Thank you to the many Albertans who viewed our election materials, those who participated in our town halls and everyone who is engaged in thinking about health care. The issues we identified before the election remain urgently relevant and our questions will help us assess any progress toward the solutions that are needed to fix our health care system.
We're counting on our new government to make health care a priority. Some of the biggest issues facing our health care system are:
- Care of the elderly
- Health care human resources
- Pediatric mental health
- Rural health care
- Indigenous health
- Primary care
- Drug poisoning crisis
- Download infographic (as of June 15, 2023) of the seven issues.
PatientsFirst.ca Election Town Hall featuring NDP Leader Rachel Notley and UCP Leader Danielle Smith
On May 22, 2023 NDP Leader Rachel Notley and UCP Leader Danielle Smith discussed health care with members of the the AMA's PatientsFirst.ca community in this Election Town Hall.
Find detailed profiles of our seven issues in the links below.
Issue
Challenges in accessing primary care have escalated over the past three years. Hundreds of thousands of Albertans do not have a family physician. Without access to primary care, chronic conditions worsen and new concerns may not be caught until they are more difficult – or even impossible – to treat.
- Every Albertan should have a medical home to call their own with a family physician as the anchor.
- It’s estimated that upwards of 650,000 Albertans are currently without a family physician or primary care provider.
- Family medicine is collapsing due to family doctor shortages, burnout and financially unstable small-business practices. Physicians need immediate and substantive support to stabilize practices and ensure longer-term sustainability.
- Without access to primary care, Albertans are turning to emergency departments for care that would be better managed by a family physician.
- Albertans are increasingly relying on allied health professionals like nurse practitioners and pharmacists.
- These providers are an important part of the health care team but are disconnected from the other parts of the system.
- The best approach is an integrated, physician-led team working together and sharing information.
- There is concern that the sustainability of the Patient’s Medical Home in Alberta is at risk. There are issues related to payment equity, a lack of support for longitudinal care and increased expectations related to unremunerated work.
- Government has taken some actions that will play into eventual solutions. These include:
- Increase to priority virtual care codes.
- Modernizing Alberta’s Primary Health Care System. A final report has been submitted to the Minister of Health, but success will be completely dependent on proper implementation.
Key questions for candidates and parties should they win the provincial election
- Albertans want access to a family doctor who is connected to a team. How will your party ensure every Albertan has a medical home?
- How will your party work to encourage medical students and residents to choose comprehensive family medicine in Alberta?
- How will your party financially stabilize and sustain the independent, small-business family practice offices that deliver the majority of primary care, including recognizing the increasing administrative requirements that are burdening them?
Issue
Over the past three years, Alberta’s drug poisoning deaths have exploded, affecting every area of the province. A combination of factors, including changes to the illegal drug supply and challenges in accessing services, are contributing to a situation that has claimed far too many lives and left too many families and communities grieving.
- Data shows the total number of unintentional drug poisoning deaths in Alberta between January and December 2022 was 1,498. By comparison, there were 626 deaths from January to December 2019 – the year before the pandemic. Drug poisoning remains the number one cause of fully preventable unnatural deaths.
- This is a complex situation that requires a range of harm reduction, addiction treatment and psycho-social interventions to reduce the immediate risk of death and support people to reduce or stop using substances. Involuntary treatment is unsafe and ineffective.
- Immediate access to a variety of opioid agonist treatment options across all health care settings, including correctional services, is needed. Include low-barrier services that: do not require individuals to have a phone or active health care coverage; do not require a booked appointment time; and are flexible for those who live in rural/remote areas.
- Supports for individuals to improve their social determinants of health (housing, income supports, medication coverage, photo identification and health care coverage) are critical for helping people to stay healthy and engaged in treatment. Local health and social organizations are integral to co-designing strategies and interventions.
- Increased access to mental health supports and treatment for associated mental health conditions is urgently needed.
- Contaminants in the illegal drug market vary considerably by region; a nimble and coordinated response to emerging areas of need is required in a local context, with input and collaboration from local leaders and people with lived experience.
- We need real-time province-wide local geographic area data on drug poisoning deaths and opioid-related EMS calls to guide baseline resource allocation and support immediate strategies to respond to new spikes.
- The Office of the Chief Medical Examiner requires adequate funding to eliminate the current lag in reporting of drug toxicity deaths, which can be more than a year from the time of death.
- Addiction is a health issue, not a moral failing. Stigma remains one of the main barriers to people reaching out for help and services. A coordinated campaign to reduce stigma and integrate services into existing locations where people are likely to seek care (e.g., hospitals, workplaces, etc.) may help prevent future deaths.
- We must ensure that each acute care hospital in Alberta has funding and resources for staff education, addiction medicine consult teams and harm reduction interventions.
- Funding is needed for addiction training across multiple health disciplines. Family physicians need to be better resourced and remunerated for integrating addiction medicine services into their practices.
- Decriminalization to keep people with substance use disorders out of the criminal justice system should be explored.
- Government has taken some actions that will play into eventual solutions. These include:
- Pre-treatment program received a $1.8-million grant from the province.
- Budget 2023 will direct $155 million into recovery communities over the next three years with a focus on long-term bed-based addiction treatment, some of which is tailored to individuals experiencing homelessness. The outcomes from these initiatives will need to be tracked and publicly reported.
- Expansion of access to opioid agonist treatment via the virtual Opioid Dependency Program.
Key questions for candidates and parties should they win the provincial election
- How does your party plan to deliver a comprehensive continuum of services for people who use substances?
- What steps does your party plan to immediately reduce the number of drug poisoning deaths?
Issue 2
First Nations, Inuit and Métis Peoples in Alberta have higher rates of chronic illness, mental health challenges and addictions due to the impacts of colonization and ongoing health inequities. They live shorter lives, continue to experience racism and culturally unsafe care in our health care system and are disproportionately impacted by the opioid poisoning crisis.
- Latest data shows First Nation male life expectancy has fallen below 64 years of age – 18.2 years lower than the life expectancy of non-Indigenous Albertans.
- A December 2021 report from Alberta Health found Indigenous peoples made up 22% of all opioid poisoning deaths in 2020 – while only representing approximately 6% of the province’s population.
- There continue to be concerning reports of racism and discrimination in Alberta’s health care facilities, with many Indigenous patients facing presumptions of substance abuse or intoxication when seeking medical care.
- Many First Nations, Inuit and Métis communities struggled to access health care during the pandemic, including receiving much-needed vaccines.
- We must improve equitable access to primary health care services across the province.
- Health care solutions must be created, implemented and assessed by Indigenous peoples. “Nothing About Us Without Us.”
- Government has taken some actions that will play into eventual solutions. These include:
- Releasing an Anti-Racism Action Plan in July 2022 to outline a path “for taking meaningful action to address racism.”
- Operating the Indigenous Wellness Core, a program that partners with Indigenous peoples, communities and key stakeholders to provide accessible, culturally appropriate health services for First Nations, Inuit and Métis Peoples in Alberta.
- The Modernizing Alberta’s Primary Health Care System (MAPS) Indigenous Advisory Panel, that recently shared advice and recommendations to help transform the primary health care system for First Nations, Inuit and Métis Peoples.
Key questions for candidates and parties should they win the provincial election
- How will your party improve health equity for Indigenous peoples in Alberta?
- How will your party ensure Indigenous peoples receive the care they need, when they need it, in their own communities?
- How will your government address racism and discrimination in our health care system?
- What will your government do to support Indigenous communities in addressing the opioid crisis?
Issue
Rural communities across Alberta are experiencing an unprecedented health workforce crisis that is forcing rural physicians to take on even more or reduce services provided in their communities. Poor work-life balance and shrinking services make it even harder to attract new physicians to rural and remote communities.
- Health human resource shortages have led to intermittent closures of emergency departments, acute care beds and other services in rural communities.
- In some instances entire programs, such as obstetrics, have permanently shut down.
- Rural AHS facilities are relying increasingly on locum physicians to staff emergency departments, even though the physician locum program was intended to offer rural physicians much-needed respite for vacations or illnesses.
- Physician burnout is causing some physicians to change their practices, move away or retire early.
- The loss of rural physicians not only reduces the availability of health care for people who live and work in rural communities, but also impacts the economic sustainability of those communities. When choosing a location to live or work, access to clinic and hospital services is an important factor.
- Lost physician capacity impacts the amount of medical student and residency training that can occur in the community. The first round CaRMS (residency) match had an unprecedented number of unfilled seats in rural Alberta programs.
- The province has taken some actions that will factor into eventual solutions. These include:
- Funding for additional training options in smaller centers.
- Support for the RhPAP/Rural Education Supplement and Integrated Doctors Experience (RESIDE) program, a pilot intended to help rural recruitment through return to service incentives.
- The Modernizing Alberta’s Primary Health Care System (MAPS) initiative is considering short and long-term approaches to build up primary care in urban and rural medicine.
Key questions for candidates and parties should they win the provincial election
- How will your government ensure rural Albertans get the care they need, when they need it, in their own communities?
- What specifically will your government do to retain physicians in rural and remote areas?
- What specifically will your government do to recruit physicians to rural and remote areas?
Issue
Children and youth were profoundly impacted by pandemic disruptions. Many children who were struggling before the pandemic saw their physical and mental health worsen, and new data indicates that these issues linger.
- The pandemic created major economic and social stressors for children and their families.
- Improved access to child psychiatry, mental health and pediatric care is needed throughout the province.
- School-based programming can be an important support for non-medical needs, with wrap around services available where children spend so much time.
- Resourcing will continue to be an issue. Access to mental health therapists through the public health care system in both urban/non-urban settings was overwhelmed by the increased demand during peak pandemic and continues to lag demand according to physicians.
- Alberta physicians reported a spike in eating disorder admissions to emergency departments and long waitlists across eating disorder programs. Alberta data is not available but a study based on data from six pediatric care facilities across Canada revealed a 60% rise in eating disorders from pre-pandemic levels. Anecdotal reports suggest that this is similar in Alberta.
- Recognizing diversity and practicing inclusion is important. To contribute to wellness and health, children should be supported to develop their own identities in their own time and should be supported to do so by their parents and health care providers.
- Infrastructure investment is needed to support pediatric patients who are transitioning to adult care and who otherwise find themselves left alone to cope. This is especially true for the medically and/or psychiatrically complex pediatric patients.
- Adequate and appropriate treatment of pediatric mental health patients may help reduce recurrence later on in adulthood.
- Families trying to get mental health care for children or youth find the system extremely complex. Patient navigators are a possible strategy to help assist patients/families with wayfinding in the system and such support would make a big difference.
- There are ongoing efforts by government and AHS to help students with their mental health:
- AHS offers programming in schools and communities and has developed a mental health toolkit and other materials.
- Alberta is funding pilot projects to increase mental health supports for children.
- Budget 2023 includes $117 million to expand services for children and youth, and $1.5 million for the Canadian Research and Education for the Advancement of Child Health (CanREACH) program to help physicians build skills to assess and treat children with mental health and behavioural issues.
Key questions for candidates and parties should they win the provincial election
- How will your government address the pediatric mental health crisis and ensure Alberta’s children and youth get the care they need both in schools/communities and the health care system?
- How will your government assist parents and families to guide children through their journeys in the mental health care system?
Issue
We are in an unprecedented time when pre-existing demographic changes causing a reduced workforce have been worsened everywhere by the pandemic, accompanied by fatigue and burnout. The shortage of physicians, nurses and other health professionals is the number one challenge facing our health care system. With ongoing shortages, we will continue to struggle to deliver the care Albertans need, when and where they need it.
- We have never faced such a shortage of health care workers in Canada. Alberta is competing against other provinces and countries for physicians while we are beginning to recover from several difficult years in this province.
- We need to plan for both the short and long-term to attract/retain/grow our supply of health human resources as quickly as possible – with priority on retaining the people we have now.
- Retaining physicians means keeping practices stable. We also need to support physicians to have healthier work-life balance and avoid/recover from burnout.
- Health care work environments have become less safe through the pandemic. We must ensure safe working environments where health care workers are treated with respect can provide the highest quality care possible.
- Alberta requires a physician resource plan that is needs-based to identify how many physicians our province requires, what kind of physicians we need and where they are needed.
- A needs-based physician resource plan must include attracting and retaining medical students and residents.
- Strategies to succeed in a competitive environment include:
- Removing legislative impediments – either on the books or in effect -- such as restrictions on billing numbers that determine where and how physicians practice.
- Removing barriers to improve mobility.
- Attracting new physicians to the province from outside of Alberta and Canada.
- Alleviating pressures in areas where there are acute shortages, particularly rural areas.
- We need integrated physician-led teams, efficiently working together to support a medical home for every Albertan.
- We need to be more self-sufficient in our physician supply and less reliant on international medical graduates.
- The newly announced federal health funding could assist with supporting retention of Alberta physicians as well as recruitment of new physicians in the immediate term.
- The province has taken some actions that will factor into eventual solutions. These include:
- Ongoing implementation with the AMA of the 2022-26 agreement that will include needs-based physician resource planning.
- MAPS investment in primary care.
- Supporting doctor training programs in smaller centres to address rural physician shortages.
- Supporting the CPSA pilot project that will accelerate registration for eligible internationally-trained physicians.
- Adding residency spaces to train more physicians.
Key questions for candidates and parties should they win the provincial election
- What strategies will your government employ to make Alberta an attractive place for physicians and medical learners to come and stay?
- How will your government identify and remove impediments to practice in Alberta for medical learners and practicing physicians?
- To help re-establish safe, respectful working environments for health care workers, will your government commit to upholding federal legislation (Bill C-3) to protect our providers in Alberta?
Issue
Across Canada, the impact of the pandemic has highlighted pressures and inadequacies of facility-based continuing care. Staff struggled to provide a basic or consistent level of care while families were unable to visit or assist their loved ones.
- A recent Auditor General report noted that Alberta’s continuing care facilities were insufficiently prepared for the pandemic, including outdated infrastructure and staff shortages.
- Seniors who remain in the community are often challenged to access essential primary care and home care resources. Most Canadian seniors live in the community rather than in facility-based care.
- Providing care to the elderly requires continuity of care, delivered by a primary care team that works together to provide a functioning “medical home.” A medical home offers compassion, understanding and knowledge, while connecting seniors to specialist care and other supports.
- The increasing shift of care into the community is creating significant gaps and increasing demands on primary care, home care and family caregivers.
- It is imperative that we support seniors to stay in their homes longer, which will require expanding the scope of Alberta’s home care program and helping physicians and caregivers coordinate the best possible care.
- Home care is often harder to access in rural communities, which may result in seniors having to leave their homes sooner, travel to other communities, or remain in hospital longer after surgeries or illness.
- There are approximately 1 million family caregivers in Alberta, who together provide as much as 90% of the care for people living in the community. It is essential that we create supports for family caregivers. They make enormous sacrifices to care for their loved ones and are the backbone of the health care system and the largest workforce in society.
- Government has taken some actions that will play into eventual solutions. These include:
- Alberta has passed the Continuing Care Act, replacing multiple acts with a single, modernized piece of legislation to address changing needs and expectations
- Alberta has already implemented some of the recommendations from the Report of the Auditor General—COVID-19 in Continuing Care Facilities.
- Budget 2023 includes $4.3B in combined operating support for Community Care, Continuing Care and Home Care programs, as well as $310M over three years to modernize continuing care facilities, including culturally appropriate care for Indigenous peoples and new spaces for communities in need.
Key questions for candidates and parties should they win the provincial election:
- How will your government ensure Alberta’s seniors receive the care they need, when they need it, in their own communities so that they can choose to remain at home?
- How will your government support family caregivers to better sustain the care they provide, and to maintain their own health and well being?
- What will your government do to ensure Alberta’s seniors are better cared for in any future public health emergency?