Alberta health care in desperate need of stabilization: outgoing AMA president

Dr. Paul Parks speaks to CTV News Edmonton on Sept. 23, 2024, after the end of his term as Alberta Medical Association president. (CTV News Edmonton)

As Dr. Shelley Duggan takes over as president of the Alberta Medical Association, outgoing president and emergency physician Dr. Paul Parks talks about the state of Alberta's health-care system, his work over the past year to get doctors a new pay model, and advice for the new leader.

Despite working towards this disagreement with the province for a year, there's still no deal in place. Why not?

Parks: That's an excellent question for the minister and for the government. We've been working collaboratively for over a year. We agreed in June 2023 that it's actually mission critical, top priority, to work on family medicine.

It's ready to go. We just need government to announce it. And despite both the minister and premier repeatedly promising that they're going to get it out, it just hasn't. So government's choosing not to act.

The action they're re-announcing is $57 million that they promised as part of MAPS (Modernizing Alberta's Primary Health Care System), and re-announcing $100 million that's federal money that they had to spend into health care. But for some reason, they are not sharing our urgency and are refusing to act and actually move forward on stabilizing the viability of family medicine practices.

It's going to be a question that I'd urge all Albertans to start asking their MLAs and government: Why? Why is government choosing not to act when we're in such a difficult situation?

The health minister said last week there's more work to be done. What's holding it up in your mind? 

Parks: It's been a year of that now, that we've been repeatedly saying we desperately need help, and the government has kept saying – and said last Thursday – that they hear us, that they're committed, but they're not giving a good reason why. There's no reason. The model is done. They can implement it, and we can get going.

The key part – why is this important to Albertans – is that, if they announce it and implement it, this is going to give hope to physicians. This is going to give hope that they'll stay, renew their leases, keep their practices open, and this will make sure that Albertans can still get access to family medicine. But right now, I'm really worried that this is just going to make the access crisis in family medicine even worse. Keep in mind there's also a proposal for the acute care stabilization, which they haven't moved one iota on, and that is critical to keep our hospitals flowing.

Do you think the public realizes what kind of situation we're in? 

Parks: That's why we're talking bluntly now.

This (is) going to have real impact on Albertans, on either them or their families, or anybody that needs to access family medicine and have routine primary care. It's also going to impact patients having to go to overcrowded emergency departments so that they have to wait hours and hours to get care.… Our access issues are going to get worse and worse, and on every front – access to emergency care, EMS care, cancer care, our surgery care.

How much will this new deal cost the province? 

Parks: Ballpark, it's very small in comparison of the whole budget for just this year. They announced today it might cost somewhere around $37 million into next year, and going years forward, it's in the ballpark of around $200 million or so.

Keeping in mind, though, this isn't income just going straight into physicians' pockets. This is actually operational money that'll help them keep their practices viable. Leases have gone up. Inflation has really impacted paying their staff and keeping their offices going.

How far did the $157 million announced last December go? Is that keeping doctors? 

Parks: The $157 million that they did put in was critical and was really necessary to just get us to this point to stabilize.

But it was always intended to bridge until the rescue came. So the new funding model would come and actually help them so they could remain viable going forward. And what government's done is given the federal money to these offices, kept them going, gave them a life preserver. But now they've cut the tether and (are) saying … Just stay out there, floating until, until we finally decide to act.

What will happen if this deal isn't reached immediately? 

Parks: We're very worried that many family physicians will decide that it's not viable to continue practicing in Alberta and they will close their practices.

There's 800,000 Albertans who don't have access to a family physician already. And (if) we lose more and more of our physicians, it's a vicious cycle. Then everybody can only go to the hospitals which are already excessively overcrowded and have to come see specialists like myself for conditions that they should have a family physician for. Meanwhile, all of the Albertans that need to get access to life- and limb-threatening care are waiting hours and days.

What do you make of the fact that the province has rolled out a new nurse practitioner model while promoting new pharmacist clinics before making the deal with doctors?

Parks: I've always said from our workforce point of view, we need more allied healthcare workers. We need way more of every type of skilled healthcare worker, but they need to be connected and team based and integrated.

But again, I think this highlights the priorities of this government, as they keep saying they're committed to salvaging and keeping primary care specialists, rural generalists and family medicine docs viable, and want them here and they value them.

What concerns do you have about the way Alberta emergency rooms are functioning? Is it sustainable? 

Parks: This premier, she ran on saying she would fix key measures in terms of EMS offload, emergency times, (and) surgical times in 90 days. And now we're over a year – 15 months in, actually – and things are demonstrably worse, objectively, for patients. Our wait times are worse, our offline-to-offload times are worse, our access to cancer care, surgical care – everything is getting worse in the acute care system.

How much is the province's overhaul of the health-care system helping? 

Parks: Unequivocally, it's making it way worse. It's actually making it chaotic.

Did it need some improvements? Did it need some optimization? Absolutely, but now we're in a state where it's just adding layer after layer of new administrations, more bureaucracy. It's making it next to impossible for physicians to even know how to navigate the system, let alone patients.

We need to get them to switch prioritizing and going to stabilize first and then look how we can optimize.

Would handing over authority of hospitals to Covenant Health help or hurt the system?

Parks: Look at the objective data: How are our clinical service providers performing right now? How is Covenant Health performing versus Alberta Health Services, for example, versus some of our charter surgical facilities.

It doesn't matter who they put in charge of being a clinical service provider … the government is in charge of ensuring it's adequately resourced, we have the adequate workforce, that we actually have the ability to deliver on what the mandate is for those clinical service providers. And right now, that would just amount to shuffling the deck chairs on the sinking Titanic.

When asked about funding for new hospitals on her radio show, the premier suggested plans for hospitals like the south Edmonton hospital had become too costly and she wanted to focus on building recovery centers and long-term care homes instead, before funding in more hospitals. What do you think of that plan? 

Parks: We absolutely need increased continuing care. But right now in our hospitals, we absolutely need increased acute care capacity. The 16 big, big ones – regional and urban ones – are all over capacity 110% or more.

So show us what the plan is. What's your action? What are you going to do?

The second piece, I'll tell you, it'll go back to that refocusing. They're going to create a continuing care organization that the acute-care system desperately needs to function properly so it can take all the continuing care patients. But right now, there's nobody coordinating that care. There's gonna be two CEOs, one in acute-care organization and one in the continuing-care organization, and there's nobody above them telling them what they have to do.

What do you make of the province announcing funding for more schools but not hospitals?

Parks: I think everybody out there applauds that we need to invest based on population for our education system. I think they would all say we absolutely need to budget and plan for the current population we have in Alberta and the future population growth in health care, as well.

How do you see the future of health care in Alberta? 

Parks: We desperately need help. We need rescue. We need it on the family medicine side, and we need it on the acute care side. And I think now we're getting to a point where we're realizing that we're going to need Albertans' help.… They need to reach out to their MLAs. They need to reach out to the minister and premier and say, 'What is the plan?'

I do think things will go continuously into a bit of a vicious death spiral if we don't stabilize at some point.

What advice do you have for the next AMA president?

Parks: Do better than I did.

The biggest piece going forward is … we've given them evidence-based plans based on the data and the population and plans that we know will work to help stabilize components. It won't fix everything. There's going to need lots of extra work to be done on workforce planning, capacity planning, looking (at) how can we be more efficiently spending our big budget in health care.

I would just say to Dr Duggan that we're going to have to keep on advocating.... You act on it.