With Cold Lake and its hospital continuing to lose doctors, the mayor is asking the provincial government and Alberta Health Services to stop the bleeding.
The City of Cold Lake and the Municipal District of Bonnyville form the largest part of the hospital’s catchment area. Cold Lake mayor Craig Copeland and MD of Bonnyville reeve Greg Sawchuk both say there are simple steps that would go a long way to attracting and retaining doctors.
Cold Lake is at a disadvantage compared to other rural locations, largely because doctors are paid more to work elsewhere. Rural doctors are permitted to charge a variable fee premium in addition to their basic fee, depending on where they are practicing. The remoteness of a community is supposed to be the determining factor.
Cold Lake doctors get a 9 per cent premium. Grande Prairie’s premium is 16.36 per cent, Fort McMurray’s is 19.98 per cent, and Lac La Biche physicians work for a 21.40 per cent premium.
“We need to be up at that 20 percent level and equal to Lac La Biche and Fort Mac and Grande Prairie,” Copeland said. “Having us that much lower really plays against our ability to recruit doctors into Cold Lake.
“If they were able to bring that modifier up to 20 percent, I think that would be an immediate win.”
Copeland said lower pay means fewer doctors, which means longer working hours for the physicians that stay. With the doctors’ clinics booked up, patients have to turn to the hospital’s emergency room for routine care, which creates further stress on the system and even more work for the doctors.
Sawchuk says people who live or work in the MD depend on Cold Lake Healthcare Centre being able to properly staff its emergency room. “The Cold Lake hospital serves a number of our residents. We do a breakdown and we usually figure that most of those people from that Ardmore line are all being served by Cold Lake services. So having that 24-hour emergency care available is extremely important,” he said.
“It’s also extremely important to our industry in the area, so if an accident were to happen they have that support nearby.
“It’s when it was brought to our attention by the doctors that we realized this is a pretty serious situation,” he said.
Sawchuk says that while the province “made a couple of steps in the right direction” by recognizing the difference between urban and rural practice, he doesn’t understand how Cold Lake doctors were assigned such a low variable fee premium.
“They probably are improperly placed, and they should actually get a higher percentage” he said. “Really, I couldn’t figure out the methodology how they came up with the percentages through Alberta Healthcare.”
Copeland said a couple of other steps would go a long way. A dedicated position for a surgical assistant would free family doctors from having to perform that role, he said; and AHS investing more for necessary equipment would help doctors while taking some pressure off of the community.
“We’re getting specialized doctors, the surgeons, the doctors that deliver babies in high risk pregnancies. But what we’ve got to ensure is that the equipment that they need for their job, that AHS is properly outfitting the equipment for the surgery,” Copeland said.
“Hearts for Healthcare has done an amazing job outfitting the hospital over the years. But I think AHS needs to step up and put 30 or 40 thousand dollars worth of surgical equipment into our hospital. That would be a real big helping hand.”
Sawchuk agrees that community groups and municipal governments have a role to play in recruiting and retaining doctors. But he says the province isn’t taking on its share of responsibility.
“Recruitment has always been a longstanding issue for most rural hospitals, and you can put incentives in place and things like that. But I’ve said this a number of times: how much downloading can you put on the municipalities? Health care is a provincial jurisdiction and it really has to start there for these rural hospitals to be attractive,” he said.
The province has been in an open fight with the Alberta Medical Association (AMA), which represents Alberta doctors. Late in 2019 the government stopped negotiations on a new agreement with the AMA and unilaterally imposed a compensation framework.
That framework would have reduced rural doctors’ pay even more. The government has since restored some pay and other benefits. But the AMA says that without a negotiated agreement, the government could take pay and benefits back any time it felt like it.
The AMA is taking the province to court to seek binding arbitration and $250 million in damages for breach of contract.
Cold Lake will soon be down to seven family doctors to serve a catchment area of about 40,000 people. The doctors have warned that unless something changes, they won’t be able to operate their clinics and staff the emergency room.
In a public letter, a group of doctors has said that they are losing morale. “Burnt out and unable to practice medicine as we trained, we have been stretched beyond belief,” the letter reads. It warns that maintaining 24-hour emergency care in addition to family practice with so few doctors is “unsustainable” and “unsafe.”
Copeland agrees. “We estimate there’s at least 7,000 people in Cold Lake that don’t have a family doc. And so it’s just putting tremendous pressure on the emergency room. Our numbers are staggering in Emerg for a city our size.”
Sawchuk says it’s in the provincial government’s hands. “A sustainable health care system ought to suit the population and the resulting demand,” he said. “It seems that the healthcare system in Cold Lake was built to suit a budget rather than the demand that is being placed on it, and we are confident that this government will have a serious look at our situation.
“This is not a healthy situation for the doctors or the patients.”