Opinion: “It is what it is” — the quiet, progressive death of Alberta’s health-care system

Dr. Gabriel Fabreau - 
Calgary Herald

In real life, most hospital deaths look nothing like the dramatic accounts portrayed on TV. My patients generally die slowly, bit by bit.


Dr. Gabriel Fabreau is sounding the alarm about the declining state of Alberta's health-care system. He is a general internist at the Peter Lougheed Centre in Calgary and an assistant professor at the O’Brien Institute for Public Health at the University of Calgary.

Since the pandemic’s start, we’ve worried about the health system’s dramatic collapse but, like my dying patients, we’re witnessing a slower death; a system imperceptibly degrading until one day, like a cancer-riddled body, it just stops working entirely.

After two years of COVID-19, our hospitals have never been worse off. Recently, Dr. Vesta Michelle Warren, the Alberta Medical Association president, wrote to the province’s physicians: “ The system is in crisis .”

Hospital staff, past burnout, can’t provide the high-quality care we expect of ourselves. Instead, we are resigned. Staff shrug their shoulders and sigh, “It is what it is.” This defeated slogan symbolizes a fatalism I’ve never seen before.

The quality of care in Alberta is degrading, increasingly unsafe and often without dignity.

Patients wait hours, even overnight , for help after calling 911 — but there’s no one to come because paramedics are trapped in ambulance bays and hospital hallways caring for patients. Our emergency departments lack space to accept another sick person. They are clogged with admitted patients because the hospital is full and we’re out of beds .

Under constant pressure, emergency physicians send sick patients home instead of asking for admissions. Hospital managers, tasked with maximizing beds, beg physicians to discharge patients daily. We acquiesce and send home sick or frail patients to make room for others who are sicker. We know prematurely discharging patients increases their risk of bad health outcomes and readmissions. These patients return, often by ambulance. Thus, the tragic cycle starts anew.

In Alberta, 568 physicians left in 2021 and 461 fewer family physicians are accepting new patients. Alberta has the most unfilled family medicine residency positions in Canada at 32. A primary care physician shortage means people can’t see the doctors who manage their ambulatory care sensitive conditions — common conditions that can destabilize and cause preventable hospitalizations.

Most tragically, we’re seeing missed cancers, illnesses so advanced they are now incurable. We know delayed diagnosis and treatment increase cancer deaths . Canadian research predicts over 21,000 excess cancer deaths by 2030. Preventable deaths because patients couldn’t or didn’t have appropriate cancer screening.

COVID-19 is still straining our hospitals. “Mild” post-vaccine COVID-19 infections often suddenly worsen multiple chronic illnesses of the heart, lung and kidney, causing emergent hospitalizations. Further, new Canadian research shows one in nine patients hospitalized with COVID-19 is readmitted or dies within 30 days. These admissions and deaths are uncounted in public COVID-19 statistics .

But health care’s biggest threat is the constant shortage of nurses. The remaining staff are now often asked to work 16-hour shifts. To cope, some units at my hospital re-implemented emergency pandemic guidelines that allow nurse-to-patient ratios to increase to 1:8. This means providing only “essential care.”

My nursing colleagues are frustrated, disheartened and demoralized. I am watching them lose their commitment to go above and beyond for patients. Front-line nurses with 20 years of experience are impossible to replace but are retiring years earlier than planned . These nurses run our hospitals, train new nurses and guide our resident physicians. Hospitals are nothing but very expensive buildings without them.

Like my patients with life-threatening but still curable illnesses, our hospitals need aggressive treatment now to be resuscitated. The cure has two basic components: increase workforce supply and reduce hospital demand.

Canada has among the lowest physician and an average nurse supply per capita among high-income countries. Both workforces are running on empty: over half of physicians and more than 75 per cent of nurses in Canada are burnt out.

To increase supply, we must hire, train and recruit more health-care workers. First, we must invest in supporting, training and credentialing the estimated 250,000 foreign-trained health-care workers already in Canada who are desperate to employ their skills. We worked together successfully in community outreach during COVID surges and vaccine clinics . Second, we need pan-Canadian licensing for existing health-care workers to increase staffing flexibility. Finally, our provincial government must re-invest in and repair relationships with primary care as ever-more Albertans lack family doctors.

To reduce hospital demand, we must stop pretending COVID-19 is over. Wastewater surveillance shows Canadian COVID transmission is cresting. This gives us a short reprieve until fall to prepare. We must use this time to focus on improving indoor ventilation and uptake of booster doses.

Alberta lags woefully behind the rest of the country with the lowest booster rates. Unsurprisingly, we also share the highest infection rates and excess mortality in Canada, the latter despite our younger population.

To improve vaccination rates, health systems must invite communities and family members to participate. We did this in northeast Calgary , a joint effort with local agencies, health-care workers and community volunteers. In our hardest-hit , highly racialized and low-income neighbourhoods, we achieved near-universal first-dose vaccination. Then, inexplicably, the program was halted, and children’s and third-dose vaccination rates plummeted.

Most Canadians may not realize our health-care system is sick. But the day they need care, they will. On that day, inevitably and tragically, they or their loved ones will come in with an ailment or injury, and they will be shocked at the skeletal remains of a system that was once a source of national pride.

Our universal health-care system is failing. Its death will not be a loud, dramatic collapse but a slow, progressive, agonizing one.

Dr. Gabriel Fabreau is a general internist at the Peter Lougheed Centre in Calgary and an assistant professor at the O’Brien Institute for Public Health at the University of Calgary .