Doctors and hospital leaders are at loggerheads in Edmonton, with disciplinary action, legal threats and staffing confusion in the wake of expired contracts that changed how hundreds of doctors across the province are paid.
On April 1, the practice of paying a stipend to doctors who perform hospitalist work ended. Hospitalists are doctors — often family physicians — who manage patients’ hospital care, particularly those with complex medical needs.
The provincial government and Alberta Medical Association (AMA) had previously agreed to phase out stipends for this work, but many groups of doctors did not have an alternative arrangement in place on April 1.
Since then, hospitalists without contracts were scheduled to work shifts without being consulted — and then became the target of disciplinary action when they did not show up, says a lawyer representing hospitalists who work at Edmonton’s Royal Alexandra and Misericordia hospitals.
Disciplinary action has also been taken against Edmonton orthopedic surgeons who diverted patients to other hospitals because they were worried about the safety of their care, according to doctors and lawyers involved in the situation.
Stop disciplinary action, AMA says
AMA president Dr. Brian Wirzba said doctors who lost stipend pay believed they had been let go from the role, whereas Alberta Health Services (AHS) and Covenant Health thought they would keep working.
He’s calling on the health authorities to cease any disciplinary moves against physicians and cancel any complaints they have already initiated.
“If we are looking at filling positions and building new models to address the patient care needs, the last thing that we want to do is have a whole bunch of physicians that were there getting disciplinary notifications, or threats of lawsuits,” he said.
A spokesperson for Matt Jones, Alberta’s hospital and surgical health services minister, said the government doesn’t direct management decisions between service providers and individual doctors.
The statement from press secretary Kyle Warner added that the hospitalists’ professional obligations did not end when stipends were discontinued, and noted that they would still be compensated.
“Physicians (hospitalists) remain contracted and continue to have an obligation to provide services, with compensation available through existing payment models, including fee-for-service and clinical alternative relationship plans (ARP),” Warner’s statement said.
Legal advice not to work
Hospitalists often work on-call overnight and on weekends, and are responsible for admitting patients waiting in the emergency room to a hospital bed.
Surgical hospitalists manage the care of patients who have had surgery, to free up surgeons and manage patients’ coexisting medical conditions. Medical hospitalists oversee inpatients who didn’t have surgery.
Wirzba said the association and government agree on appropriate hospitalist pay but are at odds on working conditions, such as work hours and patient load, he said.
Of about 30 hospitalist programs across the province, five groups have inked new contracts to continue service, according to the AMA. Seven other groups are working on developing a new pay arrangement, the alternative relationship plan.
As of April 8, 12 hospitalists who care for orthopedic surgical patients had given notice to hospitals that they would no longer continue doing the work they had been receiving stipends for, according to Acute Care Alberta. Spokesperson Vanessa Gomez would not say last week how many medical hospitalists had withdrawn their services.
As of April 7, hospitals had provided notices to three orthopedic hospitalists saying they were cancelling their privileges to see patients at the hospital, Gomez said.
Rose Carter, a health lawyer and University of Alberta adjunct professor, said hospitalists are receiving legal advice not to work in the absence of a contract.
She said hospitalists are also worried about patient safety with fewer doctors on the job.
“If the number of hospitalists has suddenly diminished substantially, which it has, and if AHS and Covenant Health are still admitting the same number of patients, that’s a very dangerous situation,” Carter said.
Carter said medical leaders are also threatening or revoking hospital privileges of some of the doctors, and said they intend to lodge complaints with the College of Physicians and Surgeons of Alberta.
“Threatening people’s licences and threatening them with loss of privileges, it’s not going to help anybody, and certainly not patients,” Carter said in an interview last week.
She called on the health ministers to step in and stop health authorities from taking punitive measures that could permanently damage their careers.
Orthopedic surgeons fire back
Orthopedic surgeons who operate at the Misericordia hospital hired lawyers to push back against the punitive measures, according to a letter obtained by CBC News.
In the April 6 letter, sent to Covenant Health and Acute Care Alberta, lawyers with the firm McCarthy Tetrault said health system leaders failed to properly heed warnings about potential disruptions to surgery and patient care at the Misericordia once hospitalist stipends ended.
The lawyers say the contingency plan for orthopedic patients at the hospital was “wholly unrealistic and inadequate.”
Although the government and Acute Care Alberta have said other health-care workers, such as nurse practitioners, physician assistants and medical residents, could fill in for absent hospitalists, two sources with knowledge of the situation said none of those professionals work in orthopedics at the Misericordia. CBC is not identifying the sources because they are concerned about professional repercussions.
The sources said in the first days of April, orthopedic surgeons were only doing day surgeries at the Misericordia, in the event no doctors would be available overnight if an inpatient experienced complications.
Although Acute Care Alberta says only two surgeries were cancelled, the sources said the hospital told them not to book some orthopedic surgeries after April 1.
The letter from the lawyers cited a case where orthopedic surgeons in late March decided for safety reasons to divert an incoming patient with a hip fracture to the University of Alberta Hospital. Covenant Health responded by issuing the most serious internal disciplinary measure possible against the on-call surgeon, the letter said.
Covenant Health initiated a complaint against a second surgeon on March 31, after that surgeon also transferred a patient with a hip fracture to the U of A Hospital, the letter said. It added that patients with hip fractures are usually elderly, live with other serious health conditions and at high risk of death.
The letter said the reduction in the number of orthopedic surgeries the doctors can safely perform is cutting into their income, and they reserve the right to pursue compensation from Covenant for the “unnecessary disruption” of surgeries.
Bylaws must be followed, says Acute Care Alberta
On Monday, Acute Care Alberta spokesperson Jennifer Vanderlaan said staff bylaws require doctors who plan to change their practice to submit documentation that “initiates a structured transition procedure.”
If a doctor doesn’t meet that requirement, an organization is responsible for meting out the consequences included in the bylaws, the statement said.
“Our priority remains ensuring safe, reliable care for patients while working constructively with physicians and their representatives,” she said.
Her statement did not address questions about disciplinary actions against doctors making decisions for patient safety reasons.
