WESTLOCK - Jason Ching had an important decision to make that would affect the rest of his life.
“During my first year of medicine I agonized over the options I had in front of me for specialization. I could follow my initial dream and try to break into the competitive world of emergency medicine, or bring forth new life into the world as an obstetrician, or participate in life-changing surgeries, or run an outpatient clinic while also being a hospitalist that manages acutely ill patients.”
Ching, 23, was born, raised and educated in Westlock, and is now a second-year medical student at the University of Alberta and he was interested in all those potential avenues to a medical career.
During the summer before his senior year at R.F. Staples School he had the opportunity to complete a student internship at the Westlock Healthcare Centre.
There, he considered a career as a pharmacist, or a nurse, or a lab technician. What he really wanted to be though, was an emergency doctor. He had a long conversation about it with an ultrasound technician at the hospital who encouraged him to go for it and with that encouragement he was able to cast his doubts aside and do just that.
Soon enough, Ching was enrolled in a four-year Bachelor of Science program and upon its completion, he was admitted to the Faculty of Medicine and Dentistry at the U of A, where he is now completing his second year.
As part of the program, students must complete clinical rotations in their third year, which most choose to do at larger hospitals in the city.
Ching will be headed to Peace River though – a town of 7,000 people, five hours northwest of Edmonton. He has made his decision:
“The life of a rural generalist who can do it all appeals to me greatly now, and it was right in front of me all along,” he said during an interview over Facebook last weekend.
Ching is exactly the type of doctor smaller communities everywhere are actively trying to recruit and retain at this very moment, but with the provincial budget last week along with the government’s decision to let its contract with Alberta doctors lapse, medical students like Ching are reconsidering their desire to start their medical careers in towns like Westlock.
He also let his thoughts on the subject be known in a Feb. 27 post on his Facebook page warning his friends and family, especially in smaller centres, about what could be coming down the line if a mutually beneficial agreement cannot be reached.
That post has now been shared 140 times and is spreading around the province, adding to the outrage already being expressed by much of the public and the doctors, some of whom are already planning or considering a move out of province.
The contract
At issue are the provincial government’s plans to introduce new compensation rules for doctors as part of a larger push to decrease spending and balance the budget by 2023.
Last month, negotiations between Alberta Medical Association and the government broke down and the master agreement between the two parties was cancelled and they have not met since. However, the formation of a working group between the government and the AMA was announced March 7 in an apparent attempt to bring the two back to the negotiating table.
At the forefront, doctors are concerned about the amount of time they are expected to spend with a patient. Addressing multiple patient concerns in one visit is currently the norm, but the suggested changes will affect how much doctors are paid for longer appointments.
Issues surrounding prenatal care, mental health, or preventative medicine in the setting of chronic illness, for instance, can all take considerable time with a patient. Ching argues the changes will incentivize spending less time with patients which will only lead to more problems down the road.
“Comprehensive primary care has been shown to save money and improve lives, and these changes look to save money in the short term at great cost to the health of our citizens and our budget down the road,” he said.
“Many physicians are content with sacrificing some earnings for the sake of providing good patient care, and the complex care time modifiers they are planning to cut helped lessen that financial burden.”
Since the changes were announced, hundreds of doctors across the province have signed their names to letters to express to the minister just how concerned they are. This includes 72 doctors from St. Albert and Sturgeon County.
Health minister Tyler Shandro said he believes much of the pushback is a result of a misunderstanding between the two parties.
“I do know that there has been a lot of misunderstanding among our health professionals in the province about what was changed. So I think there was a lot of misunderstanding. And I look forward to the Alberta Medical Association helping us clarify the misunderstanding,” he told a news conference in Edmonton last week.
“We are going to ensure that we are continuing to pay our physicians in this province so that they are among the highest paid in this country.”
The formation of the working group is a promising sign, said Ching.
“We can absolutely have a measured discussion about re-aligning physician pay when the province is struggling, but imposed cuts that mainly attack quality primary care is the last thing you should do if you are looking to achieve savings long term.”
He also points out the current fee structure is very attractive to out-of-province and international graduates, as it rewards spending time with patients. Seeing as doctors are a limited resource “the reality is that, like any other professional, we do cost money to recruit and retain.”
Recruitment and retention
The recruitment and retention of doctors is a huge priority for any municipality with healthcare infrastructure.
Some are better than others at attracting medical professionals, but if you’re going to have a hospital, you need doctors to work there.
Westlock mayor Ralph Leriger has been part of the local medical recruitment and retention committee since he entered municipal politics six years ago. The committee includes representatives from the town and Westlock County.
While requests from the Westlock News for a statement on the situation from local doctors at the Associate Medical Clinic and the Pembina Medical Clinic went unanswered last week, Leriger did have a meeting with two doctors from the Associate Medical Clinic to get a better grasp on the situation.
“They expressed their concerns to me, so I’m committed to getting more information and real information because there is so much rhetoric out there today,” said Leriger, adding the doctors he spoke to were in line with those signing letters and openly expressing their concerns to the minister.
“There is concern about our level of service here, including local doctors on call at the hospital — obstetrics services and having a local anaesthesiologist on call as well. And they’re expressing concern about future doctor recruitment.
“As a municipality, we have worked hard at our doctor recruitment and retention program and we don’t want to see that fall by the wayside.”
Leriger said he has personally taken potential physicians and their family’s around town to show them the facilities, available real estate and the overall charm of small town Alberta.
“I believe that the community should have some sort of influence in attracting and retaining doctors and building relationships has been a key part of our strategy in the last six years. But building relationships with Alberta Health Services has been next to impossible,” said the mayor.
“I’m looking for community builders. We have people that were raised locally that would like to practice locally and be near their families that can’t seem to burst the bubble of hospital privileges and as the mayor I don’t find that acceptable.”
Leriger said he would like to see the province put more consideration into the differences between rural and urban healthcare.
“I’m not saying that there will be cuts in service, but I’m concerned that there could be,” he said.
For Ching and many of his classmates, the stability of a rural practice is very appealing, not only for the chance to become fluent in many different areas of medicine, but to be able to lay down roots and feel supported as part of a community.
“There is plenty of work out there, and it’s also nice to know you are filling a great need in your community. There’s also the strong sense of community you tend to get in smaller towns. There’s a pretty good number of us who are from rural communities and interested in returning,” said Ching.
“Seeing this government, our potential future employer, tear up a mutually signed contract is unsettling. Watching them resist calls to sit down at the table with doctors to find savings that don’t devastate rural family medicine is also disheartening.”
Westlock appears to be doing something right when it comes to recruitment and retention of doctors, at least according to Ching’s advice for municipal officials hoping to snag long-term physicians to practice in the community.
“Take a personal touch when it comes to recruiting, don’t be afraid to try to understand them as a person and not just a professional,” he said, adding that ensuring the concerns of their spouse or partner and family are met is also very important.
He also recommends working with the Rural Health Professionals Action Plan, an organization whose mandate is to help provide rural citizens with better access to healthcare. They can also help get high school students in the community thinking about careers in healthcare as “homegrown talent has a higher chance of returning to the area to work.”
