Loss of rural doctors in Alberta leaves patients uncertain as contract dispute with province drags on

On the family cattle farm just outside Caroline, Alta., Nicole and Bill Houlton are busy doing the daily chores.

As they go about taking hay to the cows, there is no outward sign of the health struggles they've had over the past three years. 

Nicole Houlton, 28, has had three miscarriages. It has been a painful time that has brought into focus their reliance on their local health-care clinic and hospital at the same time Alberta doctors and the province are in a contract dispute over how to find savings while still delivering quality care.

While embarking into the unknown world of fertility treatments in Calgary, the Houltons learned they are losing their primary care physician. They also found out five of the eight doctors who work in the Moose and Squirrel Medical Clinic in nearby Sundre have given notice they are leaving Alberta to practise elsewhere. 

"We felt crushed. Going through all this fertility stuff, it's like, now what do we do?" Nicole Houlton said.

The doctors and staff at the clinic in Sundre have become like family, she said, offering a lifeline when she didn't know where to turn.

"They've been there for me 100 per cent of the way, just phone calls, emails, you name it, they're there for you."

Nicole Houlton, who also works as a butcher at a local grocery store, said she was surprised and grateful when the clinic reached out to her husband of four years as well.  

"The man is part of the loss, too."

Bill Houlton, a sawmill worker, said he didn't ask for help, but it was there for the 32-year-old anyway, "just to check on me and see how I was doing and how I was handling it."

'It was awful'

Dr. Alanna Bowie said that writing the letter that left the Houltons "crushed," telling them that she was leaving the Sundre clinic, was "so hard." 

"I don't really know what else to say other than that it was awful."

Bowie was born, raised and educated in Alberta.

She expected to spend her career in the province, practising "cradle to grave" rural medicine. Her tight network of family and friends is in Alberta.

But the contract dispute between the province and the Alberta Medical Association has left Bowie so frustrated, she said, that she is leaving for British Columbia at the end of April. She has arranged locums, or fill-in work, in B.C. until she decides where to settle permanently. 

"It was death by a thousand cuts, all of these little insidious things that made it more difficult, made my job feel more and more unstable."

In a voluntary survey conducted with members last summer, the Alberta Medical Association found that hundreds of doctors say they're considering leaving the province or retiring early.

Threats to stop doing shifts at local hospitals

In addition to the five doctors resigning from the Sundre clinic, more than a handful of physicians elsewhere in the province have publicly announced they are leaving Alberta. 

Alberta Health Services could not provide CBC with an exact number of resignations or how that compared to previous years. 

Doctors in more than a dozen Alberta communities have threatened or given notice they will stop doing shifts at local hospitals and concentrate solely on family practice.  

It's hard to say how much weight the contract dispute between doctors held in individual decisions to leave Alberta.  

But each resignation has come as a protracted battle has raged since the province cancelled the master agreement with the Alberta Medical Association last February. It wasn't due to expire until the end of March. 

It has descended into an unusually public battle of back-and-forth since then, played out on social media, in newspaper ads and in town halls organized by doctors.

"It's a new government. So they came with a mandate, kind of the iron fist, and they've been showing that," said Dr. Edward Aasman, president of the AMA's rural sector, "but it doesn't really help people work together to come up with solutions."

The AMA is suing the province for violating doctors' charter rights when it tore up their contract.  

The government says this is nothing more than a wage battle run amok.  

It says it's trying to rein in unsustainable health-care spending, including more than $5.4 billion annually spent on physician services. 

"Alberta spends more per capita on physician services than any other province," Steve Buick, press secretary to Alberta Health Minister Tyler Shandro, wrote in a statement to CBC News, "We have slightly more physicians per capita than the national average, and we pay them more than in any other province."

Bowie refutes what she calls "the vilification of physicians and gaslighting of Albertans to believe that this is all financially motivated, when in fact it's not at all." 

She said she and others will likely take a pay cut when they move to other provinces.

Instead, she said her decision to leave was cemented by the province's health-care direction and the fractured relationship between doctors and the government. 

Aasman said the AMA is actually ahead of the government when it comes to finding ways to reduce physician costs by finding savings that will have the least impact on patient care.

Large variety of jobs

By the nature of the job, many rural family physicians perform a large variety of medical services and advocates say they often have less room in their bottom lines to absorb cuts. 

Similarly, for each rural doctor who leaves or retires and isn't replaced, the effect on a community is felt more deeply, the AMA says. 

"We see a lot of orphaned patients" when a doctor leaves a small community, Aasman said."It increases the workload, the stress on the hospital, both our community and probably surrounding communities as well. That's a big thing."

The government said it is making practising rural medicine in Alberta the most attractive proposal in the country, with various financial and recruiting incentives.  

It said the very public resignations won't affect the number of physicians practising in Alberta. It is forecasting more new physicians will start working in the province than leave it.

"We do not expect shortages overall or in any specific community, apart from the normal staffing challenges in smaller centres. That includes Sundre, where the hospital is fully covered and services continue without interruption," Buick said.

Worries remain

But with their own clinic losing five physicians, Nicole and Bill Houlton remain worried, and not just for themselves.

"Our senior parents and folks, we worry about them. It's a lot harder for them to travel to a family doctor," Bill Houlton said.

Nicole Houlton said after struggling with trying to start a family, they are now left with more uncertainty.

"Nobody really knows what's coming, what to do, what the next steps are."  

Or if they will even have a family doctor come spring.