Zan Carter plans to start a family this year and she’s worried about who will help bring her baby into the world.
She wouldn’t dream of giving birth in Cold Lake. The 30-year-old kindergarten teacher plans to drive more than three hours to Edmonton for obstetric care.
Zan Carter, 30, isn’t sure she wants to have her children in Cold Lake.
“I hear horror stories from other people about the care that is offered here and I dunno how much trust I have in them.”
Her concern might be misplaced. The Canadian Institute for Health Information reports that only 0.5 per cent of obstetric patients are readmitted to hospital in Cold Lake, well below the 2 per cent average for both Canada and Alberta in 2009-2010.
But the Cold Lake hospital scores slightly higher on re-admittance for all patients compared to the rest of Canada and Alberta — 9.3 per cent of all patients were readmitted to hospital in Cold Lake compared to 8.8 per cent nationally and 8.9 per cent provincially.
Carter is not the only woman in Cold Lake who has had doubts about going into labour in her hometown.
Mayor Craig Copeland told the Cold Lake Sun in January 2014 it was “embarrassing” that so many women didn’t trust their local health care provider, in response to news that there was a record-increase of 500 ambulance trips in 2013. Although it’s less than two per day, the average increase is 50 to 100 calls per year.
“What is going on that we can’t deliver in babies in Cold Lake? That is unacceptable,” he told the newspaper.
Cold Lake’s chronic doctor shortage
What’s going on is that there just aren’t enough doctors trained in obstetrics in a city that grew 15.4 per cent between 2006 and 2011, despite what the indicators may say about the effectiveness of Cold Lake’s doctors. The city is suffering from the same chronic shortage of doctors and nurses that has plagued other booming Alberta towns since at least the early 1990s.
Each of the 14 doctors currently working in Cold Lake takes on about 1,000 patients, meaning there are enough doctors for 14,000 people. The College of Physicians and Surgeons of Alberta doesn’t have a hard rule on how many patients a doctor can take on, according to spokeswoman Barb Krahn, but medical professionals in Cold Lake say 1,000 is about average for a family physicians. Cold Lake’s municipal census population in 2014 was 15,756. The unofficial “shadow population” of workers who fly in and out to work in the oilfields inflates the official population by three thousand people, at least — no one really knows the exact number of workers in the oilfields.
“If you’re new to Cold Lake you can’t get a family doctor,” Copeland said.
The Canadian Institute for Health Information reports that 72.7 per cent of Cold Lake residents have access to a family doctor compared to 84.5 of Canadians, a situation it describes as “weakening.”
Carter moved to Cold Lake to teach in September 2011 but she didn’t get a family doctor until fall of 2013, when a new general practitioner moved in. For two years Carter went to the emergency room any time she needed medical attention, which is what most people without a doctor do in the city — and that has an impact on wait times. Carter said she’s had to wait two hours to see a doctor for a general antibiotic.
“Emerg is unfortunately viewed a bit too much as a walk-in by the community, more so than I’ve seen in other places,” said Dr. Keri Ladd, the most recent family doctor to arrive in Cold Lake.
Ladd is one of four doctors at the Cold Lake Healthcare Centre who are trained to deliver babies. Copeland said her arrival has made things a bit better for expecting moms.
But Ladd’s practice still filled up within weeks of her arrival in September. She closed her patient list when she had 1,000 because she wanted to make sure no one has to wait too long for an appointment.
“You can’t get rid of patients once you have them,” Ladd said.
Ladd said many people in Cold Lake are still coming to the emergency room for sore throats and colds, illnesses that are better off being treated in the walk-in clinic opened in June 2014.
She said the hospital is trying to educate residents about their options outside of the traditional family doctor relationship and the emergency room. The hospital walk-in clinic operates two nights per week and a primary care network opened within the hospital in 2010 to provide access to nurse practitioners. Nurse practitioners cannot write prescriptions but they offer much of the same primary care that a family doctor provides.
Katherine Blackburn, a single mother of four, has been seeing a nurse practitioner after the death of her family doctor a few years ago left her without reliable access to health care.
“I love her and I will not replace her with a doctor if another one comes,” Blackburn said.
But seeing a nurse practitioner was something of a last resort for Blackburn and her family. After the death of their long-time doctor she saw three other family physicians but each one eventually moved out of town, leaving her to start over.
Health care facilities in northeast Alberta
Click on the flags to view a summary of the health care resources in each community.
Training doctors for rural practice
Doctors coming to town and leaving after only a couple of years is a common problem for rural communities, and it exacerbates the existing shortage. It’s not tied to the boom-bust cycle of the oil industry, but because there are not enough medical professionals that come from or are in trained rural communities, according to Dr. David Kay, executive director of the Alberta Rural Physician Action Plan, a publicly funded organization that works on physician education and recruitment.
“You tend to work where you’re trained,” said Kay.
“Most of our professional schools are in Edmonton and Calgary, a lot of the jobs are here, therefore fewer leave the big city to go to smaller communities.”
The University of Alberta created a rural family medicine residency stream as did the University of Calgary in 2000 in an attempt to address this problem, with some success. Kay said 50 to 70 per cent of the 20 to 30 rural family medicine residents who graduate each year decide to practice outside of Calgary or Edmonton, compared to only 5 to 7 per cent of residents who train in the city.
“That’s what they signed up for. That’s what they were trained in. That’s who their role models are,” he said. “They also develop roots — girlfriends, boyfriends, kids.”
It’s fitting that Ladd is the wife of a Royal Canadian Air Force pilot and a graduate of a rural family medicine residency with placements in Cold Lake and Red Deer, Alta. Her husband’s posting brought her to Cold Lake six years ago and she actively chose a medical education that would prepare her to stay there for the foreseeable future.
Ladd is a good fit for Cold Lake, and the local health care committee has been trying since 2009 to recruit more doctors like her who will fall in love with the community and stay.
The recruitment challenge
Greg Sylvestre, chair of the board of directors of Hearts for Healthcare, said his committee offers up to $20,000 in financial incentives to new doctors to grease the wheels of a move. Hearts for Healthcare is a local registered charity that raises money primarily for hospital equipment and doctor recruitment.
He describes it as “an opportunity for them to get on their feet and start to earn monies before they have to incur a bunch of costs.”
Hearts for Healthcare will cover expenses such as rent, car rentals, temporary cell phones and moving costs. They do this because Cold Lake has to compete against the dozens of communities throughout Alberta that also want to hire the next available doctor, usually someone who is moving from overseas. Most of Cold Lake’s doctors are from South Africa.
“The physicians, they’re kinda brain dead. They’re interested in the practice and in the hospital — those needs are going to be taken care of. They’re going to be pretty happy where ever they live and work,” said Kay.
“But it’s the family that’s probably going to keep them or not keep them in that community, and that’s where the work of the committee becomes really important.”
But finding a doctor who is a good fit for the community and encouraging them to move to Cold Lake is only one part of battling the doctor shortage. The other part is getting the money to hire them in the first place.
Lack of health care funding
Sylvestre said Cold Lake needs money for an obstetrician-gynecologist, a specialist paid about $300,000 per year, to treat its young population with a birth rate much higher than the provincial average. The Cold Lake birth rate was 38.4 births per 1,000 women compared to the 27.4 provincial average for 2008/2009 to 2010/2011, according to Alberta Health.
He said they could also use 12 to 18 more nurses, including some trained in obstetrics; a surgeon, and more front-end and technical hospital staff.
“It’s probably in the magnitude of $2 million at least in increased operating funding,” Sylvestre said, referring to the funding deficit for the Cold Lake hospital.
The Cold Lake Healthcare Centre offers obstetrics but not all residents are confident about the quality of care.
Provincial health care funding is based on the official census population, which is why Cold Lake’s shadow population has posed such a challenge. Furthermore, Cold Lake is the biggest city in the surrounding area, meaning that people travel from places like Pierceland, Sask. — 40 minutes across the border — to receive care. The Cold Lake hospital also sees aboriginals from surrounding reserves and Canadian Forces members on occasions that their on-base clinic can’t treat a patient, generally emergency care in the evening.
Ladd said there is a medical clinic on the base that Canadian Forces members are required to use. They are actively discouraged from going to the Cold Lake hospital for medical care unless it is an emergency and the on-base clinic is closed.
Hospital manager Catherine Garon said the Cold Lake hospital has a catchment area of 25,000 people. Based on an assumption of about 1,000 patients per physician, that’s well above what 14 doctors can manage.
Despite this, the healthcare community isn’t optimistic that Cold Lake will get another obstetrician-gynecologist.
“We’re never going to get an obstetrician here permanently. It’s just how it is with small towns,” Ladd said.
She agreed that Cold Lake needs another specialist — there are currently only two doctors qualified to perform Caesarean sections, which contributed to the significant increase in ambulance trips to Edmonton in 2013.
Disagreement over Cold Lake’s needs
But Kim Fleming, an Alberta Health Services physician recruiter based in Fort McMurray who supervises the northern communities, said she doesn’t think the doctor shortage is that bad in Cold Lake, especially since the arrival of Ladd.
“Wait times are less. The shortage is stabilized,” Fleming said.
Even Kay acknowledged that Cold Lake’s doctor shortage is not necessarily critical.
“Cold Lake needs some physicians but it’s got a lot of other resources available around it and it’s not an island. It’s not isolated,” he said.
“Could it be better? Yes. But is it dire? No.”
But Garon described managing the Cold Lake hospital as “extremely difficult” and “stressful” due to a lack of diagnostic support for her hospital.
“Usually there’s a disconnect between what they think you need and what you need,” she said, referring to the relationship between Alberta Health Services and hospital administrators.
Kay said healthcare is evolving away from the traditional doctor-patient relationship toward something like Cold Lake’s primary care network, more facetime with nurse practitioners and other skilled medical personnel, but not necessarily a full-fledged doctor.
Even if Cold Lake succeeds in converting its youngest and healthiest citizens into walk-in and primary care network patients, the doctor shortage will need to be managed for years to come.
Fleming said there is still “ongoing communication” between Alberta Health Services and the Cold Lake health care community, particularly around the possibility of Cold Lake and the nearby Town of Bonnyville sharing resources.
The impact of declining oil prices
This kind of arrangement may be Cold Lake’s best chance for now at getting access to another doctor specializing in delivering babies. Fleming said the government has to see data that proves there is need for another obstetrician, and so far it hasn’t see any.
Furthermore, the Alberta government announced in the 2015-2016 budget that the province is facing a $7-billion deficit in its $44-billion budget due to declining oil prices.
To make up for the shortfall, the government is re-introducing health care premiums, which were abolished in 2008 at a time when the price of oil was returning a lot more money to Alberta’s coffers. The premiums are based on a graduated formula and Albertans earning more than $50,000 per year will be required to pay.
“We will be asking Albertans to begin to contribute directly to the costs of the health system,” said Premier Jim Prentice in a pre-budget taped address. “This revenue will start small but it will grow over three years.”
Even if the oil slowdown does eventually reduce the number of oil workers flowing in and out of Cold Lake, the city’s permanent residents are still young — 20.35 per cent of residents are between 25 and 34 years old — and they’re going to want to have babies.
Despite never having been to see the family doctor she waited so long to get, Carter holds firm to her desire to give birth in the big city hospital. She thinks she will receive better health care in the city.
“If I can help it, I will make sure I’m in Edmonton for every doctor’s appointment.”