AMA sounds alarm: Internal medicine doctors overwhelmed

Article content

With flu season as inevitable as migratory birds flying south, a general internal medicine crisis is brewing in Alberta’s urban hospitals, says the president of the Alberta Medical Association.

The loss of hospital-based subspecialist physicians is putting increased pressure on acute care, over and above a continuing bed shortage. The flight is a response to “untenable pressures on acute care and withdrawing from aspects of hospital service, and particularly from after-hours care,” said Dr. Paul Parks on Tuesday.

Article content

At Covenant Health, although the provincial website shows Grey Nuns Community Hospital’s emergency rooms open 24-7, their internal medicine services, because of a shortage of workforce and support, capped consults at the 60-patient mark after hours because they don’t have the night teams to take care of them.

“It’s been going on for a long time,” Parks said.

A lack of night coverage at Grey Nuns has in turn affected recruiting.

The hospital’s general internal medicine staff has been scaled down to three teams from four teams. As the sole in-house night coverage, its first-year medicine residents can only cover 60 patients, Postmedia has learned.

If the hospital’s general internal medicine can’t get a guarantee of enough staff by the new year, the residents and staff will be pulled.

“Those services are at risk of collapsing,” Parks said.

General internal medicine physicians care for the most complex patients with overlapping, multiple health issues — the last line of defence for complex inpatient care, they’re the spinal cord in the backbone of acute care — and they’re not to blame for the crisis in internal medicine, Parks said.

Article content

Article content

“Every colleague needs to do what’s best in order to stay well and functioning. For general internal medicine physicians, though, there really is no one to whom patients can be passed if they step back to try and stay well themselves. We need to fix this,” Parks said.

The word from the AMA’s section of internal medicine president Dr. Troy Pederson is that Edmonton Zone internal medicine had been completely overrun with no capacity for new patients, Parks said.

“This is happening as we are heading into the Labour Day weekend with respiratory virus season just around the corner. The need is urgent,” he said.

Advances in medicine have improved prognoses for patients with overlapping, multiple health issues such as COPD, heart failure, diabetes, cirrhosis, kidney disease, acute drug poisoning or alcohol withdrawal.

Pressures on the system have increased at the same time, Pederson said.

“There are many critical teams of physicians and non-physicians in hospital and they are all seeing the same negative drift in our ability to care for patients. General internal medicine fills a very unique role in acute care as we often shift to fill in gaps for the most complex and vulnerable patients.  This has hidden some of the imminent disasters when patients are diverted from rural hospitals or other sites, acute services have no coverage or are critically understaffed, or there are surges in acuity as we have seen with COVID and other crises,” Pederson said.

Article content

“We are now at a point where many hospital general internal medicine teams have run out of both fingers and toes to plug the holes and we have far passed the capacity to help — provincially we can no longer even cover the work we are meant to do,”
Pederson said.

The province needs to build up the teams that support them and their patients, Parks said.

“It’s inexcusable in this day and age to not know from day to day what support staff will be in hospital, what teams will be in place to help physicians provide care and to be asked to do the work of other professions simply because the government has not invested proactively and appropriately,” he said.

“Our internal medicine colleagues are working at an unsustainable rate and are constantly being asked to do more, with less. They’ve told me they can’t keep up much longer. I do believe that if general internal medicine goes down, acute care will collapse. This may strike some as hyperbole, but as so many other services have been disrupted and impacted, safe and timely hospital care for Albertans is truly at risk.”

In Calgary, Alberta’s health care system continues to set its own clock, and rolling general surgery diversions at the city’s largest hospitals on weekends mean hospitals continue to take turns with overnight surgeries.

Article content

What has apparently become accepted practice since 2023 was unheard of before that, Parks said.

Medical double-whammy

The issue has been building for years, including those critical years of the COVID-19 pandemic, Parks said.

“During the pandemic, they actually went up. Some of their services were at 200 per cent capacity, literally twice as many patients as the team was resourced and signed for. And that’s just been going on since after the pandemic, like it’s been regular for these teams to be at 150 to 170 per cent capacity in our big hospitals, and they’re just at the breaking point,” he said.

“In addition, over the last three to five years, a lot of the subspecialists have left the hospital. They fled the hospital because there’s just no incentive to stay in there now and do the really hard work at two in the morning, with the way the pay schedules are, the funding models. And when I say subspecialists, that would be your cardiologist, your pulmonary specialist, your gastroenterologist, rheumatology, dermatology, anybody that adds an extra layer of specialty.

When the layers of general internal medicine and subspecialty doctors leave hospitals, it’s a “double whammy,” Parks said.

Article content

“It’s getting to be at a crisis point,” Parks said.

Health ministry response

Health Minister Adriana LaGrange’s press secretary, Andrea Smith, said Wednesday that efforts underway to “refocus” the health care system will allow Alberta Health Services to focus on providing quality acute care to Albertans that need it.

She cited doctor after-hours pay measures currently in place. “We already incentivize after-hours care; in fact, in 2023-24 physicians received approximately $200 million total in after-hours time premiums,” Smith said.

“Physicians are compensated for after-hours care provided in an advanced ambulatory care centre, urgent care centre, active treatment hospital, nursing home or auxiliary hospital during defined after-hours time periods.”

Alberta Health and the Alberta Medical Association are reported to be in ongoing discussions regarding compensation targeted for after-hours service.

The current physician compensation agreement between AMA and the province was negotiated in 2022.

[email protected]

Editor’s note: This story has been updated with a response from the office of the minister of health.

Article content

Bookmark our website and support our journalism: Don’t miss the news you need to know — add EdmontonJournal.com and EdmontonSun.com to your bookmarks and sign up for our newsletters here.

You can also support our journalism by becoming a digital subscriber. Subscribers gain unlimited access to The Edmonton Journal, Edmonton Sun, National Post and 13 other Canadian news sites. Support us by subscribing today: The Edmonton Journal | The Edmonton Sun.

Article content