May 24, 2023

Our fellow Albertans,

As emergency doctors we have front row seats to a critical system-wide healthcare crisis in Alberta. Despite our best efforts to provide comprehensive and accessible care 24-hours a day, 7-days a week, we are increasingly unable to do so.  We are writing this letter to add our voices to the growing concerns of the state of healthcare in our province and as a call for action.

Signs of a capacity crisis are everywhere. The wait time in Calgary’s Emergency Departments has skyrocketed, with patients sometimes waiting up to 15 hours to be seen by a doctor. These patients often become sicker while waiting. We worry about these patients every shift.  It is now common to have 40 to 50 people waiting to be seen by a doctor at any given time in any of our emergency  waiting rooms. Frail, elderly patients languish on stretchers in hospital hallways. Patients with mental health crises are housed in the emergency room, often for several days, while awaiting inpatient beds. Sections of our emergency departments are routinely closed due to a lack of our highly skilled specialized emergency nurses. Increasingly, there are gaps without surgical and cardiac specialist coverage in our city’s hospitals. While all of this is occurring in Alberta’s largest city, we are regularly asked to consider covering rural sites who are equally suffering with staffing shortages and intermittent closures of their urgent care and emergency departments.

Every one of these patients and their families have a personal story. What they have in common is they all come to us seeking help. They are our grandparents, our parents, our sons and our daughters. We have devoted ourselves and our careers to caring for our fellow citizens and our inability to help them in a timely or effective manner causes significant distress.

 

How did we get here?

It is not surprising that a pandemic would negatively impact health care delivery. The further erosion of our emergency departments, however, is a combination of the pandemic aftermath and unfortunate and untimely government policy . Outlined below are three critical areas of concern that we feel directly impact patient care: lack of access to primary care, lack of hospital beds, and critical healthcare labour shortages.

  1. Lack of access to primary care in Alberta

Every doctor working in public health care will tell you that the backbone of our entire system is primary care. Four years ago we could proudly say there were enough family doctors for every Calgarian. Fast forward to today and it is estimated that 650,000 Albertans are without a family doctor. This is due, in no small part, to the destabilisation of primary care through government policy1.

Through the payment structure imposed by Alberta Health, family doctors are discouraged from working in family medicine clinics providing longitudinal care, and are incentivized to work in specialty roles. During the pandemic, financial support was given to new, industry-sponsored, virtual care programs, instead of existing family medicine practices and Primary Care Networks (PCNs). This has led to loss of family doctors to other provinces/countries, to private clinics, or to hourly paid positions outside of traditional family medicine practices. A recent poll conducted by the Alberta Medical Association’s sections of Family and Rural Medicine produced some alarming projections. More than half of the doctor respondents intended to reduce their family medicine practice in the next three years. Almost three quarters of the respondents indicated that the results of the upcoming election will further impact how or if they decide to continue practising medicine in Alberta.

 

Worse still, our ability to attract new doctors to Alberta is equally disheartening. A shocking 42 residency training spaces in family medicine in Alberta went unfilled this year after the first round of matching. This is compared to British Columbia having just 2 spots unfilled and Saskatchewan having none2. The future looks bleak for primary care in this province when we cannot fill positions designated to train the next generation of family doctors.

 

When patients are unable to access a family doctor for their medical concerns, they present to the emergency department as their last resort, seeking help. Patients are often sicker than they would have been had they received timely and comprehensive care by a family doctor. Providing primary care in the emergency department directly erodes our ability to provide emergency services, leading to unnecessary financial costs to the system, and resulting in less effective care for chronic health issues.

 

  1. Lack of Hospital Beds

 

Calgary hospitals often function at over 100% capacity. This is a complex problem with multiple causes, but is exacerbated by many patients admitted to the hospital who are unable to be discharged due to a scarcity of long term care spaces. An inability to discharge patients from the hospital creates a backflow into the emergency room. A patient may be admitted to an inpatient hospital bed but will physically remain in the emergency department as an “emergency in-patient” (EIP). These patients sometimes wait for days for an appropriate bed elsewhere in the hospital. On an average day across the Calgary Zone, these EIPs occupy approximately 25% of our emergency department beds. On a bad day, this number can reach 80%, leaving us with only 20% of our working spaces to treat patients from the waiting room with acute problems requiring emergency care.  

These EIPs have complex care needs that are best met by the specialty nurses and health care team they are admitted to, such as cardiology, psychiatry and internal medicine. When these patients remain in the emergency department, their care is delayed, and puts increased demands on our emergency room nurses. This can cause unfavourable nurse to patient ratios and competing demands for their time. From the patient’s perspective, languishing in the emergency department for days must be a horrific and inhumane experience. Sadly, these patients may suffer poor outcomes and significant morbidity.

  1. Critical Healthcare Labour Shortages

 

During the pandemic, emergency nurses were mandated to work overtime at the end of already gruelling shifts. Due to significant labour shortages, their holiday requests have often been denied. Further, the understandable frustration that is felt by patients waiting long hours to see a doctor is often directed at our frontline nursing staff. Amidst this situation, the government suggested a nursing pay cut. The cumulative effect has been that many experienced emergency nurses have decreased to part time work, have gone to work as emergency nurses in other provinces/ countries or have left the emergency department altogether, creating an ongoing shortage of nursing staff.

With increasing staff shortages, there are many more circumstances of unsafe and unduly stressful work environments. Due in part to this lack of nursing staff, a significant proportion of the emergency room beds are “closed” every day. A lack of available staffed spaces means that while doctors may be available to see patients, safe and private areas in which to do so are not available. As a result, patients then wait extra hours to be seen. Alberta Health Services has made the decision to hire temporary travel nurses, who are paid 2-3x more per hour than a permanent nurse and they often lack emergency-specific training. This has further fueled discontent amongst the highly trained and hard-working nurses that have devoted their careers to emergency medicine.

The labour shortages are not confined to family doctors and nurses. We are now witnessing the effects of burnout on our own emergency doctors colleagues. Many doctors, including those early in their careers, are choosing to leave for other areas of medicine. The staffing crisis is real and only getting worse.

Our emergency departments are collapsing and frontline healthcare workers have truly had enough. We cannot bear to watch our patients suffer any longer with no end in sight.

How do we move forward?

 

First, we need the Alberta Government and Alberta Health Services to recognize the current crisis. This crisis will require resources and innovative solutions to move forward. Specific priorities include addressing patients’ lack of access to primary care, inpatient bed deficiencies, and retaining our skilled emergency department workforce. It is a long road ahead to recovery. There are multiple paths we can take as we set about repairing a system that has degraded significantly over the past four years.

 

There is an election fast approaching and we hope that healthcare is a top priority for political parties and for voters. The health of our population depends on this. It is our sincere hope that whomever forms the next government will begin the process of repair, starting with the restoration of what was once a respectful relationship with frontline healthcare workers.

To our patients:

Are you having trouble finding a family doctor? Are you waiting for tests, treatment or surgery? Have you had a significantly long wait in the emergency department? We want your perspective. Submit your experiences to Patients First: https://www.patientsfirst.ca/.

Sincerely,

  1. Dr. Ahmed Saleh, MD, CCFP-EM, RGH
  2. Dr. Alexandra Pistore, MD, CCFP-EM, PLC
  3. Dr. Allison Foran, MD, FRCPC, FMC/PLC
  4. Dr. Alyssa Morris, MD, FRCPC, FMC/RGH
  5. Dr. Amanda Schreiner MD, CCFP-EM FMC/PLC
  6. Dr. Andrea Boone, MD, FRCPC, FMC/ACH
  7. Dr. Andrew Anton, MD, MSc, FRCPC
  8. Dr. Andrew Battison, MD, CCFP-EM, FMC/SHC
  9. Dr. Andrew Fagan, MD FRCPC FMC/SHC
  10. Dr. Andrew McRae, MD, PhD FRCPC. FMC
  11. Dr. Anita Lai, MD, FRCPC, FMC/SHC
  12. Dr. Anjli Pandya, MD FRCPC, FMC/PLC
  13. Dr. Anoop Manocha, MD, CCFP-EM, PLC
  14. Dr. Anthony (Tony) Chad, MD, CCFP-EM
  15. Dr. April Tozer, MD FRCPC, SHC
  16. Dr. Aric Storck, MD, FRCPC, FMC/PLC
  17. Dr. Arthur Tse, MD FRCPC, FMC/RGH
  18. Dr. Arun Abbi, MD, FRCPC, FMC/PLC
  19. Dr Ayesha Khory, MD CCFP-EM, RGH
  20. Dr. Brad Granberg, MD MPH FRCPC FMC/PLC
  21. Dr. Braden Teitge, MD CCFP-EM RGH
  22. Dr. Brenda Nakashima, MD, CCFP-EM
  23. Dr. Brendan Kelliher, MD CCFP-EM PLC/SHC
  24. Dr. Brett Shaw, MD, MSc, FRCPC, FAWM, FMC/PLC
  25. Dr. Bretton Hari, MD, CCFP-EM, RGH
  26. Dr. Brit Sunderani, MD FRCPC FMC/PLC/ACH
  27. Dr. Bryan Weber, MD, FRCPC, FMC/SHC
  28. Dr. Cameron McGillivray, MD, CCFP-EM, SHC
  29. Dr. Carly Hagel MD, FRCPC, SHC/PLC
  30. Dr. Catherine Patocka, MD FRCPC, FMC/PLC
  31. Dr. Cathy Dorrington, MD, FRCPC PLC
  32. Dr. Chase Krook, MD FRCPC SHC/FMC
  33. Dr. Christine East, MD CCFP-EM RGH
  34. Dr. Christine Kennedy, MD, FRCPC, ACH/SHC
  35. Dr. Christopher Bond, MD CCFP-EM, FMC/PLC /RGH
  36. Dr. Christopher Hall, MD FRCPC, FMC/RGH
  37. Dr. Christopher Lipp, MD, FRCPC/AEBM, FMC/PLC
  38. Dr. Christopher Rebus, CCFP-EM, FCFP
  39. Dr. Claire Acton MD, FRCPC, FMC/PLC
  40. Dr. Colleen Jackson, MD, CCFP-EM, PLC/SHC
  41. Dr. Cory Brulotte, MD, FRCPC, FMC/RGH
  42. Dr. Cory Meeuwisse, MD, FRCPC, ACH
  43. Dr. Dana Stewart, MD, FRCPC, RGH
  44. Dr. Daniel Joo, MD, CCFP-EM, SHC/FMC
  45. Dr. Danny Peterson, MD, PhD, FRCPC, FMC/PLC
  46. Dr. Dave Choi, MD, FRCPC, FMC/RGH
  47. Dr. Dave Dyck, MD, CCFP-EM, FMC/PLC
  48. Dr. David Fu, MD, FRCPC RGH/FMC
  49. Dr. Denise Watt, MD CCFP-EM FMC/RGH
  50. Dr. Donald Culos, MD CCFPEM RGH/FMC/PLC
  51. Dr. Edward Les, MD, FRCPC, ACH/SHC
  52. Dr. Eileen Kabaroff, MD CM, CCFP-EM, PLC/SHC
  53. Dr. Elizabeth Williams, MD, FRCPC, FMC/SHC
  54. Dr. Ellen Morrison, MD, FRCPC, ACH/SHC
  55. Dr. Emma Meeuwisse, MD, FRCPC, FMC/PLC
  56. Dr. Emmeline Ruka, MD, CCFP-EM, RGH
  57. Dr. Eric McGillis, MD FRCPC FMC/RGH
  58. Dr. Erik Saude, MD FRCPC FMC/ACH
  59. Dr. Ewa Courvoisier-Grzywacz, MD, CCFP-EM, SHC
  60. Dr. Fareen Zaver, MD, FRCPC, ABEM, MSc, SHC/PLC
  61. Dr. Fayaz Harji MD, CCFP-EM, DipAeroRT, RGH
  62. Dr. Fiona Stewart, MD, FRCPC, ACH
  63. Dr. Gavin Burgess, MD, FRCPC, ACH/SHC
  64. Dr. Geordon Avery-Cooper, MD CCFP-EM, FMC/PLC
  65. Dr. Gerald Lazarenko, MD, FRCPC, RGH
  66. Dr. Gord McNeil MD, FRCPC, FMC,ACH
  67. Dr. Grant Kennedy, MD, CCFP-EM RGH
  68. Dr. Grenvil Gracias, MD, CCFP-EM, RGH
  69. Dr. Haley Cochrane, MBBS ABEM FRCPC, PLC/FMC
  70. Dr. Hannah Park, MD DRCPSC FRCPC, FMC/PLC
  71. Dr. Harry Koonar, MD, CCFP-EM, FMC/PLC
  72. Dr. Harsimranjit Singh MD, CCFP-EM FMC/PLC
  73. Dr. Heather Patterson, MD FRCPC FMC/ACH
  74. Dr. Hilary Ambrose, MD CM, FRCPC PLC/FMC/ACH
  75. Dr. Huma Ali, MD CM, MA, FRCPC; SHC
  76. Dr. Ian Rigby, MD FRCPC, FMC
  77. Dr. James Andruchow, MD, MSc, FRCPC, FMC/PLC
  78. Dr. James D Collett, MD CCFP-EM/RGH
  79. Dr. James Fox, MD, FRCPC, FMC/RGH
  80. Dr. James L. Huffman, MD FRCPC, FMC/RGH
  81. Dr. James McLellan, MD, CCFP-EM, FMC/PLC/RVH
  82. Dr. Jas Fauteux, MD CCFP-EM RGH
  83. Dr. Jason Fedwick, MD, PhD, CCFP-EM, FMC
  84. Dr. Jeff Grant, MD FRCPC, FMC/ACH
  85. Dr. Jeffrey Bradley MD, FRCPC, FMC/PLC
  86. Dr. Jenn D’Mello, MD, FRCPC, ACH/SHC
  87. Dr. Jennifer Nicol, MD, MPH, FRCPC, FMC/PLC
  88. Dr. Jennifer Puddy, MD, CCFP-EM, FMC/PLC
  89. Dr. Jennifer Thull-Freedman, MD, MSc, DipABP, ACH/SHC
  90. Dr. Jenny Strong, MD, CCFP-EM, SHC
  91. Dr. Jesse Kao, MD, CCFP-EM, SHC
  92. Dr. Joe MacLellan, MD, FRCPC, RGH/FMC/ACH
  93. Dr. Joe Vipond, MD, CCFP-EM, RGH
  94. Dr. Johanne Gastonguay, MDCM, FRCPC, PLC
  95. Dr. Joline Bohne, MD, CCFP-EM/ SHC
  96. Dr. Jonathan Lubin, CCFP-EM, RGH
  97. Dr. Justin Wong, MD, CCFP-EM FMC/PLC
  98. Dr. Karen Keats, MD, FRCPC, FMC/PLC
  99. Dr. Kari McFarlane, MD CCFP-EM RGH
  100. Dr. Karl Phillips, MD, FRCPC-EM/PEM, FMC/ACH
  101. Dr. Kasia Lenz, MD, FRCP RGH/FMC
  102. Dr. Katherine Bateman, MD, FRCPC, FMC/PLC
  103. Dr. Kathryn Crowder, MD, CCFP-EM, SHC
  104. Dr. Katie Anker, MD, FRCPC FMC/RGH/ACH
  105. Dr. Katie Lin, MD MPH FRCPC FMC/RGH
  106. Dr. Kelli Sherlock, MD CCFP-EM / RGH
  107. Dr. Kelsey MacLeod, MD, CCFP-EM, SHC
  108. Dr. Kelsey Ragan, MD, MPH, FRCPC FMC/PLC
  109. Dr. Kendra Young, MD, FRCPC, FMC/PLC
  110. Dr. Kevin Haley, MD CCFP-EM, FMC/RGH
  111. Dr. Kevin Hanrahan, BPE, MD, CCFP-EM, FMC/PLC
  112. Dr. Kevin Johnson, MD CCFP-EM, FCFP/ RGH
  113. Dr. Kevin Krause, MD, CCFP-EM RGH
  114. Dr. Kip Rodgers, MD FRCPC, FMC/PLC
  115. Dr. Leo Zalmanowitz, MD, FRCPC RGH
  116. Dr. Lester Mercuur, MBChB, CCFP-EM, FMC, PLC
  117. Dr Lisa Campfens MD, FRCPC, FACEP FHH/PLC
  118. Dr. Lorissa Mews, MD FRCPC FMC/SHC
  119. Dr. Lundy Day, MD, FRCPC, ACH/UAH
  120. Dr. Mandeep Sran, MD, FRCPC FMC/PLC
  121. Dr. Marc Francis, MD, FRCPC FMC/ACH
  122. Dr. Marcie Veitch, MD, CCFP-EM, SHC
  123. Dr. Margaret McGillivray, MD, CCFP-EM, SHC
  124. Dr. Margriet Greidanus, MD, CCFP-EM, FMC/PLC
  125. Dr. Mark Bromley, MD, FRCPC, FMC/ACH
  126. Dr. Mark Scott, MD, CCFP-EM, RGH
  127. Dr. Marshall Ross, MD, FRCPC, FMC/RGH
  128. Dr. Marta Broniewska, MD, FRCPC, RGH
  129. Dr. Matthew Erskine, MDCM, MSc, FRCPC, FMC/RGH
  130. Dr. Matthew Frey, MD, CCFP-EM, SHC/FMC
  131. Dr. Matthew Grabove, MD, CCFP-EM SHC
  132. Dr. Meaghan Mackenzie, MD, FRCPC, FMC/PLC
  133. Dr. Meira Louis, MD, FRCPC, FMC/ PLC
  134. Dr. Melanie Sohn, MD, MEd, CCFP-EM SHC
  135. Dr. Melanie Willimann, MDCM, FRCPC, ACH
  136. Dr. Michael Betzner, MD FRCPC FMC/PLC
  137. Dr. Michael Kenney, MD CCFP-EM PLC
  138. Dr. Michael Szava-Kovats, MD FRCPC FMC/PLC
  139. Dr. Michael Wolf, MD, CCFP-EM, SHC
  140. Dr. Michael Geddes MD, FRCPC, MBA, FMC/PLC
  141. Dr. Miles Hunter, MD FRCPC FMC/PLC
  142. Dr. Nadim J Lalani, MD, FRCPC SHC/PLC
  143. Dr. Naminder Sandhu, MD, FRCPC, ACH/SHC
  144. Dr. Natalie Cram, MD FRCPC FMC/RGH
  145. Dr. Natasha Wright, MD, FRCPC FMC/RGH
  146. Dr. Nicholas Packer, MD, MSc, FRCPC, FMC
  147. Dr. Nick Pompa, MD FRCPC
  148. Dr. Nicola Schiebel, MD, FRCPC, SHC
  149. Dr. Patricia Lee, MD FRCPC FMC
  150. Dr. Paul McKenna, MD FRCPC, FMC/SHC
  151. Dr. Paul Tourigny, MD FRCPC FMC/PLC/RGH
  152. Dr. Pauline Head, MD, FRCPC, RGH
  153. Dr. Peter Davids, MD CCFP-EM, PLC/SHC
  154. Dr. Phil Ukrainetz, MD, FRCPC, FMC/ACH
  155. Dr. Rajat Upadhyay, CCFP-EM RGH
  156. Dr. Rhonda Ness, MD FRCPC, RGH/ACH
  157. Dr. Rick Morris, MD, CCFP-EM, PLC/RGH
  158. Dr. Rob Hall, MD, FRCPC FMC/PLC
  159. Dr. Robert Lafreniere, MD, CCFP-EM, FMC/PLC
  160. Dr. Robyn Buna, MD, FRCPC, ACH
  161. Dr. Robyn Palmer, MD, FRCPC, FMC/PLC/SHC
  162. Dr. Rory Thomson, MD CCFP-EM RGH
  163. Dr. Ryan Chuang, MD ABEM RGH
  164. Dr. Ryan Deedo, MD DipAeroRT MAvMed FRCPC, FMC/PLC
  165. Dr. Ryan Wilkie, MD, FRCPC, RGH/FMC
  166. Dr. Salima Alladina, MD, MPH, CCFP-EM RGH
  167. Dr. Sarah McPherson MD FRCP FMC/ACH
  168. Dr. Scott Farquharson, MD, CCFP-EM, FMC/RGH
  169. Dr. Scott Lucyk, MD, FRCPC, FMC/PLC
  170. Dr. Scott Seadon, MD, CCFP-RM, FMC/RGH
  171. Dr. Sean Crooks, MD, FRCPC, RGH/FMC
  172. Dr. Sean Fair, MD, FRCPC FMC/RGH
  173. Dr. Shawn Dowling, MD, FRCPC ACH/FMC
  174. Dr. Stan Bernbaum, MD CCFP-EM, FMC/PLC
  175. Dr. Stan Mayer, MD, CCFP- MD, RGH
  176. Dr. Stefan Da Silva, MD, CCFP-EM, FMC/PLC
  177. Dr. Stephanie VandenBerg, MD MSc SHC/PLC
  178. Dr. Stephen Freedman, MDCM, MSc, FRCPC, ACH
  179. Dr. Steve Clark, MD, CCFP-EM, FMC/RGH
  180. Dr. Steve Liu, MD, FRCPC, FMC/PLC
  181. Dr. Stuart G Turner, MD, FRCPC/RGH
  182. Dr. Stuart Rose, MD, CCFP-EM, FMC/RGH
  183. Dr. Sudhir Pandya, MD FRCPC DABEM FMC/PLC/RGH
  184. Dr. Tayo Dawodu, MD, CCFP-EM, RGH
  185. Dr. Thomas Rich, MD. CCFP-EM, FCFP, FMC/PLC
  186. Dr. Todd Peterson, MD, CCFP-EM, RGH
  187. Dr. Travis Novak, MD, CCFP-EM, SHC/PLC
  188. Dr. Vanessa Potok, MD CCFP-EM, SHC
  189. Dr. Verlyn Leopatra, MD, CCFP-EM, RGH
  190. Dr. Vic Goshko, MD, FRCPC
  191. Dr. Waleed Janjua, MD, CCFP-EM, RGH
  192. Dr. Yasmin Hla MD, CCFP-EM, RGH
  193. Dr. Zoë Polsky, MD

The opinions in this open letter are those of the individual doctors signed, not of Alberta Health Services or The Alberta Medical Association.

References

1https://www.albertadoctors.org/services/physicians/our-agreements/physician-advocacy-support/handle-with-care/primary-care

2 https://www.carms.ca/pdfs/5refg87STFj_R1_1_OverviewByDiscipline_EN.pdf