Battling a pandemic,‘Shandemic’

GUEST COLUMN

Dear Lethbridge and surrounding community, We are in troubling times. Physicians and the community are feeling uncertain and frightened. One aspect. of this fear is the government’s health-care cuts, which have included terminating the Physician Master Agreement and implementing a new Physician Funding Framework without expert physician involvement. This has been referred to in social media circles as a “Shandemic.”

Lethbridge physicians had planned to have a factual face-to-face with the public about the impact these changes are going to have on health care, and a large audience was expected to attend. An overwhelming public health crisis has taken precedent, however, placing the funding crisis appropriately in the background.

The COVID-19 pandemic now carries the weight of our concern, and the Lethbridge Physician Town Hall on Health Care: Public Education Forum was postponed to prevent COVID-19 transmission. Instead, every physician in this community has focused their skills on flattening the COVID-19 transmission curve to maintain the health and well-being of our patient public.

The COVID-19 pandemic is ominous and epic in scale, and your medical professionals are up to the task. As I write this, protocols have been implemented to safeguard you and prepare for the frightening possibility that our isolation guidelines prove inadequate. But let’s be honest, pandemic aside, placing ourselves in advance of risks to your health is our daily work, and is woven into the very essence of our livelihood. Your family physician treating your blood sugar and blood pressure to minimize the risk of kidney failure and heart attack is an example. As is your emergency physician examining you for abdominal pain, using imaging, labs and expert clinical acumen to assess the risk that your symptoms are dangerous and guide on safe treatment.

The same risk management skills are expertly applied by your obstetrician delivering your children, your pediatrician in the neonatal intensive care unit, your surgeon in the OR, your radiologist reviewing your mammogram, your geriatrician testing your cognitive function, your palliative-care physician attending you at home, and many more.

These examples highlight how physicians champion your health care through numerous expertly executed riskreducing medical decisions. In this manner, your physician defends you against the complex variables that would potentially harm your health; such as is occurring in the current pandemic. In Alberta’s advanced health-care system, however, these decisions are routine for you, even taken for granted. And this is a good thing, because in an organized and professional model of health care such as ours, the appropriate supports are in place to allow these risk-reducing interventions to occur as implicit properties of the system. They occur with professional expertise and collaboration, and are implemented so smoothly that you simply assume this is the norm.

This is not the norm. In fact, Alberta has an enviable model of integrated health care, with partnerships, alliances and expert consultations on your health occurring at every stage of your care pathway. Alberta can claim the concept of the Family Medical Home, the foundation of which encompasses health-care philosophies such as patient-focused, comprehensive and accessible. Intelligently applied and smoothly integrated, your routine health-care visit is exactly that, routine. For this you have to thank 15-plus years of hard work by the Alberta Medical Association, which represents the expertise of the bulk of physicians licensed in Alberta, a partnership with the Primary Care Network, a Department of Health-funded health-care initiative launched in 2005, and a legally binding Master Agreement with Alberta Health/Alberta Health Services that frames the ongoing professional dialogue driving these innovations. These collaborative partnerships have established Alberta as a Canadian leader in primary-care performance, such that our model is being adopted in many other provinces and regions.

Unfortunately, Alberta’s current healthcare system is in trouble. Beyond the COVID-19 crisis, the current comprehensive model is not guaranteed, as the system you take for granted is being dismantled. On Feb. 20, citing provincial debt and an expensive and cumbersome health-care system, the government terminated the Physician Master Agreement. Physicians were presented as unwilling to negotiate, the distribution of costs in the system misrepresented and an unfair burden of blame placed on physician billing, and physicians told they were not welcome to participate in problem solving the health-care system portion of our provincial debt. This is simply untrue, and in direct contrast to the productive history of expert physician guidance on our health-care system, and overwhelming evidence that fiscal responsibility factored into each collaborative provincial discussion.

Instead our government, despite the current medical scramble to stave off the tide of COVID-19, has proceeded to implement the Physician Funding Framework and restructure the healthcare system. A concession was made to temporarily suspend the cancellation of complex care time modifiers for primary care, but all other health-care cuts outlined in this document will proceed as planned. Attempts by the AMA to re-initiate negotiations have been declined.

So where does that leave you and your physicians? Uncertain and in total chaos, that’s where. In the midst of the current pandemic, it is hard to envision the longterm implications, but here are some immediate repercussions of these dictated cuts:

• Limits have been placed on total number of daily patient visits. After-hours walk-in clinics are now closed, possibly permanently. Your after-hours care option will be limited to Emergency.

• The eventual reduction and loss of complex-care modifiers will shorten your family physician visit time. Complex patients will require multiple clinic visits, spend more time in Emergency and suffer increased hospital admissions.

• Key palliative care, on-call trauma surgery and other critical programs have lost clinical stipends. Many of these programs will be cancelled including two vital ones below:

— The Acute Trauma on-call service, which provides general surgeon coverage for trauma. Time is critical in these instances, and an increase in preventable traumatic deaths is highly likely with the loss of this program.

— The palliative care travel stipend. Home visits may no longer be possible, and palliative patients will experience increased hospital admissions for care.

• In-hospital consultation fees are being cut, which will make hospital work unsustainable for some specialists and rural physicians.

• Emergency will experience challenges with increased volume and increased wait times.

• Diagnostic imaging fee rules and codes have been altered. Wait times will be longer. Possibly, when the provincial radiology contract is terminated, your imaging may be contracted out of province.

• If you are 74.5 or older, your drivers medical visit is no longer covered.

• “Good Faith” claims are no longer accepted. Individuals without proof of residency or Alberta health coverage, as can occur in certain challenged populations, will not receive care coverage.

• Bill 21, used to cancel the Physician Master Agreement, also stipulates that the Minister of Health can restrict new physician practitioner identification numbers, and dictate where they are allowed to work. Along with a possible exodus of current physicians, new graduates will seek practice opportunities outside of Alberta.

So, if you are finding the current pandemic frightening, then what comes next should have you petrified. Your physicians are working hard to protect you from COVID-19, but we are no longer part of the team guiding our health-care system. Instead, tax dollars are being spent to promote virtual health-care platforms such as Telus Babylon to fill the void these cuts will leave. These platforms are not supported by the AMA and have not had Alberta physician input.

Please stay informed, speak with your physician. The following links are helpful for comparison.

Realize you have a voice and your opinion is important. Please make your concerns known by emailing: premier@gov.ab.ca or health.minister@gov.ab.ca.

Dr. Garland Jonker, Campbell Clinic South

Dr. Samuel deWalle, Bigelow Fowler Clinic South

Dr. Eadaoin Ni Choileain, Bigelow Fowler South

Dr. Michael Cunningham, Bigelow Fowler Clinic West

Dr. Jessica van der Sloot, Campbell Clinic South

Dr. Fred Rinaldi, Family Medicine, Medicine Hat

Haig Clinic Family Physicians

Dr. Erin Appleton, The Lethbridge Breastfeeding Medicine clinic

Lethbridge GI & Surgical Associates

Dr. Sean Wilde, Emergency Medicine Dr. Bilal Mir, Emergency Medicine

Dr. Kevin Martin, Emergency Medicine Dr. Peter Kwan, Emergency Medicine Dr. Dionne Walsh, Lethbridge Palliative Care Physician

Dr. Elvira Smuts, Lethbridge Palliative Care Physician

Dr. Hollis Roth, Lethbridge Palliative Care Physician

Dr. Abdul Shukkoor, Lethbridge Palliative Care Physician