Patients who need emergency surgery in rural hospitals, including emergency C-sections, could be at risk, say rural doctors, after Alberta Health Services reduced the amount it pays doctors to be on call.
The changes came into effect on Oct. 1, and come after AHS reduced funding to its specialist-on-call program by $10 million per year. The rate reduction follows a decision, made in August 2019, which ended the previous practice of topping up the base amount doctors with specialist skills, such as training in anesthesia or surgery, are paid to be on call.
Under the changes, doctors with specialist training who used to make $18.27 per hour to be on call will now make $11.50.
They will also have longer to respond to calls in some instances. According to Alberta Health Services, doctors who are on-call, but not at the hospital, are expected to respond to a call within one hour, or longer, depending on the condition of the patient.
Dr. Noel DaCunha, a physician in Westlock, who is also on the board of the Alberta College of Family Physicians, says the changes will be felt in labour and delivery, an area where he works. Moms who need an epidural may not be able to get it if there isn't an on-call doctor available, he says.
"If, say, a Cesarean section needed to be done, and it needed to be done quickly, and it took three times as long to do it, almost certainly there could be a life put at risk," DaCunha said.
DaCunha does not work specialist on-call shifts, so his pay won't be affected by the changes.
The changes will be disproportionately felt in smaller rural hospitals, DaCunha said. Small hospitals don't have a full-time, dedicated anesthesiologist or surgeon on staff. Instead, a general practitioner with some specialized training in anaesthetics or surgery remains on call in case of an emergency. They are paid the hourly stipend to remain close to the hospital and stay sober. Then, if they are called in, they will bill more for their services.
Dr. Ted Braun, vice-president and medical director of central and southern Alberta for Alberta Health Services, says he understands the important role on-call doctors play and he urges doctors who have concerns about the changes to contact their clinical department heads or AHS.
However, he doesn't think the quality of care in smaller or rural hospitals will change.
"We don't anticipate that these changes are going to result in changes to the level of care delivered to patients," Braun says. "Physicians have a professional obligation to provide safe, high-quality and timely care. Certainly, we recognize that they want to be remunerated for those services and we don't anticipate that they are going to leave their patients without care in the meantime."
Alberta Health Services says it will conduct a review of the physician-on-call program next year, and will include Alberta Health and the Alberta Medical Association in that review.
However, Alberta Medical Association president Dr. Christine Molnar says rates should go back to what they were before Oct. 1, and re-examined only when that review is complete. "The AMA has stated our concerns and we have asked for a review," said Molnar. "It is very important that physicians are engaged appropriately in these discussions."
Until then, Dr. Gavin Parker, who works as a family doctor and on-call anesthetist in Pincher Creek, says $11.50 per hour may not be a great enough incentive for a doctor to say "yes" to additional call shifts. "We're not obligated to take call," says Parker, who is also treasurer for The Society of Rural Physicians of Canada. "The amount of birthdays and family celebrations and holidays we miss out on, to provide that coverage to the community. The $18 was barely worth it."
Rural physicians are also concerned that, over the long term, lower on-call pay could make recruiting and retaining physicians in rural areas even more difficult.
"In our town, and most rural situations, we never have enough physicians with these skills," says DaCunha. "We are always looking to recruit and this certainly won't increase our ability to get more physicians."