New rules for doctors struggling with too many patients as Alberta health system under strain

New guidelines are in place for Alberta doctors who, for safety reasons, decide to reduce the number of patients on their roster.

Acknowledging the province's health-care system is under strain, the College of Physicians and Surgeons of Alberta (CPSA) has updated its guidance for doctors who find their patient load is too large for them to provide safe care while also taking care of their own health and well-being.

The changes come at a time when it is estimated at least 600,000 Albertans are without a family physician.

"There's more stress in practice," said Dr. Dawn Hartfield, the college's deputy registrar. "About half of health-care providers will report being burned out."

The college previously recommended doctors use a random lottery system to choose which patients to discharge.

Under the new guidelines — which Hartfield said came about through a routine review — doctors are advised to triage patients according to their health needs.

"There is currently more demand for care than the system can support, and different patients require different levels of care: those who need access to care should be retained," the guidelines state.

Dr. Shelley Duggan, Alberta Medical Association president, said that with such limited access to primary care, the previous lottery system was leading to other problems.

"Unfortunately, what was happening … is that some patients who had significant medical problems — significant needs and comorbidities — were being let go from their family physicians," she said.

"These type of patients would often end up in acute care simply because they didn't have anywhere else to go."

The new rules advise physicians to consider discharging patients who don't need access to care or who have been absent from the practice for a long period of time, rather than those who urgently need primary care.

"We need to ensure that we're doing this with intention so that the most vulnerable patients are protected and continue to have access to care," said Hartfield.

"These are difficult decisions for physicians to make, without a doubt. And ensuring we have strategies in place that really consider the needs of the patients — that they're compassionate and fair — are really important at this point in time."

Sign of strain

It's yet another symptom of a struggling health-care system, according to health policy expert Lorian Hardcastle.

"It really does speak to the pressure that the system is under and … how much doctors have taken on," said Hardcastle, associate professor in the faculty of law and the Cumming School of Medicine at the University of Calgary.

"I think policymakers are now going to have to double down on their efforts to recruit primary care providers in order for those patients who are dropped from panels to have somewhere to go to have their medical needs met."

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Even this system comes with risks, she said, noting healthy patients require preventative care and regular screening tests. She's worried they could miss out on that if they end up piecing together care through walk-in clinics, emergency rooms and urgent care centres.

Duggan shares those concerns.

"It's disappointing. But I think if you're balancing, at the moment, you do have to try to keep those very acutely ill patients in your practice," she said.

It's unclear how often Alberta doctors are opting to reduce their patient loads. While the College of Physicians and Surgeons doesn't track those numbers, it does provide advice to Albertans who are discharged by their physician.

The key now, according to Duggan, is to get on with fixing the system.

The AMA and the provincial government announced a new pay model for primary care physicians late last year, and Duggan is hopeful doctors will find some relief once that's in place.

"If we can really stabilize the practices that are there now and then start to get more and more people to the province, then perhaps we can start to reduce this problem."

The Alberta government said a minimum of 500 physicians must enrol for the program to proceed in the spring.

The AMA is now taking expressions of interest, and, while she wouldn't say how many doctors have reached out, Duggan said she's encouraged by the early numbers.