Edmonton emergency doctors and hospitalists warn of ER backlog if stipend payments end

Some family doctors and emergency room physicians working in Edmonton hospitals have warned that the end of the stipend payment system on April 1 could jeopardize patient care and increase suffering.

In a letter sent to Hospitals and Surgical Health Services Minister Matt Jones last week, which was obtained by CBC News, ER doctors at Edmonton’s Gray Nuns Community Hospital say they worry about the end of a pay arrangement that encourages family doctors to work on call overnight and risks compromising patient care in busy ERs on weekends.

The letter comes three months after a 44-year-old Edmonton man died in a hospital ER after waiting eight hours to be evaluated for chest pains. earlier this month, Acute Care Alberta issued recommendations based on a review that looked into the man’s deathAnd the province has ordered a death investigation.

“Even if our words do not reach deaf ears, at the very least, this letter may be a witness – an excuse – when we have another unnecessary death as the decision makers continue to obstruct the services needed to keep our emergency room running,” reads the March 19 letter signed by the “Grey Nuns Hospital Emergency Medicine Physician Group.”

Although approximately 24 emergency medicine specialists at Gray Nuns did not sign their names, two ER doctors independently confirmed to CBC News that they had consulted with them and sent the letter.

Without hospitals to admit patients to wards after regular business hours, the backlog of patients waiting for care in the ER will get worse, doctors say.

He writes, “Frankly, it is shameful that a big hospital in the city is running on the hours of bankers.”

As CBC News reported, the loss of stipends could also lead to surgeries being cancelled, as the stipends of doctors caring for patients recovering from surgery at hospitals will also end on April 1.

Acute Care Alberta, the agency that oversees hospital services in the province, said in a statement that it does not share doctors’ risk assessments.

“Any claims that ending the legacy stipend for Edmonton-area hospitals will harm patients is false,” spokeswoman Jennifer Vanderlaan wrote in an email Friday.

VanderLaan’s statement said health care operators must balance fair compensation for doctors with running the health system efficiently.

Doctors worry about burnout

Dr. Parker VanderMeer told CBC News he spends about half of his working hours as a hospitalist at Gray Nuns. Their duties include admitting patients to the ER who need hospital care, and discharging patients.

Without the stipend, he said, the Gray Nuns risk not having doctors at the hospital overnight who can oversee the medical care of about 100 patients. VanderMeer said he feared it would mean he would be on call 24/7 for his patients, but there’s no way for family doctors to bill a fee for service for that on-call commitment of constantly being on their phones and computers.

He said many times on-call hospitalists are expected to handle all inpatient medical patient calls, not just their own, but even family doctors can’t bill for that responsibility. He said he believes this opens the door for a doctor to work a full day, stay up all night handling calls without any extra pay, and then report for duty in the morning.

“I think this will lead to a lot of physicians leaving their jobs and, most importantly, it’s not safe for patients,” VanderMeer said in an interview Friday.

“There is ample evidence that doctors who are tired and have not slept for several days are basically as bad as if they had had a few drinks.”

VanderMeer said this will lead him to limit the number of patients he admits, knowing he can only safely monitor so many patients at a time.

He said that this change is a blow to the morale of doctors.

“You will see family physicians moving out of areas that are less compensated, and they will leave a void that no one can easily fill,” VanderMeer said.

CBC News also spoke confidentially with three other hospital physicians who would not speak on the record for fear of professional repercussions.

All said they would reduce the number of patients admitted to hospital to keep their workload under control. All were concerned about the backlog of patients waiting in ERs getting worse.

Three hospital physicians also shared emails from hospital administrators. Some of the emails said that since the doctors have given notice that some of their services will be stopped if they do not receive the stipend, their privileges to work in the hospital may be affected. The letters also remind them of their professional licensing obligations to transfer responsibility for care to another doctor. Doctors said they believed the messages were threatening.

Government says hospitals are making contingency plans

Lawyer John Rossell said he is advising more than 100 hospitalists working in the Edmonton area on how to handle the end of the stipends.

Rossel said that if contracts requiring doctors to perform certain services expire on April 1, doctors are no longer required to provide those services, and in some cases, they may not even be allowed to provide those services.

He said that in some cases, what hospitals are asking physicians to do is unsustainable.

“You can’t put one physician in charge of 80 patients in a hospital and expect all of those patients to get the same care that they could get from a team of five or 10 physicians,” Rossell said.

He said that doctors will do their best to comply with their ethical and legal obligations.

Primary and Preventive Health Services Minister Adriana Lagrange said at an unrelated news conference on Friday that the regulatory college of doctors is required to give appropriate notice if they are withdrawing any care.

The provincial government and the Alberta Medical Association had agreed to end the use of the stipend because some doctors considered it unfair and inconsistent.

Some hospital physicians who received them have said that the government has not offered a reasonable replacement that would not significantly impact their income, or encouraged them to work weekends or overnight.

Lagrange said the doctors’ proposed solution is much more expensive than the current stipend. The AMA and the government are still in talks, he said.

An AMA spokesperson said Monday that the organization had no comment on the issue.

Although Acute Care Alberta and LaGrange said no hospitalists had received formal notice of withdrawal of services as of Friday, three hospitalists who received emails from administrators received notices in response.

Lagrange said hospitals are making contingency plans should hospitalists find their work limited.

“We will do everything we can to make sure that those surgeries and those emergency situations are addressed, and addressed appropriately,” he said. “I have the greatest confidence in our physicians and our health-care professionals that they will always put the patient first before any monetary consideration.”