SUNDRE — Replacing the five physicians who recently announced their intention to leave Sundre's Moose & Squirrel Medical Clinic as a result of the ongoing dispute with the provincial government will be no easy feat, says a founder of the clinic.
“It’s going to be an uphill battle. It takes time to recruit a physician into a rural community,” said Dr. Michelle Warren, who in 2013 opened the clinic with husband Dr. Rob Warren.
“We’re going to do our very best to recruit physicians and to replace those that are choosing to leave the province,” she said.
The clinic announced that Dr. Danielle Diaz, Dr. Mark Diaz, Dr. Alanna Bowie, Dr. Carly Crewe and Dr. Anthony Willmot have provided written notice that they will be leaving the community and province at the end of April 2021.
Despite the challenging hurdles on the road ahead, Warren made clear the clinic's doors remain open.
“I think that has been a concern, that people have assumed the worst that the clinic is closing — we’re not going anywhere.”
Tyler Shandro, the governing UCP’s health minister, previously promised replacement physicians would be brought in to fill any gaps left by doctors who decide to withdraw hospital services or leave the province.
But Warren seemed to think that’s wishful thinking, and that physicians cannot simply be quickly replaced on a whim.
“Anyone who thinks recruiting and retaining physicians is easy hasn’t spoken to anybody in any medical community in Alberta that’s been involved. They will tell you it’s very difficult,” she said.
“In July, when Minister Shandro broached with the CPSA (College of Physicians and Surgeons of Alberta) the idea that physicians could not leave Alberta, or retire or even get sick for that matter without having a full-time replacement already queued up, it just shows that realization that you can’t just pull a doctor out of thin air.”
Out of an initial number of interested physicians who request more information about a community before making any decisions, only a handful will actually decide to visit the area, and fewer still might commit to choosing to establish a practice there, she said.
“I think the recruitment side is going to be next to impossible,” she said.
“I’m hopeful we’ll get doctors who’ll come in for short periods of time.”
After all, finding physicians who are willing to act as temporary replacements for several months at a time is better than not having anybody at all, she said.
And although homegrown physicians and other health-care professionals who completed their student residencies in small communities were once more likely to be compelled to set roots there, that trend has changed as a result of the frayed relationship with the government, she said.
“Rather than having the majority of those new physicians staying in Alberta, the majority are leaving. So, our pool of people most likely to come in to fill these needs has shrunk.”
The health ministry has been tossing about ideas to make up for these substantial losses with no concrete plans yet outlined, “but honestly, I don’t think he (Shandro) truly realized that physicians were going to leave,” she said.
That was despite being warned that some doctors, whose skills are portable and in high demand, would likely leave if the situation became untenable, she said.
“If you’re working in an environment that is abusive or toxic, you quit and you go and you find yourself another job somewhere else that’s better for you.”
The looming specter of uncertainty has not inspired any confidence among health-care professionals, and Warren admits having no clue what health care in Alberta will resemble a year or two from now.
“I don’t think anybody does,” she said.
But she considers herself a “glass half full” personality who remains optimistic against adversity.
Having personally experienced the post-Klein era cuts that had left the province’s health care reeling, Warren said the situation eventually did recover and improve, even if it took 15 years.
“This government will do what it’s going to do. There will be fallout, there will be consequences, (but) things will eventually stabilize and then they’ll have to throw money into health care to try and bring physicians in.”
However, even during what she called a golden age of health care in Alberta, finding a suitable physician candidate took on average anywhere from six to nine months.
When the Warrens built their clinic in 2013, she said they did so at a time when the community had just gone through a significant loss of doctors — seven physicians at the time chose to leave or retire all at the same time.
“Because of that experience, we knew it took time to recruit in. When we built our associate agreement at the clinic, one of the big things that makes it stand out from other companies was a nine-month notice period that for physicians who wanted to leave, they needed to provide nine months of notice.”
Provided they found a replacement first, they could leave before the end of those nine months, she added.
“But it was put in there intentionally. At the time we put it in, I never thought we would have five physicians leave at the same time.”
The departure of the five doctors was a heavy blow.
“We’re pretty devastated,” said Warren.
“Because it’s a family over there, and they’re in a different phase of life than we are. They’re starting in their career, most of them have young families — they’re looking at what the school system’s going to be like, what is my child going to be taught, what are the values in the province that I’m going to raise my family.”
Their decision did not so much stem from any singular event or incident, but rather was the result of “more a cumulative effect of the things that began last December and just continued on through the spring and summer,” she said.
“I think for each of them, they reached a point where they said, ‘I don’t want to be in Alberta anymore.’”
But given the choice, she said the physicians who decided to leave the province told her that if they were to stay in Alberta under improved circumstances, Sundre is where they would want to be.
“Our medical clinic, the community of Sundre, their patients — that’s not what’s causing them to leave. It’s a bigger picture than that. So how do I fix that? I can’t — it’s out of my hands. There is nothing that I can do that will make it better for them. Those are decisions that I have no control over.”
She praised her colleagues not only as talented doctors that “the other provinces and territories will benefit from,” but also as “amazing human beings that will be missed. But we understand why they’re doing what they have to do, and they have our support.”
“Because this is just devastating to them as well. And it’s a decision that they have not come to easily, and it’s taken them I’m sure many, many months of tears and indecision as to know what was best for them and their families to do.”
Now, three doctors remain committed to staying at the Moose & Squirrel Medical Clinic — Dr. Gina Smith, Dr. Rob Warren, and Dr. Michelle Warren.
“We’re not going anywhere,” she said.
“We will continue to look after our patients, and do our best to look after the patients of those that will be left without a family physician, and a big part of that is recruitment. It’s something that I’m committed to doing, and it’s something that the physicians that are leaving are committed to doing.”
While the clinic’s remaining doctors will endeavour to take on now-orphaned patients, that might not always be feasible, she said, adding physicians can only work so many hours and see so many people in a day.
“And burnout is real,” she said.
“For those physicians that are staying and looking after those who no longer have a physician, it’s going to be that balance of how much more can you give before you burn out,” she said, adding burnout has the potential to metastasize into physical illness as well as mental health issues.
Sundre is not alone in facing “the same crisis,” she said, adding the community joins Rocky Mountain House and others in northern as well as eastern Alberta that have often struggled to not just recruit but especially retain physicians.