Some rural doctors in Alberta are deciding to offer fewer services, saying new measures imposed by the province are putting their practices in jeopardy.
The changes mean there is significant risk that many might decide to permanently close their practices, said Dr. Christine Molnar, president of the Alberta Medical Association.
“What’s happening right now is breaking their hearts in so many ways,” she said. “They are trying to find ways to survive in their businesses so they can stay in their communities and with patients and neighbours.”
Eight doctors in Sundre, Alta., for example, have said that after July 1, they will no longer work at the local hospital.
The doctors have said they will continue to offer care at the Moose and Squirrel Medical Clinic in town, as well as visit patients in the nearby town of Caroline, but recent funding changes have meant they can’t work at the hospital.
“We know the Alberta government needs to save money, and that healthcare is a part of this, but unfortunately instead of working with us, the government has chosen to dictate cuts,” Dr. Jena Smith, who works at the clinic, said via Facebook video.
“Doctors have spoken up for months and have said many times there is a better way to meet financial constraints and not damage patient care, but government didn’t listen,” she said.
Sundre isn’t the only rural town seeing doctors revoke services.
In Lac La Biche, Alta., 10 doctors decided to stop emergency room and obstetrical care at the local health centre effective July 31.
In Stettler, Alta., seven doctors resigned from offering emergency room care at the local hospital.
Many doctors across the province are hurting, said Dr. Carly Crewe, during the video on Facebook. Crewe works at the Sundre clinic.
“We know you (doctors) are feeling defeated, distracted and misunderstood,” she said. “We see the sacrifices you are making right now and we thank you for them.”
Much of the changes revolve around compensation.
For one, Molnar explained, doctors will now receive less money than they normally would when working in hospitals.
She said the government argues that because these doctors use Alberta Health Services facilities, which are entirely funded by the province, they should be paid less.
In rural settings, doctors usually work in hospitals and clinics. They still have the same overhead to pay at the clinic, essentially making it less affordable for them to work in the hospital, Molnar said.
“They need to see if they can afford to still do the hospital work, or do they now have to focus on that community clinic?” she said.
Another change that is affecting rural doctors revolves around medical liability insurance, Molnar said.
She said governments provide reimbursements to help cover some of the insurance costs. Doctors pay the remainder.
In Alberta, however, the province has reduced its reimbursements by half, Molnar said. This has particularly affected people who practice surgeries and obstetrics in rural settings, she said. Doctors practicing obstetrics help with pregnancy, childbirth and the postpartum period.
Usually in urban settings, she said, if doctors perform about 150 baby deliveries in a year, the first 100 can pay for the insurance. So, if reimbursements are cut and if rural doctors aren’t doing as many, it makes it difficult for rural doctors to continue to practice, she said.
Since the changes were announced earlier this year, the province’s doctors have been in a lengthy dispute with the government.
It’s reached to a point where the Alberta Medical Association has sued the province.
The association argues the province violated doctors’ rights when it tore up and replaced their funding agreement.
The province passed legislation that gave political leaders the power to unilaterally end deals with doctors, the association said.
It is seeking $255 million in damages. The claim says the government failed to properly consult with doctors, entered negotiations in bad faith and created an environment where it was impossible to have meaningful negotiations.
“The relationship with government has never been worse,” Molnar said.
The government hasn’t filed a statement of defence. None of the allegations have been proven in court.
On the issue of pay, however, the government has repeatedly said it isn’t making cuts to health care.
Doctors argue that even though there are no cuts, there are no increases that accommodate for Alberta’s growing and aging population, as well as for inflation.
As well, the province has previously argued that doctors in Alberta are highly paid when compared to other provinces. It’s MacKinnon report points to findings that show clinical payments to doctors are 35.2 percent more than the comparator provinces of British Columbia, Ontario and Quebec.
The Alberta Medical Associations has disputed these findings, providing its own report that shows Alberta doctors only make 5.7 percent higher than comparative provinces. By 2021-22, it says Alberta will fall slightly below the average at -2.5 percent.
Molnar said the association understands costs need to be reduced.
She said it offered solutions for the province to find savings, arguing some were more significant than what has been imposed, but the government didn’t bite.
“They rejected the offers we had,” she said. “We wanted to work collaboratively to sustain quality of care, as well as fiscal responsibility.”
The province has paused changes to the way doctors bill the government for longer patient appointments. It would have resulted in doctors being paid less for longer-than-normal patient consultations.