Exactly ONE YEAR ago I signed an MOU with the Minister @AdrianaLaGrange to expeditiously work on the new FM funding model.
I looked her in the eye and said we have to get this done expeditiously.
She said that she is a person of her word, and "this is her promise to deliver"
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In the MOU it was expressly written that this work was to inform the 2024 budget - as time was of the essence.
It was a new govt, and a new relationship, and I fully believed the promise given.

Now: I don't even believe the MOU was worth the paper it was written on.
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Some quick thoughts on this new PC Org announcement🧵:
- I wish Dr. Simmonds success, and will gladly work with her if the intent is to truly create a robust foundation of Primary Care Access for our HC system
- short of announcing the CEO - there were NO actual specifics here
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https://twitter.com/AdrianaLaGrange/status/1846215707513495975

maybe that's good... maybe the govt intends to give the new CEO carte blanche to actually succeed

but, how can you set up an entire new org and not even have a clue as to how you are going to fund it???

feels like the emperor has no clothes on here
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I feel this thread needs more detail.

The Premier’s office releasing stats they KNOW don’t paint the true picture is a clear sign of how they think of FM docs in AB.

A list:

1 as an aggregated COST that they think accomplishes HC delivery goals

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https://twitter.com/pfparks/status/1844599906876448945

2 they don’t get that the > 5000 FM docs can provide care that isn’t longitudinal FM. FM docs working in EDs or Hospital can make a viable living, while those in private community offices cannot. Govt has been told this for 15mnths… they don’t care.
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Hey Calgarians: are you watching what's happening in EDM hospitals, scratching your head, but being thankful it isn't happening to you?
Well, don't get comfy! The GOVT has decided NOT TO ACT and is allowing the FM Hospitalist funding model to wither and die
why you should care:/1 Calgary hospitals have over 850 pts covered and cared for by FM docs under the FM Hosp Alt Relationship Plan (ARP, a non-fee-for-service model)

Over last 15mnths Govt has ignored acting on a critical update (it's been ignored for over 15yrs), so all docs fleeing it
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Hosp Overcrowding has been going on for a long time, but has been getting much much worse since the Pandemic.

AMA gave some solutions in Dec 2023 - govt did nothing.

Since taking over in June 2023, govt has done NOTHING but DESTABILIZE acute care
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https://twitter.com/thebreakdownab/status/1843525279404499259

EDM zone - no capacity, GIM capped
Central Zone - no capacity, “we are so tired”
North Zone - equally struggling, massive workforce issues
Calgary and South Zone - shortly following behind in overcapacity

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ONE MILLION DOLLARS A DAY

Rough estimate of what govt is paying on HC consultants in Alberta

Govt will quickly spout “fake news”, but ask to see the receipts before you believe them

It’s hard to get at this number, as govt is intentionally trying to downplay and hide it
🧵 /1 Investigative journalists should FOIP and dig and add it all up..
Many credible sources have indicated it will be somewhere in that range…

Whatever the number ends up being it is FAR TOO MUCH, and it carries some HUGE ISSUES…

Let’s think about it:
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So much bad news going on with HC in AB, I feel like this might have been missed
Our govt's current plan to address a very unstable and struggling HC system is to:

1 ACTIVELY DESTABILIZE it more
2 fragment and create more admin
3 create more bureaucracy further from front lines And how is govt planning to pay for a larger GOVT bureaucracy? They didn't put nearly enough money in the budget so current plan:
1 take the money from AHS operational funding
2 spend spend spend on consultants to set up more admins
3 hire more suits, far from the frontline
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There are a lot of disgruntled people who used to have jobs working in health care in government. Here is what I’ve heard from some of them.
🧵 1 the environment and culture in govt - aside from being anti-medicine, which ought to be bad enough - stifles good advice. Nobody speaks truth to power. They’re afraid and they’ve watched their colleagues get marched out the door
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Couldn’t agree more w this 🧵, please read the whole thing👇

But a specific note on “competition” and “profit” in a HC system w a single-payer system.

“Profit” just means TAXPAYER money going into the pockets of businesses and corps, without choice

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https://twitter.com/jmeddings/status/1839661814055137291

When a procedure is publicly funded, it is paid for by govt by your TAXPAYER dollars.

Introducing “profit” means similar service but someone taking a cut… that someone is more and more the big corps.

Prices/profit go up more? No prob govt will just tax you more!
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This week in Alberta:
Cancelled pediatric surgeries at the Stollery - due to a lack of anesthesiologists.

REAL ORs sitting empty. REAL children and their family's lives negatively impacted.

At same time the scheduled surgeries occuring full speed in the community CSFs
/1 There is no coordination or planning of:
workforce
capacity
surgical prioritization

there is NO plan, other than disintegration and siloing of the acute care system is to continue

govt/AH given solutions, choosing NOT to act
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Highway of broken promises 🧵.

For FM Specialists holding out hope for a new funding model to ensure their practices remain viable... govt again is releasing promises that "they remain committed"...

Unfortunately I can no longer suggest that hope is imminent in Alberta
.../1 The timeline outlines govt's "committment" and promises since they took power in June 2023.

They do NOT share our urgency, our SOS is unanswered.

There is no implementation date coming.

Best case scenario now: possible implementation by April 2025 (they're next budget)

.../2

This is a picture of Access Block from a REAL Canadian ED (not in AB) that gives a glimpse of overcrowding

Pts lined up on stretchers in a hallway, waiting HOURS for care

For AB major EDs, at this moment, picture this but worse: hallways are more narrow and more pts lined up
🧵 This is happening daily, and getting worse.

At this point and time it is NOT occurring due to increased resp viruses (covid, influenza, RSV, and more) that we know are coming, or already here and spreading.

We already have very limited surge capacity…
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All hospitals struggling with GIM coverage, but interestingly the Covenant Health facilities have been doing the worst in EDM Zone
But for some reason they are completely under the radar

CH has restricted Access by “capping” in its facilities for yrs /1

edmontonjournal.com/news/local-new… When one Health Authority caps in a zone more pts get diverted to the other hospitals, run by AHS.
Why is AHS responsible to take the added volumes, while CH doesn’t even have to publicly report their staffing struggles?
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Some obvious concerns with the idea of adding more clinical “service providers” (CSP) and DISINTEGRATING our HC system.
A 🧵

https://twitter.com/rmoutlook/status/1828201013309747557

1 - this means MORE BUREAUCRACY , more administrators, more middle mgt, more red tape

= MORE COST!

*UPDATED POST*
- please repost and amplify, as I didn't want to delete the original post as it has garnered important attention of Albertans.

Mea culpa: I honestly thought the image below was obviously AI to punctuate my written point. I'm sorry for any confusion.
🧵below
/1 Edmonton Zone hospitals literally overflowing with sick Gen Internal Med (GIM) pts. Currently the Zone has no further capacity, and the EDs are all holding sick GIM pts requiring hospital beds and specialized care. Literally functioning on one discharge at a time mode now... /2

Caveat Emptor Alberta!

A Rexall "Pharmacist Care" Walk-in Clinic in Calgary... it will be SELLING you something... so definitely BUYER BEWARE.

Over 20yrs in medicine in AB and I couldn't tell you what this is, what service it can or cannot provide, or who is regulating it!
/1 Pharmacists are an integral part of the HC team, so this is NOT a criticism of pharmacists.

But I cannot tell you what training in diagnosis this team has, what standards apply to them, or who you might turn to if they misdiagnose you or bad care is delivered.... /2

Let's break down some of the points raised in my thread regarding the Acute Care Access Crisis.
A 🧵(spread out over the next couple of days):

https://x.com/PfParks/status/1822303983865942417

Access to non-family medicine speciality care in both the community and hospitals is deteriorating in AB

Due to neglected attention to our hospital teams, Access is becoming critical in our hospitals...

AMA provided some key solutions that have not been acted upon by AH/govt

Confusion exists around FM docs with smaller panels:

Less than 500 FM docs in AB have panels <500 pts, and almost ALL of these have smaller panels because they do other critical HC work.

A thread 🧵
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What kind of other work can a FM specialist do?
Obstetrics, hospital care, emerg, anaesthesia, surgical assist, mental health, addictions, specialty population care... pretty much ANYTHING in the HC system.

They are generalists with endless options re practice style

Excellent article: ability to pay is already determining who can access life changing surgery in AB.

These private clinics also rob already depleted HCW resources - nurses and anaesthetists - from a public system that is struggling to do ALL surgeries

calgaryherald.com/opinion/column… Because there are no guardrails/rules around who works in private facilities (private or publicly paid) our public facilities are suffering for HC workforce

We have many hospital ORs sitting empty… no anaesthetists or teams to staff the complicated emergency or cancer surgery

Emerg physicians across the province are warning the system will NOT hold. Govt MUST act.

A 🧵 on the current unacceptable state of our acute care system

Some examples of our current crumbling hospital system:
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edmontonjournal.com/news/local-new… Some examples where we spend more money inappropriately due to lack of upfront investment and dysfunction:

1 Growing EIPs - sick pts stuck in the ED for DAYS due to no beds in the hospitals
2 Growing ALCs - pts safe for discharge but no continuing care spaces in the community

“Capped services”
We will be hearing more of this AB.
With capacity and workforce challenges, many in-pt consulting services are indicating it is unsafe to continue taking MORE overcapacity pts into the hospital.
Services are “capping” = no more consultations/advice/admissions This means:
Not only will sick pts remain in overflowing EDs - with a constant stream of new sick pts to be seen…
But specialty consult services will no longer provide care, advice, consultation to the pts in the ED