the doctors who helped develop the letter.

"This is an unprecedented letter in Calgary. In 16 years here, I've never seen physicians get together to write something like this," Dowling said. "And that's a function of what's happening right now … we felt it was important for us to advocate for our patients and advocate for our primary care colleagues who are going to be severely impacted by this."

The new rules, which are now scheduled to be in place on April 1, will change how doctors are paid. One of the most controversial developments involves changes to a fee known as a complex care modifier, which doctors were able to charge if visits took longer than 15 minutes.

Dowling said the complete impact of the cuts would likely mean that family doctors won't be able to provide a complete level of care, which might mean more people could be pushed to Calgary emergency rooms.

"We're already bursting at the seams as it is. Undoubtedly, these proposed changes will increase the volumes in the emergency department, which is, from a patient perspective, not where they want to be getting their primary care," Dowling said. "From a system perspective, it's far more expensive, and less efficient and less effective."

'We share the same goal'

In an email to CBC News, a spokesperson for the health ministry said the Alberta Medical Association failed to put forward alternatives that would hold the line on physician compensation.

"We share the same goal as these physicians, improving care for Albertans while ensuring our health system is sustainable," said Tara Jago. "We are maintaining funding for physician services at $5.4 billion, the highest level ever and 25 per cent per capita higher than the national average."

Jago said that Alberta remains an "excellent place" to practise medicine, and "one of the lowest taxed provinces in the country."

"Even after the changes are fully implemented, Alberta doctors, including those in emergency departments, will still be among the highest paid in Canada," she said.

Comprehensive care

According to the letter released by emergency room doctors Friday, patients with complex medical conditions or mental health illnesses will "suffer the most" having to seek care in emergency rooms.

Edward Les, another Calgary-based ER doctor who signed the letter, said though he didn't like to read "catastrophizing" in the news about the proposed changes, he did feel that some impacts would be felt in the Alberta medical community.

"Most physicians will stay [in Alberta]. We're dedicated to our patients, we'll stick it out, grind it out," he said. "But, absolutely, the way this is playing out, it's becoming increasingly clear that in order to remain financially viable, some clinics are going to have to do things differently."

One of the unintended consequences of what has transpired, Les said, would be felt in the next generation of doctors.

"A larger proportion of those doctors will choose to establish roots in their profession in other jurisdictions where they feel more respected and where they can expect to have a proper relationship with government," he said. "That's really unfortunate, because that's our next generation of medical leadership."

In her statement, Jago said those physicians who felt that fee-for-service payment would not be viable should instead consider an alternative model, which she said will be expanded and improved this summer.

Emergency rooms outside Calgary

In Stettler, located northeast of Calgary, some doctors say they've given their notice to Alberta Health Services that they will rescind their emergency room practising privileges.

Dr. J.B. Lombaard, a family physician in Stettler, told AHS Friday morning he no longer wishes to work in the emergency room.

"[Working in an emergency room] comes with a personal cost and sometimes with a financial cost," Lombaard said. "Financially and personally, I had to make a decision on whether it was still viable to me.

"I don't know how to word this. But the financial reward makes it bearable for us to do it. And now there's just nothing incentivizing us to do it."

Lombaard said six out of nine doctors who work at the ER in Stettler are planning to rescind their privileges as of April 1, with the rest following suit in June.

"It's a high-risk job, medically and legally, and it's a high-stress job that takes me away from my family," Lombaard said. "So this means I'm spending time with my family, as opposed to sitting in the emergency room."

In a statement, AHS said it was working to ensure there would be no gap in service at the Stettler emergency room and would arrange to bring in temporary physicians in the interim.

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