Hundreds of Alberta seniors face losing doctor home visits as debate about physician fees heats up
Shirley Bremault was shocked when she found out the family doctor who visits her Calgary retire‐ ment community once a week is closing up shop at the end of August.
"Seniors need that care and now we don't have it," said Bremault. "We're very upset."
Bremault lives in United Active Living's Fish Creek lo‐ cation, which includes an in‐ dependent living and assis‐ ted living facility.
According to Bremault, residents were told the fees doctors get paid by the province to conduct home visits had been cut by 20 per cent and her physician felt his practice was no longer fi‐ nancially viable.
"We have people with dia‐ betes that need to be moni‐ tored," she said. "We have people with cognitive issues that need to be monitored. We have people in wheel‐ chairs that have health is‐ sues. I don't know where they're going to get their care from now."
This situation is unfolding at a time when Alberta is ex‐ periencing a shortage of family doctors.
Bremault started a peti‐ tion and wrote about her concerns to the province's health minister, the premier and others.
"There's a lot of people in limbo - a lot of people miss‐ ing a lot of sleep - because we don't know what to do now."
Arianne Brady, vice-presi‐ dent of marketing and com‐ munications with United Ac‐ tive Living, said 60 residents at its Fish Creek and Garrison Green locations will be im‐ pacted.
"We're concerned about the overall impact on health long term as a result of not having such direct in-home access to a primary care provider," she said, adding many residents have limited mobility and are without ac‐ cess to vehicles.
"[It] may mean folks ... end up in emergency rooms, which is a much more expen‐ sive cost to our health-care system than some of that preventative care."
Hundreds impacted, doctor says
Bremault is one of hundreds of seniors in Calgary and Ed‐ monton expected to lose their family physicians who are employed through Dr. Tanner Redel's mobile clinic over the next few months.
The Redel Clinic, where Bremault's doctor works, specializes in providing home visits for seniors. It covers over a dozen seniors facilities in both cities.
"Most of our doctors have already left or given their of‐ ficial notice to end their clin‐ ic by the end of the summer," he said.
"This is directly due to the recent pay cuts."
Redel expects the number of physicians on his roster to be cut in half, from eight to four, by the end of summer, leaving about 600 Alberta se‐ niors without a primary care provider.
"I worry about their [the patients'] overall health and their quality of life. I believe we have a huge impact on preventing emergency room visits and deterioration in their health," said Redel.
The amount doctors are paid for many care-home vis‐ its dropped by about 10 per cent in April of 2023 and an‐ other 10 per cent last month.
The way fees are struc‐ tured, Alberta doctors have been paid more for home visits than for traditional of‐ fice visits.
According to the Alberta Medical Association (AMA), the fee reductions - designed to align pay with other sce‐ narios such as an in-office as‐ sessment - are being phasedin over a number of years and another is expected next year.
The change impacts home visits in assisted living facili‐ ties, seniors lodges and per‐ sonal care homes. It does not impact doctors caring for people in long-term care fa‐ cilities or those who live in their own homes.
The AMA said the fee re‐ duction only applies to sec‐ ondary patients. That means the first patient a doctor vis‐ its in the building in a single day is reimbursed at a higher rate and subsequent patient visits (in the same building on the same day) are paid out at the lower rate, which is now $61.69 per visit com‐ pared to $76.15 just over a year ago.
The pay for an initial home visit increased slightly this year to $88.86.
A limited, in-office assess‐ ment pays $39.49. Doctors can charge more for complex patients.
"These seniors need ac‐ cess to primary care and they need access to family physi‐ cians. It's just looking at where best to spend the money on these codes," said Dr. Paul Parks, president of the Alberta Medical Associa‐ tion.
"For the first call, it's ap‐ propriate to be paid at the higher rates. But then it was‐ n't deemed the best use of our resources to pay every other visit at that facility at that higher rate."
According to Parks, the AMA asked the province to use the savings to boost the fee for patients with higher needs and even more mobil‐ ity issues in long-term care facilities. And those fees were increased.
Redel disagrees with the cuts, noting his average pa‐ tient is 88 years old and has a number of medical condi‐ tions.
As a result, appointments for these patients take much longer and doctors see fewer patients on home visits, he said. And he's calling for the fee reduction to be reversed.
"Before the pay cuts there was at least fair pay for seeing seniors in their homes versus what we would have gotten for working in a clinic and putting through large numbers of patients."
Redel said his clinic likely won't survive another reduc‐ tion next year.
Minister willing to re‐ visit
Health Minister Adriana La‐ Grange said the fee reduc‐ tion was negotiated through an annual process with the Alberta Medical Association.
"There's negotiations that happen on an ongoing basis ... and I'm happy to have an‐ other look at that," she said during a news conference on Thursday.
"If it's not working for physicians then we definitely need to look at it. But, again, this was a negotiated rate with the Alberta Medical As‐ sociation."
A statement provided by LaGrange's office said, in part, that addressing physici‐ an shortages and staffing problems are a priority.
The province said it aims to make Alberta an attractive place for doctors to work, noting its working with the AMA to develop a new family physician compensation model.
"When it's fully imple‐ mented, we expect it will make Alberta a national leader in recruiting and re‐ taining primary care physi‐ cians."
Meanwhile, Parks said se‐ niors care - which is inher‐ ently more complex - needs to be addressed as those de‐ tails are worked out.
"We don't want barriers or impediments to our se‐ niors getting access to care," he said.