Edmonton emergency doctors and hospitalists warn of ER backlogs when stipend payments end

Some family doctors and emergency room physicians working in Edmonton hospitals warn that an April 1 end to stipend pay arrangements could put patient care at risk and increase suffering.

In a letter penned last week and sent to Hospital and Surgical Health Services Minister Matt Jones, which was obtained by CBC News, ER doctors at Edmonton's Grey Nuns Community Hospital say they worry the end of pay arrangements that incentivize family doctors to work on call overnight and on weekends risks compromising patient care at the busy ER.

The letter comes three months after a 44-year-old Edmonton man died in the hospital’s ER after waiting eight hours for evaluation of his chest pain. Earlier this month, Acute Care Alberta released recommendations based on a review that looked into the man's death, and the province has ordered a fatality inquiry.

“Even if our words fall on deaf ears, at the very least, this letter can be a witness — an alibi — when we have another unnecessary death because decision-makers continue to hamstring the very services we need to run our emergency room,” reads the March 19 letter signed by the "Grey Nuns Hospital Emergency Medicine Physician Group."

Although the approximately 24 emergency medicine specialists at the Grey Nuns did not sign their names, two ER doctors independently confirmed to CBC News they had consulted on and sent the letter.

The doctors say that without hospitalists to admit patients to wards after regular business hours, the backlog of patients waiting for care in the ER will get worse.

“Frankly, it’s embarrassing to be a major hospital in the city running on bankers’ hours,” they write.

As CBC News has reported, the end of stipends may also lead to surgery cancellations, as the stipends for doctors who care for patients recovering from surgery in hospital will also end April 1.

Acute Care Alberta, the agency that oversees hospital services in the province, said in a statement that it does not share the doctors’ risk assessment.

“Any assertion that ending legacy stipends for Edmonton-area hospitalists will cause harm to patients is false,” spokesperson Jennifer Vanderlaan wrote in an email on Friday.

Vanderlaan’s statement said health-care operators have to balance fair compensation for doctors with running the health system efficiently.

Dr. Parker Vandermeer told CBC News he spends about half of his working hours as a hospitalist at the Grey Nuns. Among his duties are admitting patients from the ER who need hospital care, and discharging patients.

He said without the stipends in place, Grey Nuns risks not having doctors staying at the hospital overnight who can oversee the medical care of about 100 inpatients. Vandermeer said he fears that would mean he would be on call for his patients 24/7, but there is no way for family doctors to bill fee-for-service for that on-call commitment to be constantly by his phone and computer.

He said there are times that on-call hospitalists are expected to handle calls for all admitted medical patients, not just their own, but family doctors can’t bill for that obligation either. He said he believes it also opens the door for a doctor to have worked a full day, be up all night handling calls for no additional pay and then to have to report for duty in the morning.