Acute care is an aneurysm ready to rupture

May 14, 2024

Dear Members,

The acute care system in Alberta is like an expanding aneurysm that could rupture at any time. The clinical and operational channels through which patients flow are severely weakened; the walls containing the aneurysm are thin and ready to give. It is increasingly difficult to support and stabilize patient care. From physicians to the allied health care colleagues who provide Tier One supports, we do not have the people we need.

There’s no single solution to fix what’s wrong, but the first priority must be to retain the amazing talent that we already have in Alberta and attract more of the best and brightest to our province. Physicians will come only if they can be part of stable, innovative, supportive and well-resourced clinical environments. I would say that is not part of Alberta’s brand right now.

Compensation is not the only tool we have, but it’s a powerful one. Our Acute Care Stabilization Proposal integrates and realigns various components we have taken to AHS and government to help solve patient care and patient flow problems. More than ten years of inability to resolve such issues has resulted in the aneurysmal state our acute care system is in today.

Our proposal addresses the following:

Alternative Relationship Plans

Alberta has the lowest ARP uptake in Canada: 14% of physicians in Alberta are on ARPs vs. 29.5% nationally (as of 2021). Most Alberta ARP pay rates date back to 2002, using methodology that was tied to fee-for-service rates. These rates have failed to keep up, mainly due to changes in utilization per physician over the years.

Availability and after-hours care

After-hours access to specialty care is a major factor that determines patient flow through and from the emergency department. Delaying admission for hours – or overnight – worsens ED wait times and causes those patients to experience more complications and deaths. Incentives are poorly aligned with the increasing demands for acute, complex care that often needs to be provided outside of “banking” hours. Meanwhile, there are few, if any, incentives for clinics to provide extended hours in the community.

Reduced rates

Postponed due to AMA advocacy, 2020 imposed rate reductions (and an AHS review of stipends and how much overhead they would charge physicians in facilities) discouraged both hospital and community-based physicians from working with high-acuity patients in acute care facilities, frequently after-hours. We are asking government to remove this threat from our foreseeable future.

Once these long-standing issues are addressed, I believe Albertans will experience significant improvements to acute care. The AMA's Acute Care Stabilization Proposal has been developed based on the experience of physicians, caring for their patients in hallways and in the very late or early morning hours of the day. Thank you to the Specialty Care Alliance, sections and program teams for your help to finalize the latest version of the proposal that we will table with government shortly.

Please join our acute-care focused Inside Scoop Virtual Town Hall (member login required) on Wednesday, May 22 (rescheduled from May 16) for more information.

Returning to the aneurysm analogy: The acute care system is overstrained, under-resourced and ready to burst. Aneurysms can be treated effectively, with fewer complications, and with lower risk of death if the intervention occurs before they rupture. Acute care is about to become one of four organizations into which the system will be reorganized. We desperately need solutions that cut across specialties and acute patient populations that require better access to hospital and community care. Our proposal meets that bar. We will keep you informed on the discussions to advance it. We know the diagnosis; can we get the patient to the operating room on time?

Regards,

Paul Parks
President, Alberta Medical Association