Five of the eight doctors working at the Moose & Squirrel Medical Clinic in Sundre, Alta., have given written notice to their patients that they will be leaving to work elsewhere.The clinic made the announcement on its Facebook page Sept. 4, and cited the provincial government's fraying relationship with family physicians as the catalyst."As promised back in February and March, we at the clinic have been transparent and open about the actions of the government and its impacts on our clinic and community," the post read."We are deeply saddened to announce that five of our physicians have provided written notice that they will be leaving our community and province at the end of April 2021."The announcement follows the withdrawal of the clinic's services from the Sundre hospital in July, when doctors said provincial health care funding cuts forced them to choose to keep the clinic running instead.Terry Leslie, mayor of Sundre, said he had not heard about the clinic's announcement, but acknowledged that the issue was ongoing in the community.In a statement, a spokesperson for the health ministry said the government wished the five physicians the best in their careers and thanked them for their service to their patients."When physicians from the Moose & Squirrel Medical Clinic decided to cease providing services at the Sundre hospital, AHS worked with physicians from a different clinic to ensure that the hospital remained fully covered," said Tara Jago in an email."Our government will continue to ensure that services at the hospital are fully covered and that Sundre residents have access to family doctors."Jago said the province's budget deficit contributed to recent changes in how Alberta's doctors are paid."It's not unreasonable for the government to want to manage the budget for doctors, which is 10 per cent of Alberta's entire budget," Jago said. "Our goal through this process has been simply to hold spending to current levels."A 'heartbreaking' decisionAccording to the Rural Sustainability Group, which was created to draw attention to what it calls an impending health-care crisis in Alberta's rural communities, the exodus will leave about 5,000 to 6,000 Albertans without a doctor.One of the physicians who will be ending her services at the Moose & Squirrel next spring is Dr. Carly Crewe.She has been working there for the last five years — since she started practicing medicine, Crewe said. It was where she imagined spending the entirety of her career.This made the decision especially painful."I really believe that I won't find colleagues and a culture and a staff that supports physicians … like that anywhere else when I leave. And so, it's a really, really heartbreaking decision to have to make," Crewe said."But it has come down after months of, really, my joy and my career being degraded … there has just been so much disrespect thrown our way, and I cannot remain in a province where my skills are not valued anymore."The unwilling sacrificeThe province has not been honest with the public about the changes that they are making to the healthcare system, Crewe said.Furthermore, doctors are being vilified on social media, and she is tired — of being called greedy, or money hungry.For the last two and a half months, she has been working in the Northwest Territories, and to get what she described as some "fresh air" away from Alberta."Coming to a new location … put into stark contrast how different my enjoyment for my job was — in Alberta versus somewhere else, where I was away from the government," Crewe said."I had really started to lose the love for my career in Alberta. And it's not because the medicine changed, and it's not because the patients changed."Crewe has given up a lot for her career, she said. Her family has made sacrifices, too. "I'm just not willing to really sacrifice everything I've put into becoming what I am ... to work in a province where I'm so disrespected."Escalating tensionsAfter coming to power in April 2019, the UCP signalled early on that health care — which at $20.6 billion eats up 42 per cent of the province's operating budget — would be a key target for cuts to rein in spending.Tensions between family physicians in Alberta and the provincial government escalated in February, when Health Minister Tyler Shandro unilaterally ended the Alberta government's master agreement with the Alberta Medical Association (AMA) under Bill 21, and imposed a new funding framework. The AMA, which represents the province's doctors, filed a lawsuit against the government in April, alleging Shandro's actions breached their charter rights because they were denied arbitration. The province filed a statement of defence in July that denied doctors' charter rights had been breached and accusing the doctors of "job action" for either withdrawing, or threatening to withdraw, their services.That same month, the AMA released a survey that suggested 42 per cent of the 1,740 doctors who responded are planning to leave the province.Another 87 per cent said they would alter their practices in response to the pay changes. Nearly half said they would change or withdraw services they provide to hospitals and other AHS facilities.Shandro responded to the AMA survey by threatening to publicly release the billings of individual physicians."Since Albertans should know the facts, the government is also exploring introducing physician compensation transparency, as exists for public servants in Alberta and physicians in a number of other provinces," he said in a news release at the time.'Albertans are going to suffer'The state of the relationship is so fractured that Dr. Sam Myr, who is with the Rural Sustainability Group, said she believes it will actually be difficult to recruit new doctors to replace the ones that are leaving Alberta.And in the spring, Crewe said that Bill 21 will also allow the province to tell new doctors where they must practise medicine in Alberta."In reality, what we need is some sign that [the] government is actually willing to listen to our very real concerns of how they are changing health care for the worse in this province, and how much Albertans are going to suffer," Myr said.Physicians in at least 10 communities, including Sundre, Pincher Creek and Lac La Biche, have already either withdrawn services or indicated they plan to leave.Because they are an essential service, physicians can't strike, Myr said. And because Alberta's doctors have lost the right to arbitration, the only recourse for those who want change is to leave the province, themselves."That's the only option to get out of the situation that we're in right now," Myr said.But the government attempted to challenge that, too.The final strawIn a letter written by Health Minister Tyler Shandro to the College of Physicians and Surgeons (CPSA), he implored the CPSA to change its standards of practice for physicians by July 20 in an attempt to stop the province's doctors from leaving their practices en masse due to an ongoing dispute over pay."Patients in these communities," Shandro wrote, referring to rural communities, "should not have to face an entire group of physicians withdrawing services."The letter asked the CPSA to change its standards of practice for physicians, and in order to stop the province's doctors from leaving their practices en masse, or withdrawing services.This letter was the final straw for Crewe. She said that it was what prompted her resignation."I feel like [Shandro was] threatening our profession's right to self-regulation," Crewe said. "I just have no trust for what that means for this government with my profession."According to Myr, the government's actions are unconstitutional. The fallout from eroding programs, and a shortage of physicians, could take a decade or more for the province to recover from.She believes it will get worse before it gets better."It's quite terrifying to be a contractor in a situation like that, where you have absolutely no rights, and you might be able to be told exactly where to go, and that you're at fault if you leave," Myr said. "I really don't blame physicians for leaving at this point."