Alberta emergency doctors sometimes work for free, medical association says

The new president of emergency medicine for the Alberta Medical Association says ER physicians already coping with long hours, staff shortages and jammed waiting rooms are also being obligated, in some cases, to work for free.

Dr. Warren Thirsk says Premier Danielle Smith’s government has yet to follow through on a promise to reimburse emergency room doctors for so-called “good faith” payments.

“There’s been lots of excuses, but the bottom line is no one has actually received a penny for those suspended good-faith payments,” Thirsk said in an interview.

“On average, every emergency physician in this province is out thousands of dollars for free work.”

Good-faith payments reimburse ER doctors when they see patients who don’t have identification and can’t prove an Alberta Health Care Insurance Plan billing number. 

Thirsk said the United Conservative government stopped those payments when it ripped up the master agreement with the AMA in early 2020. He said it promised to bring back those payments when the two sides agreed to a new deal in September 2022.

But to date that hasn’t happened, he said.

“I’m legally and morally bound to look after you (if) you’re unidentified (as a patient),” said Thirsk, an emergency room doctor at Edmonton’s Royal Alexandra Hospital.

“(And) I’m going to look after you because it’s the right thing to do no matter what the problem is.”

He said ER doctors are paid by the patient and by the diagnosis of that patient. 

“When the contract was signed (in 2022), one of the conditions was they were going to fix the good faith (payments) right away,” said Thirsk.

“And then they found red tape.

“Even now we haven’t been paid for a good-faith billings.”

Health Minister Adriana LaGrange’s office did not immediately return a request for comment.

Provincewide delivery of medical care is handled through Alberta Health Services, with an annual budget close to $17 billion.

AHS, in a memo to staff made public this week, said it is forecasting a budget deficit and is seeking 10 per cent cuts to overtime and outside service delivery to help balance the bottom line.

Alberta, like other jurisdictions, is facing long waits for care and overcrowding in emergency wards.

Thirsk, an emergency room doctor for 25 years, said the problems are founded in a system that views health workers as costs rather than investments.

He said emergency doctors are routinely asked to cover off vacancies and shortages in other jurisdictions, particularly at the hospital in Red Deer.

“It’s become a regular thing. We probably get once a month an AHS email asking us to cover a shortfall in Medicine Hat, in Lethbridge, in different cities,” he said.

“I think that all the emergency departments across the province are stressed out and are just overcapacity. And I think that that’s unfortunately the new situation normal.

“There’s probably very few emergency physicians who haven’t seen a patient seriously harmed or even die from the gaps in the system, and it’s frustrated all of us. There’s nowhere to take this.”

Asked about the general sentiment he hears from ER colleagues, Thirsk replied: “They want out. Everyone wants out. People are desperate to get out. (They ask) ‘How can I get out? What else can I do? This isn’t fun anymore.’ Those are the quotes I hear right now.”

He said he has little faith a massive restructuring of Alberta Health Services will solve the problem.

This year, Smith’s government aims to dismantle Alberta Health Services to create four agencies linked to specific areas of care — such as acute care and primary care — all answering to LaGrange and cabinet.

Thirsk said the province is creating silos in what needs to be an interdependent system linked to patients rather than specialties.

“As a front-line worker who has no resources to look after the patients in front of me and is apologizing for that every day, I find it incredibly frustrating that we will drop $80 million into an administrative reshuffle,” he said.

“Giving four silos just means you’ve got four different ways to say, ‘It’s their problem, not mine.’

“We’re on the Titanic, and we’re rearranging the proverbial deck chairs.”