SUNDRE — Starting on Canada Day, doctors at a local clinic will no longer be providing their services at the Sundre Hospital and Care Centre.
Dr. Michelle Warren of the Moose & Squirrel Medical Clinic confirmed that in an interview, saying Alberta's UCP government is unilaterally making changes to, among other things, physician compensation without meaningful consultation.
“Effective July 1, our doctors are no longer active staff in Sundre (hospital),” said Warren, who runs the clinic with her husband Dr. Rob Warren, referring to previously announced plans to instead focus on their practice.
The local doctors, and many others throughout the province, have for months expressed concerns in light of not only the provincial government’s unilaterally imposed changes, but also summarily ending the master pay agreement that has created an atmosphere of uncertainty and unease among physicians.
Health Minister Tyler Shandro previously said in February when announcing the government’s decision to tear up the contract, that the move was necessary because of a stalemate with doctors regarding how to reduce costs and improve services.
MLA Jason Nixon has also previously stated that the health minister would bring in physicians to replace any doctors who rescind their hospital services.
Doctors at the Moose & Squirrel Medical clinic gave notice months ago about their intention to withdraw their hospital services. Warren said the UCP has not done anything to inspire a change of heart for the physicians at the clinic to reconsider their decision to withdraw services from the Sundre hospital.
“Nothing has changed for our group,” said Warren. “The government is doing what they decide to do, when they decide to do it, without any involvement of the Alberta Medical Association, without any involvement of physicians, without any real idea as to what they’re messing with.”
As a result, she said, doctors at their clinic plan to ride out the provincial government just like the pandemic.
“I feel like we are settling in for a siege, and between COVID and the UCP, we are just going to try to survive and wait them both out,” she said.
She cited the complete absence of stability as the primary reason behind their commitment to remain firm about their decision.
“With the unilateral changes that happen without communication or warning, it is simplest for us just to focus on what we have control over,” she said.
“In rural communities around Alberta, doctors are leaving, retiring and changing services — and many more have said in the absence of a signed agreement, arbitrated or otherwise, they too will leave. Most give one year’s notice.”
Asked how she would respond to people who claim the Alberta Medical Association and physicians are holding patients hostage in a game of politics, Warren said, “The government is the one that tore up a valid contract as we entered the pandemic. The government is the one who instituted unilateral changes to physician compensation during the pandemic.”
Even before the pandemic, she pointed out doctors throughout the province, including the physicians at Moose & Squirrel, had repeatedly expressed concerns about the unintended consequences of the government’s actions that would make maintaining private practices untenable.
“They did it anyway,” she said. “People that are making the decisions don’t understand the complexity of health care.”
As a result, she said doctors running clinics had to carefully reconsider how they could keep their practices viable.
Their options, she added, were limited.
When the income a business generates decreases significantly, one must choose to either increase the cost of the product or service and pass it onto consumers — which is not possible in medicine since doctors don’t directly charge patients for visits — or ramp up efforts to do more of what earns revenue, she said.
“In our case, seeing patients," she said.
In worst-case outcomes, as has been seen in some communities across the province, the business is shuttered, she said.
“They fired their staff, they closed their doors, they worked virtually from home, (and) minimized the amount of overhead that they have to pay.”
That’s a scenario the Warrens aspire to avoid.
“We provide services to over 4,500 patients. If our clinic closes, where do those patients go?”
And the Alberta Medical Association has had to fight tooth and nail for the few positive reversals or changes, such as instituting pandemic virtual codes similar to what was done during the H1N1 outbreak, she said.
“After much negotiation and much public pressure, the government did so. They didn’t do it right off the hop. They were one of the last provinces to do so, and they did it, I would use the word grudgingly,” she said.
Although doctors get compensated the same regardless of whether they spend 90 minutes on the phone with a patient or only 11 minutes, that approach “allowed us to basically hobble along.”
Managing the financial impact of COVID-19 was already stressful enough without the government’s shortsighted decisions further complicating matters, she said.
After initially laying off some nursing as well as front-end staff in March to ensure lease payments could still be covered, Warren said they have all since been rehired “because we’re going to be working more days in the clinic, weekends and evenings as well.”
Also recognizing the critical importance of hospitals, she said without clinics, there won’t be physicians to man those facilities since “working in a hospital alone isn’t enough, not in a small community.”
So to survive not only the pandemic but also the changes regularly imposed on a whim by the government, she said they decided to focus exclusively on their clinic in the hopes of as much as possible providing the patient care necessary to prevent people from requiring emergency assistance in the first place.
“It’s not about the money. Because at a certain point, when you make enough to cover your basics, it’s about how you’re treated. It’s about the sense that you’re replaceable — ‘go ahead and leave!’ — they don’t care about you,” she said.
“You are blocked by your (health) minister, you are degraded and put down on social media all the time by him and his press people. There is just no trust there. The relationship’s been badly damaged,” she said, adding it will take a monumental effort on the government as well as minister Shandro’s part to heal that rift.
“We’ve been given no reason to have any faith — we’ve been given every reason to have no faith,” she said.
“He’s been caught in lies multiple times, with paper trails backing up the fact that what he is saying are lies.”
The lines of communication have also been non-existent, she added.
“He hasn’t reached out. It’s hard to have faith or trust in someone who doesn’t communicate with you. As a physician, I don’t learn things from Alberta Health, I don’t learn things from the minister. I learn it on Twitter on a Friday night,” she said.
Physicians and the association want to work with Alberta Health and the minister, but that’s a two-way street, she said.
“So, to people who say we’re holding patients hostage: no, we’re not. We’re doing what we’re doing so we can be here for patients.”