Where are the Doctors?

The 5 Year Action Plan – Part 1

On Nov 30 the Alberta government released its 5 Year Heath Action Plan.  The Health Minister said it’s “… what Albertans told us they expect…” This appears to be a reference the Health Minister’s Advisory Committee;  the same Committee that Dr Noel Grisdale, the outgoing Alberta Medical Association president, said excluded the AMA from the public participation process and re-designed the healthcare system in 75 days.  A task that Dr Grisdale characterized as “mission impossible”.  Notwithstanding the AMA vote of no confidence, the PCs pressed on and eventually came up with 3 radical changes to the healthcare system.  They rolled the 9 regional health boards into the AHS, they made a 5 year funding commitment and they pushed through the new Health Act.

The next chip to fall was the 5 Year Health Action Plan.  The press release states it will reduce wait times for hip surgery and in ERs, provide more continuing care spaces, provide quicker access to radiation oncologists and emphasize wellness.  What the press release fails to make clear is that these promises won’t become reality until March 2015—4 years from now.  More on the issue of clarity in Part 2.

First a quick overview of the 5 Year Plan itself.  It contains 5 strategies.  These are (1) improving access and reducing wait times, (2) providing more continuing care for seniors, (3) improving primary health care—everything from screening to access to health practitioners, (4) staying healthy and (5) building one health system (a catch-all for everything from revamping the Health Act to improving patient safety).  The strategies are supported by short-term and mid to long-term (mostly long-term) action plans.  But as we all know, the devil is in the details.

Let’s focus on one example, reducing wait times and improving access to GPs and specialists.  The Plan promises that in 2015 a patient will have access to cancer treatment within 60 days.  This is premised on having access to a GP within 2 days, access to a radiation oncologist within 1 month and access to radiation therapy within 1 month after that.  The Plan’s goal is to deliver access to radiation therapy by Mar 2012, however it is unable to deliver timely access to a radiation oncologist, presumably the person who would schedule a patient for radiation therapy, until Mar 2013—14.  Furthermore, timely access to a GP, which is the first hurdle a patient needs to overcome in order to get the referral to the specialist in the first place, is not addressed at all.

The Plan is curiously silent about doctors, period.  It fails to acknowledge the probability that the number of GPs and specialists will have to increase in order to meet the wait time/access targets.  The only reference to accessing medical personnel appears in the discussion of Strategy #3—improving primary health care.  This is the grab bag of health promotion, screening, rehab, etc.  The Plan notes that a variety of professionals are required and that primary care teams are effective.  Can’t argue with that, but in describing how Albertans will better connect to family doctors and other providers the Plan simply states it will “Expand Albertans’ access to primary health-care teams, giving 100,000 more Albertans access to primary health care”. This is a tautology—I am going to expand access to primary healthcare by giving 100,000 more Albertans access to healthcare—and leaves open the critical question of how?

All of which raises a fundamental concern with the 5 Year Health Action Plan.  Where are the doctors?  And how is Mr Stelmach going to deliver “the best-performing, publicly funded health system in Canada” by building more facilities but not adding more GPs and specialists?  Is this an oversight or is Mr Stelmach simply creating a demand for the private doctors who will be called in to deal with the backlog when patients are denied access to treatment because they can’t get past the first portal—seeing a GP within 2 days—let alone the second portal—getting an appointment with the specialist within 30 days?  Could it be that the people who worried about the privitization of Alberta’s healthcare system, first proposed by Ralph Klein and recently confirmed by Dr Raj Sherman, were right?  I guess that’s what happens when the AMA ticks off the Health Minister (then Mr Liepert) by telling him that he’s embarking on mission impossible.

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