TL;DR: Alberta would need 11 hospitals in Edmonton and Calgary to be resourced to the Canadian average. 1/6 🏥 Why is Alberta’s healthcare system under such strain? It’s not "management"—it’s a numbers problem 40 years in the making. Let’s look at the data. 🧵 #AbLeg #CdnHealth
2/6 If you want ALL the gory details I have them written down here, btw - work in progress: ).
Basically, decades-long policy of "efficiency" has left no surge capacity: our system works brilliantly on a Tuesday in May, but breaks every December.medium.com/@AntibioticDoc…
3/6 📉 The Bed Gap: In 1980, Canada had 6.75 beds per 1,000 people. Today, Alberta’s big cities are down to ~1.4. That’s the same ratio as India or Syria. Meanwhile, Germany sits at 7.8. We are forced to run "lean" to the point of breaking.
4/6 🛑 The "Exit" Block: Between 20% and 37% of our hospital beds are filled with patients waiting for long-term care (ALC). When the "exit" is blocked, the Emergency Room becomes a parking lot. "Hallway medicine" is terrible for patients and heartbreaking for healthcare workers.
5/6 🏆 The Paradox: Despite this, Albertans have better cancer survival rates than the UK or Germany. My colleagues are putting it all out, all the time for our patients, with ZERO surge capacity. We have 102-120% occupancy daily. The goal for function and cost savings is 85%.
6/6 Problem: Deliberate downsizing ("efficiency") since the 1980s. Now Canada runs the lowest "curative" beds in the G7, and Calgary and Edmonton (1.4 beds/1000) sit near India and Bolivia- we could manage it because of good primary care, but we're underresourcing that too.
6/6 ✅ The Fix:
1️⃣ Acknowledge we need to catch up, then match population growth
2️⃣ Long-Term Care patients need LTC beds
3️⃣ Recognize the real costs of running at >100%
HCW burning out to prevent terribly substandard care is not a long-term plan.
Bonus Math: Canada- avg 2.5 beds/1000, OECD/international avg 3.5/1000, Edm/Calgary 1.5 beds/1000: 3800 beds to get to Can avg, 7,295 to OECD average, optimal community hospital size is 300-400 beds.
Each hospital: 2500-3200 people: nurses, doctors, plus other HCW/staff.
Bonus Comment: Don't get hung up on math. Big picture example: government has not built a hospital in Edmonton since 1988, our population has more than doubled, and we are a referral centre. This has been predictable, predicted, and not dealt with for a looooong time.
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Alberta COVID vaccine planning news release (shorturl.at/U15nE) has some major shockers.
First- it IS $$$ and it IS newly provincial dollars (like all other vaccines). NACI provided guidance (shorturl.at/r0fWf) in Jan as provinces bought supply ~March.
One note re :"wastage": AB had 10% lower vaccine uptake than BC but I'm not sure how many people were aware it was recommended. The campaign didn't use the word "COVID".
Now, most >65y olds in community will pay ?>100$ for COVID vaccine
>65: 1/2 of the hosp, 2/3 of the ICU adm, and 3/4 of the deaths in the pandemic
2024-2025 Alberta data: >60years: hosp 2432, ICU 108, deaths 249
COVID vaccine recommended by NACI
Median income 36K in Canada
Look, I just wanted to share that this article has been shared among physicians across the whole country and no one seemed surprised that rural docs- who are HEROIC- are overworked and overstretched.
What jumped out to people was this quote: 1/ search.app/bCGbkHsRTnQVpf…
Bolded below, the quote from Premier Smith implies docs aren’t working enough. Umm, what? None of us know any family (especially rural) docs doing one day a week. 5 days a week plus evening and weekend call. Charting til midnight. 40+ h a week for 500-1000 complex patients 2/
Would certainly be possible. Going to look after nursing home and hospital patients, staffing an emergency room, doing procedures all take time too. You can’t be in two places at once. (In today’s complex medical world 500-1500 patients to look after is a lot!)
All to say
3/
you don’t have to agree and value every thing a person has done or said to potentially still consider them a worthwhile human (that you don’t agree 100% with.)
(Yes, there are egregious,extreme, untrustworthy people this doesn’t fit)
1/
In science? Maybe you really value someone’s ideas or work in one area but think they are out to lunch or treading out of their expertise in another.
In families, you may value your relatives terrific, helpful family-community mindedness, but hate their takes on politics.
2/
There are times when it’s ok to disagree about some things, keep boundaries, still appreciate some good features or good ideas.
Here, I follow some people/groups who agree with each other and some who loathe each other.
Some I agree with mostly and some very occasionally.
3/
❄️Pre winter holiday break
Straight talk:
Did you get an influenza vaccination this fall?
A COVID XBB vaccination?
Surprisingly high # of patients lately haven’t- not because they are opposed necessarily: many just don’t know it was useful
1/
But this is a HIGH RISK influenza year, it’s high intensity H1N1 (last year was H3N2) and we haven’t seen that for a while, lots of 18-65Y hitting hospital, pregnant, critically ill, the classic H1N1 thing -but also recent peak in >65.
A sadly classic Christmas in ICU
2/
Even if it’s peak we see another half of the cases in the way down so YES get your shot.
Downside (heard this 2x this week) “I got a flu shot once and got flu right after, I’m never going that again,”
it’s just human to think that but if there’s an explosion of infections …
3/
Alberta Government survey questions below seem perhaps suboptimal and could bias results.
(They have a website devoted to the rather controversial Alberta pension plan proposal with this survey).
Having done some survey instrument and exam question design, I have thoughts.
1/
I think this states there will be savings (100% probability) and offers no space to comment… 2/
This followup now tells the person doing the survey that they indicated they want the APP and the outcome they were forced to select and furthermore do they want that as an implied guaranteed option of higher benefits or a bonus cheque 3/
I’ll never forget when a public health doc told me, a naive Infectious Diseases resident that vaccines don’t use the same cut off assessment as medicines or other interventions like procedures. They have to SAVE money for the system to be publicly funded.
Decisions to fund 1/
Treatments like medicine or procedures usually use a cut off based how much they cost to save a good quality of life for a year. shorturl.at/CGMX8
Depending on a countries wealth maybe $ 50,000 and lower is more justifiable. Vaccines? are expected to save money.
2/
This is bizarre. I mean why the higher bar? I think systems should value life saving things by the same measure. By any measure they are the most inexpensive and effective health interventions we have.
On the other hand, alternative products and supplements
2/