Thread by @TRexMD780

Hi folks. It's been a long time. I have been off this platform for many reasons. It's pretty toxic around here sometimes and I needed a long extended break. It was nice. I probably won't stay for long.

But let's talk about Family Medicine in #Alberta 👇

1/x

On July 1 2024, I officially closed my practice. After 9 years of doing community Family Medicine, I became another casualty of this province's horrific treatment of Family Doctors. No one took over my panel. I tried, I really did. But it was impossible.

2/x

I knew this was going to happen about 6 months in advance, although quite frankly, I had been entertaining the concept for almost a year. I did many things to try to alleviate the stress:
-I cut down my panel size
-I found a niche interest
-I even moved clinics

3/x

But the reality was that no matter how many individual changes I made, I couldn't escape the bigger problem: Alberta's primary care and community medicine was on fire, and the government was ignoring it. It was death by a thousand cuts and, mentally, I couldn't stand it

4/x

No matter what area of medicine I was managing, it was a disaster. Here's a list of all the barriers I was facing, in no particular order:

-NICU stretched beyond capacity, transferring and discharging patients to me before they wanted to because they desperately need space

5/x

-Children being unable to access funding in every area of their lives: speech therapy, mental health, ASD/ADHD assessments, EA support, learning supports, General Pediatrics, etc.

-Teens having little to no mental health support anywhere. Peds Psych wait times of 1-2yrs

6/x

-Wait times of 6-8weeks for patients to "urgently" see a Psychologist through Access 24/7, and even longer for a Psychiatrist and no guarantee of long-term follow up

-taking care of discharged patients from Psych units for psychosis on medications I'm not familiar with

7/x

-DBT programs being shut down, and then huge barriers being created for community docs to refer to group programs

-No one can afford their meds and then our province refuses to sign on to a drug plan (p.s: Blue Cross is not actually an option for a lot of ppl)

8/x

-Chronic pain clinic wait times being 1-2 yrs +. And then the chronic pain specialist says "Ya I don't manage opioids, good luck"

-Adult ASD wait times are 3-5yrs+. I just stopped putting people on the list

-No adult ADHD assessments available anywhere publicly

9/x

-Home care stretched well beyond what they could handle

-wait times for Geriatrics or Geri Psych being 6mo + b/c they're stretched well beyond what they can do

-wait times for Ortho Surgery, particularly for feet or shoulders, were unknown because they were so long

10/x

-I was never successful in my entire career of getting a patient a publicly-funded breast reduction. Nearly 10 yrs of practice. Isn't that incredible?

-Patients being discharged so quickly from hospital that blood cultures are still pending, me being asked to follow it up

11/x

-Surgeons asking me to prescribe pain meds upon discharge post-op, take out sutures less than 2 weeks from surgery, remove JP drains, wound care management for months or more

-Being asked to manage pre-op coagulation and forms when I don't know the nuance of the procedure

12/x

-Endless, endless, endless paperwork. Private disability. WCB. AISH. Fed govt forms. Prov govt forms. Did you know the GoA, GoC and AHS have the most onerous forms? Isn't that ironic?

-Pharmacist sending me endless refill rx through an automated system

13/x

-Needing to review every lab test, imaging test and consult twice on Connect Care b/c for 5 yrs, they never figured out how to remove the duplication issue for community docs

-skyrocketing costs of overhead & staff, no increase in my billing since I started

14/x

-unmanageable increased medical complexity of patients

-astronomical wait times to get patients into long term care or assisted living

-no MDs available to take care of patients in LTC or assisted living

-patients waiting for months in hospital for LTC placement

15/x

-seeing patients in follow up after they left ERs without being seen because the wait time was too long - but they went in for concerns such as chest pain, difficulty breathing, infection with fever and even, someone who was hit by a car (I can't make this up folks)

16/x

-dynalife/APL calling me at 2am for a critical lab result that was drawn at 9am the day before

-swabs, vials and requisitions from labwork being changed nearly every 6 months and being unable to keep up, and then getting all my tests rejected repeatedly

17/x

-wait times for facilities like Poundmakers, Lakeview and other addiction sites being several months away

-being told I can't prebook patients in for detox as a GP anymore, so they go up to Alberta Hospital and hope to get in as walk-ins

18/x

-huge wait times for patients to be seen for gender affirming care due to chronic underfunding of the only Gender Clinic in YEG

-watching funding for LGQBT2S+ folk just vanish every time I turn

-watching funding for houseless folk just vanish every time I turn

19/x

It goes on and on and on.

And then - @ABDanielleSmith & @AdrianaLaGrange have the audacity to tell us last weekend that Family Doctors don't deserve a comprehensive payment plan for the work we do.

To say that I'm disappointed is an understatement. I'm enraged

20/x

Alberta resident physicians are the second worst paid residents in the country, aside from Quebec.

Nova Scotia, BC and PEI all currently have designed comprehensive and competitive payments plans for GPs

Do you think anyone is going to come here to train? Or work? No.

21/x

So. To the @Alberta_UCP:

Thank you for destroying Family Medicine.

Thank you for setting fire to Acute Care in hospitals.

Thank you for pushing wait times to astronomical levels in nearly every specialty in Alberta.

Thank you for decimating this province

21/x

Why am I thanking them?

Because perhaps when they are done ripping this province to shreds, the voters of this province will see their parents dying in hallways in hospitals, their children in classrooms of 40+ kids, their sister unable to access oncology care on time....

22/x

....their partner's suicide attempt bandaid-ed in a psych unit with no ability to arrange follow up, their utility bills balloon beyond what they can pay for so they sell their home, their municipal infrastructure fall to pieces b/c the city lost it's funding....

23/x

....all in the name of "Conservatistim.....

Perhaps at the end of all this, #Alberta will wake up and say "What the f***k did I do? Why did I vote for this?"

Thank you Danielle Smith. I can not wait until I say "I told you so"

Good luck #Alberta twitter. Until next time

/fin

*Conservatism. lol. When you rage without spell checking.

(also, for all the millennial docs out there, this post was inspired "The Emptiness Machine" - Linkin Park. If you wanted lyrics to express how frustrated you are: "Don't know why I'm hopin' for what I won't receive")