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Friday, November 17, 2017

Rural physicians and nurses in short supply

Pincher Creek Health Centre (file photo)
Chris Davis - On September 14 Pincher Creek Associate Clinic Executive Director Jeff Brockman appeared as a delegation before council for the Town of Pincher Creek to discuss concerns about staffing retention and recruitment at the clinic, which serves a region of approximately 8000 people (my estimate). Brockman received a sympathetic ear from councillors and the mayor. Related, albeit indirectly, on September 16 in the Alberta Legislature, Rimbey-Rocky Mountain House-Sundre MLA Jason Nixon (UCP) queried Minister of Health Hoffman about the government's response to the ongoing rural healthcare practitioner crisis in Alberta.

Brockman told Town council that there has been a higher than normal turnover of experienced positions recently, "and it's made it a little more complicated for us, as some specialized skills have left." He said the clinic is currently recruiting for enhanced surgical skills, particularly to keep the obstetrical program in place. In the past year two of three obstetrical physicians have left. Brockman said it was more challenging to recruit for obstetrical skills because there is no equivalent position in the United States and the numbers are low in Canada.

Brockman said he reached out to Marie Everts, the Town's Marketing, Events and Economic Development Officer, for some assistance and it was suggested he speak to council about the clinic's concerns. Mayor Don Anderberg later suggested that Everts was congruent with the clinic's need to get the word out, with direction from council and administration. "Part of the great community (here) is the healthcare system," said Anderberg.

Councillor Lorne Jackson asked if it would be a good idea to hold a recruiting event similar to the one the clinic held in 2013 as part of a Rural Physician Action Plan.

Brockman said there were lots of people interested, but getting the right people was the biggest concern, in terms of retention and the ability to happily assimilate into Pincher Creek's small-town culture. In response to a query from councillor Scott Korbett he said that attracting those with surgical skills was the most pressing need, and that he wants to make sure the remaining practitioner doesn't get burned out. He added that there were locum (temporary) people helping out at this time.

Councillor Sussanne O'Rourke said the excellent care she receives at the Pincher Creek Health Centre was one of the primary reasons she decided to make Pincher Creek her home.

A couple of days later MLA Jason Nixon (UCP) spoke in the legislature about Health Care Professionals in Rural Alberta, this week being Nurse Practitioner Week in the province. "Nurse practitioners provide high-quality, cost-effective services," said Nixon. "They could play an important role in alleviating pressure on Alberta's health care system and help to improve rural health. Unfortunately, one of our visitors here today, Tammy Surbey, has about 350 patients that will
soon be without a Nurse Practitioner (NP) because the system doesn't fit practitioners within existing funding frameworks of rural health care delivery."

Aside: In a 2016 petition posted at albertanps.com Surbey wrote "I am a NP in a small community with a lack of physicians which in turn causes a lack of accessibility to many Albertans. We need a proper funding model so NPs can improve accessibility for Albertans and provide quality healthcare for less money than physicians." Bernice Reurink of Coaldale wrote "I would like funding to work more hours as an NP to provide healthcare to my community." Joanna Everson of Cochrane wrote "I am an acute care NP who has started a valuable out patient clinic. I have won awards for my mentorship and patient care. I WILL lose my job this year for no other reason than a lack of designated funding. I am coded as management out of scope! Cuts that affect that designation WILL affect front line providers until the funding for NP's changes!" There are many similar comments posted to the petition.

Back to the legislature on November 16: Nixon asked if the government "change the funding model to acknowledge the various types of health care professionals?" Minister of Health Sarah Hoffman replied "We are certainly working to make life better for Albertans by investing in health care and improving services that families count on. In Alberta right now we have about 510 nurse practitioners, that are a valuable part of that health care team. We are working to find ways to continue to expand their role in the system, and we certainly wouldn't be able to do that if we followed the advice of the Leader of the Official Opposition on cutting 20 per cent from the budget.

Instead, we're working with our health care professionals to find ways to expand scope and increase opportunities for them and all Albertans." 

Nixon responded "Right now in many communities throughout rural Alberta there are no doctors accepting new patients. Instead, there are wait-lists just to have a doctor, let alone to see a doctor. This is unacceptable in a province that spends $59 million per day on health care. Recruiting and retaining doctors, nurses, and nurse practitioners is a never-ending battle in rural Alberta. It's not that medical professionals don't want to live in these rural areas; it's that ihey keep having to overcome political red tape while what they should be able to do is focus on taking care of their patients. Premier, what is your government doing to address their frustrations and ensure that rural Alberta gets efficient and effective health care?"

"I was proud this morning to be at AAMD and C and have meetings with a number of folks," said Hoffman. "We know that attracting and retaining health care professionals is an important priority for this government and one that we take very seriously. We've been able to revisit the RPAP program, I think, with great effect. Just this morning I met with folks from the Fairview area and Worsley and was happy to make sure that we informed them that we've been able to secure a new doctor who is a Canadian-trained medical graduate who will be starting there this summer. We'll continue to make sure that that happens in all parts of the province, that we get the best care in the best place."

The back and forth between Nixon and Hoffman continued, and at one point Premier Rachel Notley also commented, saying "Let me just say that our government is absolutely committed to ensuring that we protect and preserve and, in fact, improve upon our important – important – public health care system because we know it matters to Alberta families, and we know that it matters to Alberta communities. It is not something that will be done, though, if someone takes 20 per cent out of the system or if someone starts experimenting with new ways to privatize, which, of course, are both things that the members opposite have already talked about doing. We have work to do, we know. We have many challenges we inherited, but we're going to get the job done."

Nixon's response to that was somewhat vitriolic. "I'm not surprised that the NDP anger machine is choosing to deflect from their abysmal record. However, notable professor Dr. Tombe said in response to the NDP's fearmongering: “Goal by [Jason Kenney] to balance by [2023] is entirely credible. Doesn't (necessarily) require any spending cuts. Certainly not drastic.” He then outlined what he called UCP leader Jason Kenney's plans for the economy.

Debates aside, it seems apparent that rural communities like Pincher Creek are continuing to face a healthcare practitioner crisis.

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