‘Stressful as pandemic’

Frontline doctor says changes to billing will damage healthcare system

Dr. Heather Shonoski [Twitter photo]

Susan Thompson
South Peace News

Despite the looming global pandemic and pleas from doctors across the province to at least wait until the crisis is over, the Alberta government has gone ahead with changes to how doctors are paid and who can access healthcare.

A local family doctor says it is doubling the stress of facing COVID-19.

“This is a nightmare,” Peace River’s Dr. Heather Shonoski says, her voice full of obvious exhaustion and worry.

“We are already stressed beyond belief as physicians dealing with the impending COVID-19 surge. We’re doing everything we can to keep people safe, hours and hours of education and meetings and planning so that when a surge hits we’re ready.”

Dr. Shonoski says morale has hit an all-time low as doctors face the prospect of up to 40 per cent reductions to their pay, and not being paid at all if they treat patients without a healthcare card.

The Alberta Medical Association [AMA] says 400 clinics are having to lay off support staff or consider closing, and the association is preparing legal action.

Meanwhile, in addition to billing code changes, the elimination of complex care plans will make it more difficult for physicians to spend time care planning with ultra-complex patients, and end of funding for drivers medicals for seniors over 75 may restrict the ability of some seniors to get around on their own.

Dr. Shonoski worries new location restrictions for practice will also force newly-graduated and urban doctors with no experience in critical care into rural communities. She says it has taken years to learn how to be a rural doctor.

Dr. Shonoski says other changes will have the effect of reducing psychiatric care, and whether accidentally or by design, seem to financially incentivize medically assisted deaths over palliative care.

Dr. Shonoski says the changes are just as stressful as preparing for the pandemic.

“I’m quite afraid for health in rural Alberta,” she says.

“When COVID is over are we going to have a primary healthcare system for our rural residents?”

Ever since the provincial government scrapped the master agreement with doctors in February, doctors have been trying to advocate for themselves and their patients even while being swamped with the task of preparing for the single greatest challenge to the healthcare system since Spanish flu.

On March 30, 800 doctors sent an open letter asking the provincial government to at least delay the changes until after the peak of the crisis [see letter on page 7].

Doctors at the Peace River Medical Clinic sent a letter to the government of their own in early March. Dr. Shonoski also sent an additional more detailed letter to Peace River MLA Dan Williams March 6 in the hope of helping him understand the complexities of medical billing.

All three letters seem to have largely fallen on deaf ears, with only changes to time-based billing being put on pause for now, after an outcry of concern they would prompt doctors to spend less time with patients.

“When we use these time modifiers, we are actually being paid less than if we were to churn through a person every five or 10 minutes. We are doing this because we care,” Dr. Shonoski says.

Dr. Shonoski says she has not yet heard back from the MLA, even though rural patients in Peace River and La Crete already face disparities in their healthcare due to the factor of distance.

She says medical billing is not easy for a layperson to understand, and in rural areas, “It’s quite different from a physician working in the city.”

“We’re in talks right now to find a solution going forward, but it’s hard for us to plan when we don’t even know the details yet,” Dr. Shonoski says.

“We were given the information on what the billing codes would be in hospital only a day before they were implemented. We still don’t fully have clarity on how that affects rural medicine. No one has been informed, so we have absolutely no idea how much we’re going to be paid, or if we can pay our staff, or pay our rent, or keep the lights on.”

Dr. Shonoski says the overhead of running a medical clinic doesn’t stop costing money while doctors go to work in the emergency department instead of the clinic.

“The cost of a medical clinic is minimum $100,000 per year per physician. If not higher,” she says.

She says that means it doesn’t make sense comparing rural physicians, who are essentially small business owners, with emergency room doctors who don’t have any overhead costs.

“They had a very vague paragraph and we’re not even sure how to interpret it, and they’re not taking calls right now, comparing us to say an emergency physician who works only as an emergency physician. But they are not paying overhead like we are to maintain a rural clinic, and of course every small business in northern Alberta is paying more because of regulations,” Dr. Shonoski says.

She adds 85 per cent of the changes now in place target primary care, and she doesn’t understand why.

“Having a family doctor who knows your history is one of the only things proven to reduce costs in the healthcare system, and there is good data it reduces mortality,” she says.

Peace River, McLennan, High Prairie and other small towns in the Peace have generally had trouble attracting new doctors to the region. Local committees have spent countless hours working on doctor attraction and retention.

Yet Shonoski says, “I think new grads are going to leave in droves.”

The University of Calgary’s residency program had 20 spots left unfilled this year, which is unprecedented.

“My fear is that we are never going to get any doctors up here again, and the doctors that are here are going to burn out and leave, and we don’t want that to happen to our population,” she says.

“If we have fewer physicians to serve them, we’re not going to be able to see them in clinics, the emergency wait times are going to go up, and people are going to suffer.”

Dr. Shonoski will be relying on the healthcare system herself, since she is currently pregnant.

“And I’m still showing up to work every day. I’m still seeing patients,” she says.

“We took an oath and we have a duty of care for our patients and we want what’s best for them. A broken system is not what’s best for them.”

Dr. Shonoski says family doctors are putting their lives on the line, and don’t want to hear the government is slandering them or going to physician’s homes and yelling at them, as Health Minister Tyler Shandro recently did in an incident that led the NDP opposition to call for his resignation.

For his part, Shandro has said the government will provide whatever resources are needed during the pandemic. The recently passed provincial budget keeps compensation for doctors at $5.4 billion.

“We have to trust that they will protect us,” Dr. Shonoski says.

“We are saying this is an emergency. Primary care will crumble. Rural medicine will crumble after this, without the crisis.

“To know we can’t count on our elected officials to have our backs is just devastating,” she concludes.

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