Northwest Alberta loses child psychiatrist as province makes shift in how doctors are paid

·4 min read
Bonnie Smith and her 14-year-old son Turner Smith. Turner lives with a rare chromosomal condition called Cri du Chat, or 5P- syndrome. His mom says seeing a psychiatrist has helped improve his quality of life. (Bonnie Smith - image credit)
Bonnie Smith and her 14-year-old son Turner Smith. Turner lives with a rare chromosomal condition called Cri du Chat, or 5P- syndrome. His mom says seeing a psychiatrist has helped improve his quality of life. (Bonnie Smith - image credit)

When Turner Smith met Dr. Paul Soper, it changed the young boy's life.

Turner, now 14, lives with a rare chromosomal condition called Cri du Chat, or 5P- syndrome. In 2018, he was struggling at school with behavioural issues, like biting and aggression, and having trouble sitting and participating in class, says his mom Bonnie Smith.

Night brought sleeping difficulties, common in kids with 5P-.

"Before midnight he would move from his bed to my bed. It would turn the house upside down if he for some reason lost his way in between. There was no consistent sleep going on in the house. He was loud. He was chaotic," Smith said.

Sometimes he'd be up at 2 a.m., ready to start his day. But because he needs constant care, someone else needed to be up with him, Smith said.

But within a year of seeing Soper, a child psychiatrist based in Edmonton, things began turning around for the family from High Level, Alta., about 800 kilometres north of Edmonton.

"There was a diagnosis for him and it turned our whole life upside down," Smith said. "And then we met Dr. Soper, and once again, we're able to turn everything right side up."

But now the Alberta Health Services program that brought the two together is ending. Turner's last appointment with Soper was on Dec. 15.

Stipend contracts

For 14 years, Soper has spent three days a month treating children and adolescents in northwest Alberta under an AHS funding arrangement known as a stipend contract. Turner was one of about 150 youngsters on Soper's active patient list in that region.

Twelve stipend programs, including Soper's, will end on Dec. 31, as AHS works to remove a patchwork of agreements that make physician compensation inconsistent across the province, spokesperson Kerry Williamson said in an email.

Stipend programs are a holdover from when health services were provided by multiple regional authorities for care ranging from palliative services and maternity care to organ transplants and child psychiatry, according to the Alberta Medical Association (AMA).

Williamson said some stipend programs will move to a different compensation model called an alternative relationship plan, while others will be funded through the physician on-call program.

Sixty-three stipend programs will continue for limited periods while a transition is sorted out.

But a dozen programs, including Soper's, will end.

'Can't justify it anymore'

Soper said his remote work came at a cost to his family and the stipend allowed him to take time off to be at home.

"Without that, I can't justify it anymore," he said Monday.

Soper is in favour of being replaced with local specialists. To AHS's credit, he said, that's what was supposed to happen.

Soper was informed in the spring that two psychiatrists had been hired to offer services in northwest Alberta and his contract would not be renewed.

But in the summer, he learned one of the psychiatrists wasn't coming and the other, because of demand, would only see patients over age 16.

"So then I asked them again, 'Are we still going ahead with this, given that there isn't going to be anybody to replace me?' And it was on Oct. 20 that I was told for sure that mine was ending," he said.

Soper was able to refer some urgent cases to Grande Prairie. For other patients, he prepared to hand them over to pediatricians or family doctors, writing notes that detailed treatments and suggestions for next steps, along with an offer to be available by phone.

AHS is actively recruiting a new visiting child psychiatrist for the region, Williamson said.

Careful transition urged

The stipends were initially introduced to fill gaps in services available to Albertans, said AMA president Dr. Michelle Warren.

The AMA isn't opposed to ensuring pay is consistent and fair, but the 1,700-plus physicians affected by stipend program changes have concerns about how it's happening, she added.

Alberta Medical Association
Alberta Medical Association

"The problem that the AMA has had with this is that it was very much a top-down approach. So Alberta Health Services contacted the physicians and basically told them this is what was going to happen," she said.

Some AMA physicians launched a committee and have been working with the province on an alternate way to phase stipends out.

"Without a plan in place, we are going to see gaps in care," Warren said. "We are going to see those reasons that they came about in the first place rearing their heads again."

One of those gaps seems to be where Turner Smith has landed.

His mom plans to consult a pediatrician in the new year about connecting with psychiatric services, perhaps remotely.

It can be hard to get into a family doctor in the north, let alone see a specialist, and she's worried about what will happen to her son and other child psychiatry patients in the region.

"I just feel like here we go again," Smith said. "We're going to get turned upside down."

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