Dr. Braden Manns with the Cumming School of Medicine joins Alberta Primetime host Michael Higgins to discuss a new study on Alberta’s doctor shortage, including recommendations for the province. This interview has been edited for clarity and length. Michael Higgins: You analyzed mountains of data to get a full picture of the physician landscape in Alberta. What kind of information were you combing through for this study? Dr. Braden Manns: We looked at essentially de-identified or anonymized records for Albertans who visited comprehensive care family physicians. The kinds of family physicians who look after babies, look after adults with diabetes, all the way to the care of older adults. We looked at that over 16 years. We know we’ve got challenges with primary care access. Maybe up to a quarter of Albertans don’t have access to a family doctor, and even those who do can’t get in to see them quickly. MH: This is a significant amount of information to process. Did you use tools such as artificial intelligence to put all the data into perspective? BM: We started using that for some generation of codes. But no, it’s a process of carefully cleaning, linking the data, just finding out things like. Do we have the same number of family physicians as we did 16 years ago? Interestingly, Alberta’s population has gone up by about 40 per cent over that time, and the proportion of family doctors have gone up by about 40 per cent as well. Yet, we know that access is a lot more difficult. There’s a lot fewer family practices that are actually open for new patients. So we needed to comb through data to try to understand why are we having those access challenges. MH: Does your study establish where challenges around Alberta’s doctor shortage are concerned? What’s at the heart of this? BM: It tells us a little bit about what does our family medicine workforce look like? Over that 16-year period, a lot more of our family physicians were trained in lower middle income countries, we’re importing a lot of them. So we’re seeing changes in the types of individuals that are working as family physicians. We’re also seeing that they work differently. A lot more family physicians who graduate are choosing to work exclusively in hospitals, not open a family practice. Of those who do open family practices, they’re open fewer days of the year to see patients, and they’re seeing about 15 per cent fewer patients per day. I don’t think that’s because they’re out golfing. We can talk about why that is. We’re seeing people with more chronic illnesses, sicker people. MH: Is that the why more chronic illness, more serious things to deal with? BM: Yeah and I’m not a family physician, but when I talk to family physicians, they tell me the people that are sitting in their waiting rooms are different than 20 years ago. We were able to quantify that. So what we’re seeing is twice as many people with chronic health conditions like diabetes, high blood pressure, heart disease and people requiring more support from family physicians. There’s about twice as many people with five or more chronic conditions. So you can imagine when they come in the office, it’s not a quick visit. That means they’re being seen more frequently by their family physicians, and those visits presumably are taking longer. MH: What does this say about the structure of Alberta’s health system, especially as the UCP government continues its overhaul? BM: The government has started a primary care agency, and having a plan for primary care is great. That plan needs to encompass family physicians, not just the resources that go alongside the primary care networks, but that’s a good start. A new funding model, that kind of funding model is needed for family physicians to work in teams. I think that’s really where we need to move, and that’s not going to be an easy transition. MH: When you say teams, how widely encompassing is that? BM: There’s very high quality studies in tens of thousands of people in primary care that say when older adults with multiple health concerns are looked after by teams like a nurse, a diabetes specialist, a physiotherapist, a social worker, patients are more likely to get the care they need. They have better experiences. Actually, the team likes it too. The nurses, the physiotherapists, the family physicians, like it as well. So we have the starts of that with primary care networks, but not enough resources are put into that. So for every 10 family doctors, we might have four allied health clinicians, and they can do some good work. I’ll say this, as a doctor, you’re better off seeing a physiotherapist for your back pain than your than you are coming to see me. So there are certain jobs that allied health can do just as well. We need to be reserving the physicians for the types of jobs that they’re best at, setting out plans, making diagnoses, dealing with people with complex health conditions. MH: Are there takeaways from the study where either training or recruitment of new doctors are concerned? BM: For sure, what’s very clear is there is a deficit of people within primary care, and it’s not just family physicians, but other clinicians. We need to re-envision how teams work together, but it’s clear that we are short, and this kind of quantifies that. It says that we’ve got about as many family physicians, but they’re not working in the same ways as they were. So we’re going to need more of them, and we’re going to need teams. MH: So what’s the takeaway for the provincial government if they dig into your study? BM: We did present this to them. They’re aware of this. In fact, we presented some preliminary findings as they were coming up with this new family medicine funding model. Now it’s getting a plan for primary care access, getting teams working together, more investment in primary care. And yes, we will need more family physicians, but particularly in certain areas of Alberta, and this will help with that.
