Several doctors who practice in the Lac La Biche area have jointly filed a letter of resignation, saying they will no longer perform duties in the community's W.J. Cadzow Hospital as of July 31 of this year.
Their intentions were sent out today in a formal letter to provincial and local healthcare officials as well as local media. Doctors Richard Birkill, the hospital's current chief of staff and managing doctor at the Lac La Biche Medical Clinic, along with doctors Handre deRidder, Coenraad Claassens, Laurette Laubscher, Raylene Lategan, Eugene Marais, Cornelius Nortje, Barend Herbst, Feroz Parker and Tracy-Lee Lindebberg all signed the resignation letter.
On Associated Medical Clinic letterhead, all 10 doctors cited "government funding changes to our Schedule of Medical Benefit Claim fees" as their reason for "restructuring our Medical Practice to cope with the loss of income."
The provincial government recently announced plans to alter the way Alberta's general practitioners are paid taking away what Birkill has said previously accounts for about one-third of a doctor's annual pay. The cuts, he has said, come from a series of a dozen recommendations documented in a recently released overview of healthcare in the province. Provincial officials said they were acting in the best interests of the province's residents, noting that doctors in Alberta were paid significantly higher than other provinces. While the provincial government did walk back some of the recommended changes to billing in the wake of the COVID-19 pandemic, they still maintained a will to cut funding for on-call hours claimed by doctors who also work in hospitals. Those changes would see doctors who are on-call for obstetrics and emergency shifts at hospitals lose almost 50 per cent of what they currently claim in on-call billing.
Birkill was contacted for comment today about the resignation letter, but couldn't be reached before the first deadline of this story. In an interview with the POST just over a week ago, he said the government's plans to chop the on-call pay would be the equivalent of paying a certified doctor $10 per hour.
Lac La Biche County Mayor Omer Moghrabi told the POST this afternoon that he isn't surprised by the notice given by the doctors. The mayor is also a community member of the regional health authority.
"We knew it was something that could come," said Moghrabi, referencing the breakdown in negotiations between the provincial government and the Alberta Medical Association, conversations with regional health professionals, and a regional meeting held last month in Bonnyville that drew dozens of Lakeland residents and doctors from medical centres in Lac La Biche, Bonnyville, St. Paul and Cold Lake. "There was a discussion about resigning their hospital privileges at that meeting."
Despite the fore-warning, the mayor says the resignation letter is a concern for the region.
"I am worried — not only for our county, but also for the neigbouring people who come to our hospital," he said, listing communities like Janvier, Beaver Lake and Heart Lake Cree Nations, Kikino, Buffalo Lake Metis Settlement and Goodfish Lake. "We serve a wide range, from a wide area."
Emergency and delivery effects
With the 10 doctors threatening to step away from hosp tial duties, only a few doctors who only work shifts at the hospital would remain. The strain caused by the departure of the vast majority of doctors on the emergency ward and in obstetrics services would face serious challenges.
In 2019, there were 180 newborns delivered at the W.J. Cadzow Hospital. With not enough doctors to run the obstetrics services, expectant mothers would have to travel out of the community.
"You are looking at a minimum of two, two-and-a-half hours to drive to get your baby delivered," said the mayor.
The potential for decreased services at the local hospital will have an effect on the economics of the community, says Kal Polturak, the chairman of the Lac La Biche Regional Health Foundation, a not-for-profit society responsible for raising funds and awareness for needed medical services in northeastern Alberta. The foundation and its donors have raised the funds to bring a CT scanner service to the W. J. Cadzow Hospital and were significant promoters of the new dialysis ward in the facility. Portable heart monitors and a range of other items have been secured for the hospital due to the efforts of the foundation and its community connections. Polturak worries that without doctor-assisted services at the hospital, the community will suffer.
Polturak says he understand the underlying wage issues, but says the result of the resignation will leave everyone poorer.
"Nobody wants to lose a piece of their income, but right now, there really is no sector of society that is exempt from what we are going through. If this goes ahead, it could be devastating for the community," he said, adding that the recent push to attract and retain medical professionals in the region — something local doctors have been supporting as well — will be wiped away. "With no specialized services for doctors to practice, it will be one less reason to come to the community if you're a doctor."
Lac La Biche County council plan to raise their concerns across the province in the coming days, seeking support to bring Alberta's doctors and provincial government officials back to the bargaining table. Moghrabi said his council will use the combined strengths of the Rural Municipalities Association and The Alberta Urban Municipalities Association to pressure the two sides to re-connect. A similar group resignation took place in a few southern Alberta communities two weeks ago, just days before the Alberta Medical Association filed a legal lawsuit against the provincial government for breach of contract. Across northeastern Alberta, as of Thursday afternoon, only doctors in the Lac La Biche area had issued their notice. Health professionals in Bonnyville, Cold Lake and St. Paul had not issued a similar intention.
Replacement docs could fill gaps, says GOA
Alberta Health Minister Tyler Shandro's press secretary Steve Buick told the POST Thursday night that if the local doctors drop their hospital shifts, provincial assistance will be provided to maintain services.
"If these physicians choose to voluntarily give up their privileges in a way that would reduce access to care, we will work with AHS to replace them and ensure access is maintained. We will also begin exploring longer-term solutions to augment and stabilize physician services in Lac La Biche and any other community as required," he told the POST, adding that he couldn't specifically say if rural doctors in other regions had sent similar letters of intent to the government. "We cannot provide confidential information about individual physicians — but there has been no significant increase recently in notice of intent to withdraw compared to the average."
According to Buick, the province's ministry of Health is maintaining its $5.4 billion physician payment budget for 2020. With recent changes to support physicians during the COVID-19 pandemic, he adds, those payments will likely be even higher. The ministry officials are also saying that planned changes to per-patient visit fees have been replaced with unlimited call or online visit fees, and that AHS has suspended planned changes to stipends paid to physicians.
In the days following the Alberta Medical Associations legal action against the province, and relating to the Lac La Biche doctors' announcement today, Buick also pointed out a clause in the Standards of Practice for the College of Physicians and Surgeons of Alberta that states a member must not withdraw services that directly or indirectly support a job action if the action would put patients at significant risk.
Get back to the table
Mayor Moghrabi says residents will likely express concerns towards both sides of the medical debate. He can also see both sides, but questions the timing of the government's continued push to go after doctors' earnings.
"I think the reaction from residents is going to be, 'You're kidding,' and I think they will be mad at both parties," he said. "Our resolution to present will be as nice as we can be, being respectful — but I have to say that we are the only place on the globe right now that is fighting with its medical people in one of the best medical services on the planet."
Council's formal response and request to get the doctors and provincial officials back to negotiating is expected to be formalized in the coming days.
"We are going to keep on moving forward in terms of trying to get both parties to the table," the mayor said.
*This article was updated at 11:49 pm April 16 to include comments from Alberta Health Minister Tyler Shandro's press secretary.