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"A storm is coming": Experts sound alarm on pandemic dangers as rural doctors threaten to jump ship

Local experts are warning the provincial government's push for fiscal restraint could weaken the health care system's ability to respond to a pandemic crisis, as Alberta reports its first confirmed cases of COVID-19.

Deena Hinshaw, chief medical officer of health for Alberta, confirmed Thursday a Calgary woman in her 50s is believed to have contracted COVID-19, also known as the novel coronavirus, while aboard the Grand Princess cruise ship in California. The woman returned to Alberta Feb. 21 but didn’t go into self-isolation until Feb. 28. She is expected to make a full recovery.

On Friday, Hinshaw confirmed a second case in the Edmonton zone of a man in his 40s who just returned from a business trip to the U.S.

On Monday there were seven cases of COVID-19 in Alberta.

COVID-19, a new respiratory virus first detected in Wuhan, China, in December has spread to more than 95,000 people across six dozen countries, causing more than 3,200 deaths.

“We are taking this extremely seriously,” Hinshaw said, adding they are working to contain any possible spread of the novel coronavirus as they wait for laboratory tests to confirm the diagnosis.

As global concern over the spread of COVID-19 rises, so too rises anxiety from Alberta’s rural family doctors who say the government’s efforts to squeeze more value out of health care spending could push doctors out of rural areas, creating holes in the province’s health care system as it prepares to face a potential pandemic.

“We are already working on a very small number of physicians, and if some leave, it’s not likely that those that remain actually have the capacity to meet the needs of the community," said Edward Aasman, president of the Alberta Medical Association’s Section of Rural Medicine.

Months of negotiations between the Alberta Medical Association and the provincial government came to an abrupt hault at the end of February when the province threw out its existing funding contract with Alberta doctors and imposed nearly a dozen changes to the way physicians charge for their services in an effort to keep spending on physician compensation flat.

The Alberta Medical Association warned these changes – such as adjusting the way physicians bill for treating patients with complex needs, capping the number of patients a physician can charge for seeing in their clinic in a day and eliminating clinical stipends that were once used to attract doctors to underserved parts of the province – could potentially bankrupt small town medical clinics.

“A lot of the cuts seem to be targeting rural medicine,” Aasman said.

The uncertainty is driving doctors out of Alberta’s smaller municipalities, like Dr. Cathryn Zapf, who said in late February she would be closing her clinic in Canmore in June because of these fee reductions.

Two doctors being recruited to serve patients in Drayton Valley and Breton will no longer be going to Drayton Valley's Claro Family Practice, even though one of the doctors “loved the clinic and the town. I just don’t trust this government.”

And at a community meeting Feb. 23 in Sundre, Alta., Dr. Carly Crewe, a physician with the town’s Moose & Squirrel Medical Clinic, said “this will have drastic consequences to our sustainability as medical clinics in rural Alberta.”

In a letter to Kathleen Ganley, MLA for Calgary-Mountain View, Calgary psychiatrist Will White warned the impending changes will have “serious damaging ripple effects throughout the system.” The letter was signed by nearly 600 doctors from across Alberta.

As for forcing these changes in the face of COVID-19, White wrote, “a storm is coming.”

Aasman said there are around 440 doctors practising in Alberta's rural communities. For every 100,000 patients in rural Alberta, there are between 50 and 60 doctors to care for them, far fewer than the provincial average of 240 doctors per 100,000 people, he said.

“It doesn’t take too many to leave to get down to an unmanageable number,” Aasman said.

A Health Canada report published in 2003 following the SARS outbreak – a novel coronavirus detected in China in 2002 spreading to 8,500 people and causing 900 deaths globally, including 44 in Canada – called family physicians the “sentinels” in a potential pandemic outbreak, as they are the ones likely to see sick patients first and recognize the symptoms.

Infectious disease physician Stephanie Smith said having a robust system of family physicians “is absolutely key” in detecting and responding to a potential pandemic outbreak. The associate professor in the Division of Infectious Diseases and director of infection control for the University of Alberta Hospital said the vast majority of patients will probably not come to the hospital because they are not sick enough – they’ll end up going to their family doctor.

Of those infected in Canada with SARS, one in five were health care workers.

In the event of a pandemic outbreak, Smith said, urban hospitals under the pressure of dealing with a large influx of sick and contagious people may look to rural hospitals for support.

“If we started to have a lot of cases and a lot of transmission, then I think our urban hospitals will become overwhelmed and there will be need to have some patients in more rural hospitals,” Smith said.

“If there is no one to take care of them, that's going to be a problem.”

When asked about this issue, Alberta Premier Jason Kenney balked at the suggestion that the government was making cuts to the healthcare system, and instead was seeking better value for taxpayer dollars by finding efficiencies within the system.

“Even at a time of significant fiscal and economic challenges, we are funding health care at record high levels, the highest levels in Alberta history, the highest per-capita levels in Canada,” Kenney said.

The Alberta government has committed to maintaining operational spending for health at $20.6 billion in 2020-2021, including $5.4 billion for physician compensation.

A review of Alberta's health care system, conducted by Ernst & Young and released in February, suggested long-term savings initiatives could save the system between $1.5 and $1.9 billion annually. Alberta Health Services is expected to report back with how those initiatives could be achieved in May.

Last fall's Blue Ribbon Panel on Alberta's Finances found Alberta was spending $5,077 per capita on health while British Columbia, Quebec and Ontario spent an average of $4,239, but Kenney said that doesn't necessarily mean Albertans are getting better care.

Budget 2020 pledges $500 million over three years as part of a plan that aims to see 80,000 more surgeries performed to improve lagging surgical wait times. Less than half of all surgeries in Alberta in 2019 were performed within their clinically recommended targets.

“There are no cuts,” insisted Health Minister Tyler Shandro, who blamed anxiety among Alberta's physicians on “a lot of misunderstanding.”

“We are going to ensure that we are continuing to pay our physicians in this province so they are among the highest paid in this country,” said Shandro, who was speaking at the Mazankowski Alberta Heart Institute on Wednesday.

Ron Kneebone, a professor of economics with the School of Public Policy at the University of Calgary, disagrees.

Kneebone said on paper Budget 2020 maintains health care spending in Alberta, but those numbers don't take into consideration population growth and inflation.

“As we move into the future, prices are going to be higher. Even if the government spends exactly the same amount on you and me and provides the exact same services, each year they are going to be more expensive,” Kneebone said.

In a move to balance Alberta's budget by 2023 despite a challenging economic climate, Kenney has called for a 2.8-per-cent reduction in overall operational spending in Alberta.

After adjusting for population growth and inflation using projections from Budget 2020, however, Kneebone said that number is closer to 14 per cent.

This also means although the provincial government has committed to “maintaining” health care spending, Kneebone said when adjusted for inflation and a growing number of patients, “actually, it's going to fall by about 12 per cent.”

Smith said Alberta is better prepared than ever to face a potential pandemic. Aasman hopes it stays that way.

“If a pandemic comes, we certainly want to do our best,” Aasman said. “We hope we don't get sick so we can.”

Claire Theobald, Local Journalism Initiative Reporter, St. Albert Gazette

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