Advocacy Letters

View our advocacy letters that are awaiting publication or have been published.

• Pharmacist led clinics
• Keep primary medical care out of AHS purview
• Nurse practitioners and siloed care

Pharmacist led clinics

As the nation-wide crisis in primary care continues, the AMA is very aware there are not enough family physicians to provide Albertans the care they need in the current system. Lethbridge is often mentioned as a critical case, but there are many other communities with similar struggles. In the first report last week of 8,000 surveys from the Alberta Medical Association PatientsFirst.ca community, over 35% of those who signed up to participate in our survey because they are waiting for care reported they do not have a family doctor while they are struggling with complex issues after two pandemic years: 24% say they are waiting for a surgical procedure and nearly 30% are waiting to see a specialist or for referral to one. Across the province, over 20% of those surveyed have indicated a wait time of over a year. Nearly 35% have an unknown wait time. In this environment, patients have been trying to find immediate aid to provide much needed stop-gap care.

We are fortunate to enjoy top-notch skills and knowledge of allied health professional colleagues such as pharmacists, nurse practitioners, physiotherapists, occupational therapists and more whose skills and knowledge contribute to the overall care of Alberta patients. They should be enabled to work to their full capabilities. What we know, however, from studies around the world is that, when all providers work together in a patient-focused team, there is not only better access to care, but better outcomes and patient satisfaction from care received. The team approach also reduces pressure on existing wait lists. When we invest in a robust primary care system like this, patients just do better and there is less duplication, error and waste.

We believe that the solution to our primary care crisis is ensuring that every Albertan has a family doctor at the heart of a high-value primary care team involving many health professions. The patient-physician relationship is the core so that patients receive what they need, when they need it. For the role that they play, Family Medicine specialists receive training that is second to none and creates physicians who are as at home in rural areas working in acute care and emergency rooms as they are delivering babies or doing cradle-to-grave medicine in community medical clinics. With the training they receive, they are uniquely placed to help sort the medical problems brought to them, and by managing those problems, keep patients in the community and out of the hospital.

To serve the patient best and improve efficiency in primary care, our focus and resources should be on the team approach. Every Albertan deserves to have a team wrapped around them as they live their lives and travel the health care system. 

Physicians know that access is not what it should be and we understand the desire to fill the gap by multiplying independent clinics operated by other professionals. When there are not enough family doctors to go around, patients may see an independent pharmacist-led clinic as a solution. The care they can obtain, however, is limited to what is actually feasible with the limited training pharmacists receive in the key components of the physical exam and everything involved in assessing, diagnosing and managing patients’ common primary care issues. For this reason, there will be many patients who will still be redirected from the pharmacy to the emergency room when it is apparent their issues require the skills of a physician. Without tracking and sharing the data and outcomes of those encounters and no one aware of all the things that are going on, the patient ends up being responsible for holding all knowledge of their care without anyone to help them manage it. To be clear, this happens today already. We should work hard to prevent it from happening in the future, not make the problem worse.

Popping up new stand-alone points of access is not the solution or what patients deserve for their primary care. They deserve teams of complementary professional services, coordinated by the family physician with full information sharing so that everyone knows what is happening and can work together. This should be the goal and it’s going to take time to get there. In the meantime, let’s put our efforts into breaking down silos instead of letting them multiply.

When it comes to the primary care needs of Albertans, health care that is fragmented into different piece will have to be reassembled at some point, often in times of crisis. If we continue to encourage the proliferation of multiple, disconnected avenues for primary care, by the time we can restore our physician workforce, it will be the patient left holding the bag.

- Dr. Vesta Michelle Warren, President, Alberta Medical Association

Keep primary medical care out of AHS purview

Edmonton Journal, August 20, 2022

Re. “No easy answers to doctor shortage,” Letters, Aug. 13

We agree that a high-functioning health-care system requires robust community-based primary care, co-ordinated with acute care in Alberta Health Services.

We disagree with any approach whereby primary care would fall under AHS management. Over 95 per cent of primary care is run by physician businesses that are part of local infrastructure, so community experience matters. Other health systems have succeeded by investing in primary care management on the front lines, keeping patients out of the hospital system where possible.

Alberta needs additional support for primary care with comprehensive, co-ordinated teams of health professionals. Our acute care system must also be resourced to respond to patient needs with timely access to care. Let’s keep more patients healthy in the community by supporting primary care practices that manage complex, chronic care. That’s the way to deliver value for patients in an efficient, sustainable health-care system.

 - Dr. Vesta Michelle Warren, President, Alberta Medical Association

Nurse practitioners and siloed care

Edmonton Journal, August 11, 2022

The Alberta Medical Association, including our section of family medicine and section of rural medicine, would like to comment regarding Susan Prendergast’s piece (“Alberta’s nurse practitioners could help solve the health crisis,” Opinion, July 29).

We couldn’t agree more that Alberta’s primary care system is in trouble and desperately under-staffed. We have insufficient numbers of nurses, doctors and other health providers to serve Albertans. Too many are waiting to find a family physician of their own or for other care such as tests, treatment programs or procedures and surgery.

Alberta physicians know the value nurse practitioners bring, whether working in remote communities, within primary care network teams or within the hospital system. We need more of these highly trained professionals functioning at their full scope of practice. We support this direction in general for regulated health professions and have no issue with the full use of their skills by these colleagues.

Alberta physicians know the value nurse practitioners bring, whether working in remote communities, within primary care network teams or within the hospital system. We need more of these highly trained professionals functioning at their full scope of practice. We support this direction in general for regulated health professions and have no issue with the full use of their skills by these colleagues.

The journey is worth it, though. With hard work ahead, ultimately the patient can be supported from cradle to grave by a caring team of professionals in a seamless, information-rich, high-quality journey through the health-care system. We believe that the family physician should continue to function as the anchor of the medical home but that is not a barrier to full practice and high-value participation in a team environment by our nurse practitioner colleagues (or pharmacists, physician assistants or other regulated health professionals).

The evidence in Alberta and other jurisdictions shows that when patients obtain their care in a medical home that is integrated in a larger medical neighbourhood, they have better outcomes and increased satisfaction. They visit the emergency department less often and suffer fewer relapses and readmissions when they are sent home.

This saves the system both time and money. Let’s work together for transformative, integrative change that breaks down silos instead of building them up. This letter draws heavily and excerpts from a White Paper Primary Care 2030 (albertadoctors.org) developed by the Primary Care Alliance. The paper promotes the concept that the medical home allows everyone in the system to do what they’re best at.

Today, patients, doctors, administrators and others spend too much of their time navigating the system. Instead, let’s orient the players in the system around the patient. Let’s efficiently orient other specialties, professionals and health resources in a way that is designed to reduce red tape, unnecessary delays and gaps in communication. Let’s streamline things for patients and for all providers.

Specialists will spend more time on their clinical work and less time on administrative way-finding. Primary care teams will operate more efficiently by co-ordinating and sharing the load appropriately according to skill and profession. The patient will engage with a core team and specialist support in the manner that best suits them and their needs.

This sounds like good medicine to us.

- Dr. Vesta Michelle Warren, President, Alberta Medical Association