Please Give Me a Reason To Stay

This is a follow-up piece to my last post Incompetence and Consequence: Alberta’s New Framework for Health Care, in which I describe why physicians are so upset over the Alberta Government’s cancellation of their contract with doctors, and why the government’s sudden cuts targeting primary care medicine are so damaging and will actually increase cost to the health system in a very short period of time.

An excellent 3 minute visual summary of the problem can also be viewed here.

Most of this post is not my words but those representing a sample of the hundreds, if not thousands of family physicians, rural physicians and specialists across Alberta who have spent the last 6 days trying to understand the magnitude of the change just thrust upon them, planning and sometimes weeping while they struggle to decide how they can continue practicing medicine in Alberta, and realizing it will be impossible to provide the same quality of care they have previously provided to you, their patients. Despite the government’s mainstream and social media advertising campaign patting themselves on the back for not cutting overall health spending, they continue to stubbornly ignore the devastating impact they are about to have on primary care due to cuts already made and fee changes scheduled to come into effect April 1 2020. This despite numerous warning from physicians of all specialties since their proposals were first released last November. In a complex health care system it is less important how much money you spend, and more important how you spend it. They have chosen to ignore the input from the many experts in health care in this province and to make these decisions on their own. Here are the fruits of this incompetence, after less than one week.

Meet Dr. Tannis Spencer, a doctor running a family practice in Edmonton, and doing extra work during her evenings and weekends in the form of home care visits to palliative patients, and sorely needed detox treatment for addictions. She recently made the difficult decision to start closing her palliative care practice, as it is becoming too financially difficult to maintain all components of her work. This tough decision inspired her to share the following words with fellow physicians, who encouraged her to pass her story on to others. She has invited me to share her words on my blog. Following her story, you will see screen captures I have collected over the last few days of Alberta doctors on social media, publicly sharing their frustrations with their patients and with the Government of Alberta. You can find these and more discussions on twitter at #ABdocsforpatients

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“I found a random assignment from grade 5 while cleaning out my basement a couple weekends ago. On the bottom it said, “Future Plans: To see Egypt, become a writer and a doctor.” I can’t believe I wanted to be a doctor as far back as grade 5.
But wait, I also wanted to be a writer. I paused for a long time looking at those words. No one really knows I loved to write novels and short stories, because I never pursued writing after high school. I went straight for medicine, full speed ahead.

Now I barely have time to read a book unless I’m on vacation.

This weekend, I asked myself “Why am I doing this?”

It’s a question that has sadly come up much more often than I care to admit. As I approach the official “5 year post-graduate” mark from Family Medicine residency, it feels like 2020 will be the worst for Alberta doctors.

Maybe I should have been a writer instead.

I am so very tired everyone, and I think I speak for all Family Doctors when I say those words. I think anyone can understand that being on overnight call is exhausting. People might get that working from 9am to 9:30pm with only 30 minutes for lunch and no break for dinner is pretty tiring too. I’ve been working long hours, charting on days off, burning my eyes out on a computer until I needed glasses and then being unable to stop for at least 14 days at a time before I take a day off – it’s physically demanding.

Emotionally, I am drained too. People don’t go to the doctor to say “Hey doc, everything is fine, just wanted to check my blood pressure”. They come in with “Doctor, I felt a lump in my breast” or “Doctor, I am only 17 and I think I’m pregnant”, or “Doctor, I was gang raped over a decade ago and I am finally telling someone now”. I never truly have ‘easy’ days. I understand that part of my job is to take on that emotional burden of the sorrows of humankind, and then file it away on the drive home so that I can be emotionally present for my husband, my friends and myself. I can do it. I’m learning how to do it. But it is exhausting.

I accomplished the goal of being a doctor, starting from the dream of a little girl in grade 5. The dream to help people. To be a doctor.

Last week, that dream was soured by the sweeping policy changes made by Tyler Shandro, Jason Kenney and the UCP. This is really not about money. This is about Tyler Shandro telling the little grade 5 girl that still lives inside me that doctors are ‘bad’ and then watching her heart break. After all these years of school, sweat, tears and misery, the government thinks doctors are simply expendable. We aren’t worth even the respect of proper negotiation. We aren’t worth honouring a contract. We are worthless to the UCP government.

We must bend a knee before our government and their wishes. We belong to them.

When I go into clinic on April 1st, start the time clock and turn to that woman who just lost her husband to cancer, and tell her “You have 10 minutes”, who do you think will be blamed?

Shandro? Kenney? The UCP?

No, not in this province.

The overwhelming majority voted UCP. When Kenney arrived, he came on a cloud with the voices of angels singing his praise, as he floated gently into the Alberta Legislature with money flowing from the deep oil wells in his pockets. He can do no wrong. He is as blue as the pure sky.

No, instead they will blame me for the decline in patient care. They will blame doctors. They call us greedy, money-grabbing, and irresponsible health care spenders.

I don’t want to work here anymore, Alberta.

I don’t want to be hated by you.

I am so tired of being surrounded by people who voted for men in suits who are using slimy propaganda and fake news to make me look like a greedy doctor who only did this for money.

I just want to live out the dream of that little girl in grade 5. To help people. To be a doctor.

But I am already so very tired. We all are – the Family Doctors of Alberta have been burned and we are just so tired. How long are we going to fight for you until we decide it isn’t worth our health and sanity anymore?

One of my palliative patients said to me before he died, “Dr Spencer. can you please take care of my wife when I die?”

I said to him, “I promise. I’ve got her.”

Please don’t make me break that promise Alberta.

Please give me a reason to stay.”

Dr. Tannis Spencer.

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01-Care and crying02-Crying onions03-lost sleep04-Childcare05-Retire Rural06-Imaging delays07-PhysFamilySupport08-Suicide note09-Respect10-leaving AB11-Leaving12-lost graduate13-In training

Palliative- Lethbridge14-MH grad leaving15-Warren-116-Warren-2

Today I cried
(Dr. Charlene Dinakaran, Family physician, Edmonton Zone)

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Lest you think Doctors have not tried to educate the minister through his new preferred communication platform of twitter, or have not agreed to take fee reductions both under past governments and currently please see the below:

 

01-AMA-102-AMA-203-AMA-304-Against evidence05-Costs rise06-economic sense07-evidence-risk08-attack09-Negotiations failure10-Previous concessions11-Lies called out

 

Please add your voice to those of Alberta doctors to stop the drain of physicians out of the province, keep good family practice financially viable, and return to the negotiating table to find actual, sustainable savings in the health care budget. We are trying to sound the alarm before it is too late.

Thank-you,
Dr. Sean Wilde, MD, CCFP-EM

 

[EDIT: Please see this letter to the minister of health signed by 85 concerned Calgary emergency physicians. ER doctors have always advocated for more investment in primary care and home care as this is what reduces cost and crowding in emergency departments]

 

[EDIT: Please sign and share this change.org petition asking the Minister of Health to return to the negotiating table with doctors to find sustainable health care savings that won’t decimate Alberta’s health care system.]

 

Minister of Health: Tyler Shandro
423 Legislature Building
10800 – 97 Avenue NW
Edmonton, AB
Canada T5K 2B6

Phone: 780-427-3665
Fax: 780-415-0961
E-mail: health.minister@gov.ab.ca
Twitter: @shandro

 

Premier Jason Kenney
307 Legislature Building
10800 – 97 Avenue
Edmonton, AB
T5K 2B

Phone: 780-427-2251
Fax: 780-427-1349
E-mail: premier@gov.ab.ca
Twitter: @jkenney

 

9 thoughts on “Please Give Me a Reason To Stay

  1. I’m sorry but I had to stop reading at the four page suicide note. I am a nurse working mental health and addiction and family doctors are the critical glue that allows me to help my patients. The ones that link, monitor, have the relationship, know the details, and can guide decisions about care. Always the first part of my assessment: do you have a family Doctor? Wtf are we going to do now? They are gatekeepers and coordinators… 💔😭

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  2. So tell me then. What should the government do? Highest health spending in Canada, something has to give. I’m not disagreeing with the article , it’s disgraceful what’s happening to the healthcare system. I just would like to know what would make it better?

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    1. Good question. First of all, working with professionals (in any field or organization) to find cost savings is always better than working against them. In health care doctors and nurses have collectively and individually suggested a number of ideas, but there is no interest from the government to continue collaborative discussions. Doctors have negotiated several cuts to their own pay over the last 7 years as we want to the system to be sustainable. We have made further reduction offers and will continue to do so in a way calculated to minimize the impact to patient care and keeping Alberta an attractive place to practice medicine, to the avoid health system problems experienced in other provinces. Total costs continue to rise because the population of Alberta is increasing, and so is the complexity and cost of health care per person (as it is elsewhere). Arbitration is available and acceptable to ensure neither side is able to overstate their case and run rampant over the other. We asked for it, government refused.

      Additionally, Alberta is trying to maintain the same services it has enjoyed under a prolonged oil boom without the need for a provincial sales tax, which every other province collects to fund the same services. We need to decide as a province whether the benefit of lower taxes is worth the inevitable eventual trade off of having inferior health, education and infrastructure services, rather than relying on the pipe dream (pun intended) of high global oil prices and corporate environmental responsibility turning in our favor. If the consensus is that deep service cuts are the better alternative, then it is more important than ever that experts in the field (not accounting firms) help make the hard decisions on what to cut and how, to avoid the path the UCP has set down: destroying primary care (the foundation of health care) while dumping money into infrastructure projects (the most expensive environments to provide care).

      Thanks for your thoughts.

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  3. I’m honestly really discouraged. I’m seeing the fervour and the pain and passion all the docs are pouring out, trying to make the government understand. But at this point, I have to think that they do understand. They just don’t care.

    As an out-of-province med student, I had been open to practicing in AB after training, but this definitely sours me on the whole idea.

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  4. What can one say but HOW SORRY I am to SEE this HAPPENING…I have Family in Alberta in the Oil Patch and I had to be careful what I said about “KENNY” I know a little about this errrrrrr and his belligerence, arrogance and Ignorance ….God Bless and Protect you ALL

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  5. I have written letters to my local MLA, Tyler Shandro and the Minister of Finance to plead the case for Alberta doctors with no response except that they got my mail, but no feedback. I am not a doctor, but a patient with medical issues and have always had excellent care. I honestly believe that quality care will degrade. I fear for the deep cuts that will soon come into effect and am very much afraid Alberta will not be able to retain or recruit qualified physicians to our province. The ramifications are tremendous!

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  6. I feel outraged that the Alberta government has decided to unilaterally change our health care system. The measures being implemented will seriously impact both doctors and patients. Thousands marched to protest the decision to reduce the category of my nearest hospital to that of a clinic. That was back in the Klein era but we were heard and we still have a hospital in a neighborhood of approximately 60,000 residents. At least that is the last number that I heard. What will happen now? Our neighborhood is still growing. Will everyone be safe with these cuts? A few weeks ago, I needed to visit the ER because it was after my doctor”s office hours and the Medicentre nearest me had closed at five o’clock. It took three and a half hours for me to get two stitches and a tetanus shot. The procedure took only ten minutes. I am grateful that there was a doctor there. I am worried about what will happen to patients when the doctors leave Alberta. That happened under Klein and I recall how difficult it was for patients waiting to see a specialist or have diagnostic tests. Longer waiting times is going to result in more people dying because they don’t get an early diagnosis. I, for one, don’t want to see healthcare slip back to the dark ages. Telling people that it is all in their head and take two Tylenol and call in the morning if things don’t improve, will become the normal level of care. Albertans deserve better.

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