Report from RF: Urgent care needed for system

May 17, 2022

Dear Members, 

The Representative Forum met Friday and Saturday (May 13-14) and received updates, deliberated and provided direction regarding government discussions and the Income Equity Initiative. We will have more to tell you on those fronts soon. Today, I want to share my overall impressions of what delegates had to tell the Board.

The system is in crisis. This was the message that your leaders conveyed over and over. COVID and the care deficit are a big part of it, but most issues predate the pandemic and are now much worse. The care deficit itself is generating its own secondary deficit. The scale of this crisis is daunting. Inadequate physician supply is the common denominator leading to burnout and resulting in poor health of physicians and all members of the health care team.

We heard from many physicians who are desperate to find family doctors for their communities following the departures or early retirements of their colleagues. Increasingly, specialty services lack coverage as physicians struggle to meet the demand in their community practices while still maintaining hospital services. The family physicians who do remain are urgently seeking ways to manage thousands of orphaned patients on top of their own overflowing patient rosters. Emergency room doctors, surgeons and other hospital-based physicians are discharging patients with complex and chronic health care needs and trying to keep them well and safe when there is no family physician to assume their ongoing primary care. Without access to family doctors, more Albertans are showing up in emergency and acute care when adequate primary care would have prevented or mitigated disease or death.

Then there is the opioid crisis. Delegates shared, painfully, that opioid and drug toxicity maintain their deadly grip. We heard this from physicians in the big city emergency departments and inner-city clinics, but also in well-to-do urban neighborhoods, rural family medicine practices and, finally, from forensic pathology colleagues who are seeing this in the morgue.

In pediatric mental health, the waves of eating disorders, suicidal ideation, self harm and depression are unmanageable. Families and loved ones who try to manage with inadequate resources are themselves becoming unwell and unable to provide the support that the children and youth need.

Advocacy is critical. Problems can’t be addressed until they are out in the open. We must find immediate, short- and long-term solutions to all these problems. This begins by helping everyone understand what is happening in our system.

That’s the idea behind the AMA’s Care Deficit Assessment Series of issue papers that we launched some weeks ago. Later this week we will release Issue 4 regarding Emergency Departments. As is often noted, the EDs are the “canary in the coal mine” for gaps in the system. Deterioration in primary care, under-supplied rural care and all aspects of the care deficit tend to show up first at the ED triage desk. Please watch for this issue paper. I think it warrants a lot of discussion.

Where it’s possible, we will always seek solutions. In the ongoing disorder and scramble for resources, physicians are seeking ways to solve these big problems. At the RF, motions were passed to empower the AMA to take action in the opioid toxicity crisis. The sections of Pediatrics, General Psychiatry, Addiction Medicine, Rural Medicine and Family Medicine came together to present and propose strategies for improving pediatric mental health. I will have more to share on this soon.

How do I feel after this RF? I am hopeful that a new provincial agreement can be negotiated to bring some stability to Alberta physicians – to help retain those physicians who have been going above and beyond for Albertans, and to help establish venues for collective problem solving by the AMA, government and our system partners.

I am, as always, inspired and uplifted by the passion, integrity and wisdom of our colleagues in the Representative Forum.

I will write again soon. Please get in touch any time in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org.
• Comment publicly on this President’s Letter (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member). 

Sincerely,

Vesta Michelle Warren, MD, CCFP, FCFP
President, Alberta Medical Association