It’s been 32 months since the first case of COVID-19 was detected in Alberta. And it’s been just shy of three years since the coronavirus was first detected in China. Some mark the pandemic as the beginning of a “collapse” in health-care systems across the western world.
But Edmonton ER physician Dr. Sandy Dong said the cracks in the system started showing decades ago.
Dong pointed to the first incident he heard of a patient who stayed overnight in an emergency department waiting room to see a doctor, also known as “boarding” a patient.
“I actually remember the day when the first patient who was admitted to hospital was boarded,” Dong said. “That happened in the 90s. So you can point to that as a start of collapse that we’re just seeing continue.
“Now some departments are operating near 100 per cent of beds. People waiting for beds upstairs and that’s a continuation of collapse.
“But I do remember my first day of noticing that and we wondered, ‘What does this mean?’ And little did we know that it’s the start of all of this.”
Often described as on the front line of the health care system for individuals, primary physicians – commonly known as family doctors – have become increasingly difficult to find.
Reports from major centres like Lethbridge have shown tens of thousands of Albertans don’t have access to a family doctor, instead having to go without.
Securing primary care, prescriptions
A 93-year-old Edmonton man said he’d rather deal with his medical needs on his own than interact with the health-care system in Alberta.
Gilbert “Gil” Bernal relies on his daughter Jacqueline to assist him with his daily care needs after struggling to find a family doctor for months.
“I deal with my pain and my problems because I don’t think there’s anything anyone can do. That’s the system,” he said.
Before COVID-19, Gil was extremely active, even completing a 26-day road trip to the United States with his daughter.
When the pandemic hit, he was living in an apartment inside a seniors facility. Due to pandemic public health restrictions, visitors and activities were limited and he became extremely isolated.
“He started to get depressed,” Jacqueline explained. “He wound up living with me for three months and then we moved him back to the centre on the assisted-living side.”
Gil’s health declined further and he ended up in hospital. His daughter then moved him to a long-term care facility at Jubilee Lodge in Edmonton.
Jacqueline said it was during this time that he was provided a doctor through the lodge.
That medication included a cancer-prevention pill, one that he needs on a consistent basis.
“We went five or six days without that pill,” she said.
The pair were able to secure medications to last Gil a few days at a time, but no doctor was able to take him on as a patient.
“I was shocked. I figured my own doctor could take him on as a client because she had taken over for the doctor we both had previously had (before he moved to a care facility). But she was booked solid because she had taken on new clients.”
In the fall, Jacqueline scheduled a “meet-and-greet” with a potential family doctor for January 2023.
“I used the government app ‘Find a Doctor’, but they were all in north and west Edmonton (and many were full). It was hard to find them on the south side,” she said.
In October, Jacqueline secured a family doctor for her dad.
“If and when I need a doctor, I depend very much on my daughter to locate or find medical help,” Gil said.
The province-wide search for a doctor
About one in four Albertans are without a dedicated primary care doctor, according to an October report from the Nurse Practitioner Association of Alberta (NPAA).
NPAA had advocated to act as primary care doctors, but factors that include the primary care network model prevents them from doing so.
The Alberta Medical Association has also collected data on primary care. In a May survey of 8,200 people who were waiting for care, 34.5 per cent were without a family doctor. More than 97 per cent of respondents indicated some form of deficit in personal health care. The AMA is currently working on a follow-up report.
Dong said a lack of primary care physicians means Albertans wind up at the emergency department for help or avoid getting care for problems that eventually culminate in a trip to the emergency department (ED).
“The ED is kind of the proverbial canary in the coal mine. It’s where things go wrong. People in crisis will end up in the emergency department. And I think what we’re seeing is many problems that have kind of tipped into crisis mode: primary care, housing, long-term care, home care,” he said.
“Many things have to happen for people to come to the emergency department, and if we can fix the inflow and then help with the outflow so people can be discharged safely to the appropriate environment, that would actually solve all of our (emergency department) problems.”
The demand for emergency departments spans age ranges.
The Stollery Children’s Hospital in Edmonton and the Alberta Children’s Hospital in Calgary have seen unprecedented demand for their emergency departments as children and families across the province are getting hit by a triple-whammy of viral activity from influenza, RSV and COVID-19.
“The best health care, if you have a viral illness and you don’t need emergency services, would be to try to contact your family doctor or pediatrician,” Stollery’s medical director Dr. Carina Majesic told reporters recently. “We have contacted our community pediatricians and they are doing extended hours in order to try to help alleviate the demand on emerge.
“If this year is anything like our previous years in viral illness, we have not reached the peak yet.”
At the start of the pandemic, Alberta’s EMS system did not fare poorly, according to one paramedic Global News spoke with.
“It didn’t functionally really change the way we do our work, other than just with a little bit of extra PPE at the start and end of the call,” the paramedic said. “It was still: respond out into the community, find someone, help them, bring them into the hospital.”
The paramedic spoke with Global News anonymously for fear of losing his job.
“COVID wasn’t the thing that hurt us, not to a really noticeable extent,” he said. “It’s 10 years of neglect.”
With more than two decades’ experience as a paramedic, he pointed to burnout as the cause of EMS staffing shortages.
“We recruit. We recruit continuously. The recruit classes get filled. Our issues are around retention,” he said. “Just being inside the system and running so hard and so short – we’re burning people out at a rate that we’ve never seen before.”
The population growth of cities and the province as a whole has outpaced the addition of ambulances and crews.
“We don’t have the resources on the road compared to our call volume like we used to,” the paramedic said.
“When you look at a place like Edmonton, you’re talking five per cent a year — that’s two or three trucks every year that they should have been adding for the last 10 years.
“We don’t have 80 ambulances. On a good day maybe we have three dozen, and that’s essentially unheard of at this point.”
A health-care system built on the past
The need for care grew during the COVID-19 pandemic, but one health policy expert thinks this period may also present a window of opportunity for change.
Lorian Hardcastle is an associate professor in the faculty of law and Cumming School of Medicine at the University of Calgary.
She said the pandemic has brought into “sharp focus” areas of weakness in the health-care system.
“I think the quintessential example is long-term care,” she said. “Another is surgical wait times. I hope we see various provinces with different models of thinking (about these things) and then we can learn from each other.”
She explained that health care challenges of today and decades ago can be boiled down to the issues of cost, access and quality.
“Right now, the tension seems to primarily be on access.”
The health-care system was built around hospitals and doctors, but Hardcastle said the needs of the public have changed.
When Medicare – Canada’s publicly funded health-care system – was introduced in 1968, the country looked a lot different.
“Canadian Medicare consists of medically-necessary hospital and physician services. Then, we have everything else as somewhat of an afterthought,” she said. “So we have a patchwork of programs for funding pharmacare, long-term care and home care. All of those things have played second fiddle to hospital and physician services.”
If the system were to be built from scratch today, Hardcastle thinks money may be spent differently.
“I think the focus would be less on acute care and treating health care problems, and more on prevention and addressing issues upstream before they become problems requiring acute care intervention.”
She noted that when Medicare was brought in, there was an acknowledgment that it should be expanded to pharmaceuticals.
“That was part of even fairly early conversations, but we just haven’t seen that expansion,” the health law professor said. “And we’ve continued to see a system that really focuses on hospitals and doctors instead of looking at the system as a whole.”
Jacqueline said she was pleased to see the Alberta government recently sign an agreement with the Alberta Medical Association and increase funding to areas like healthcare aides.
“But I suspect that there are a lot more weaknesses in the system,” she said. “And because I’ve never really had to access the system, I’m not aware of them.”
Jacqueline’s 93-year-old father said in his lifetime, the approach or attitude toward a patient – bedside manner – has deteriorated.
“The doctors that I encounter really treat me as, ‘Oh, well, just another patient’ and not much interest.”