Think twice about matching to a residency program in Alberta.

[throwaway_33]

I'm a resident in a training program in Alberta. The political situation is not looking so hot right now, and I wanted to share some information that I want you all to be aware of when interviewing here and when making your rank order lists. 

First of all, there is Bill 21, which allows the Ministry of Health to restrict prac ID / billing numbers as of April next year. It allows the government to restrict new doctors to only work in certain regions of the province. For instance, if the government deems there to not be a need for your given specialty in an urban area, they may decide not to grant you a billing number. Even if you grew up in Alberta, and trained in Alberta. Practically speaking, details of this are very uncertain right now, but what we know is that Bill 21 applies to all specialties, and most think that it will impact family medicine the most. The UCP government even advertise this front and centre: https://www.alberta.ca/physician-resource-planning.aspx Here's another article on this: https://cmajnews.com/2019/11/21/bill-21-practice-permits-1095835/. The most frustrating thing about this is that there is no guarantee that I will get a job in the city I live in here in Alberta, despite the fact that my family is here and that I trained here. 

The relationship between Alberta doctors and the government has deteriorated substantially in the last couple of years. There is talk of cutting physician fee codes, which may happen April of this year. They've already cut GP codes. Personally, I know a lot of doctors who have already moved away from Alberta, and there is very little trust that exist between doctors and the government. 

Lastly, is COVID vaccinations. I am a resident on the front lines, and I have not been vaccinated. This is a throwaway account, and without going into specifics, I am on the front lines, seeing patients. I work long hours on call and I see patients regularly in the emergency department. Residents in my program have advocated to our program director, to the department, to PGME. We have sent letters to higher ups and officials in the Alberta government to no avail. All we get is empty platitudes and "be patient". The most frustrating thing is that preceptors I'm working with have been vaccinated, and often times, I am spending more time in the emergency department than they are. Nurses in the emergency department are vaccinated and I am not. I think actions speak louder than words. This just goes to show how much they care about the health and well being of residents. To be fair, depending on the specialty, residents have been vaccinated depending on the rotation (for instance, in medicine, ICU, etc.) so depending on who you talk to, some residents may have been vaccinated and some may be waiting months longer. 

Over all, things have been very frustrating over the last year. It would be good to generate discussion about how other residents in Alberta feel about all of this. I just want you to have a more balanced view and make the most informed decision possible when deciding to do residency in Alberta. 

[lovemedicinesomuch]

are you a family medicine resident?

[shikimate]

The situation reminds me of New Brunswick. I believe for many years NB's fee code was lowest in the country, and that resulted in a significant exodus of physicians, from 1992 to 2019, NB used issuing of billing numbers as a way to "manage" the supply of physicians and where they can practice. This was lifted in 2019 but has already left NB with a bad reputation and will probably negatively impact recruitment for the foreseeable future. Looks like AB might be going down the same path as NB. 

[bearded frog]

I think the first two issues to raise are worth debating, but are not particularly relevant to residency, although I know a lot of people try to do residency where they plan to practice, there doesn't seem to be an issue if one plans to practice elsewhere after residency. The vaccine situation seems to be shared by Saskatchewan and I agree is deplorable.

[MSWschnoodle]

Brutal.

Out of curiosity are you still getting reimbursed for part of your CMPA fees? I saw that Alberta was trying to cancel that but then someone pointed out there will be nobody to deliver any babies in the province if they get rid of the program. I'm just curious how that came out in the wash? I'm from Alberta and I'm kind of hoping I can some day go home 

[throwaway_33]

On 2/28/2021 at 3:32 PM, MSWschnoodle said:

Brutal.

Out of curiosity are you still getting reimbursed for part of your CMPA fees? I saw that Alberta was trying to cancel that but then someone pointed out there will be nobody to deliver any babies in the province if they get rid of the program. I'm just curious how that came out in the wash? I'm from Alberta and I'm kind of hoping I can some day go home 

Yes, we are. As a resident, in our PARA agreement, we get roughly $150 every month. I'm not 100% sure about reimbursement for CMPA fees for staff though. I do recall hearing many stories (some on the news) over the last year where some rural town in Alberta does not have enough doctors to cover emerg/OBGYN/surgery/other services because of all the doctors leaving. 

[throwaway_33]

On 2/27/2021 at 4:47 PM, lovemedicinesomuch said:

are you a family medicine resident?

Nope, I'm in a 5-year residency program.

[birdy21]

This has been something that has been on my mind lately and I have actually asked about it in my Alberta interviews (something along the lines of "do you foresee any of the government changes impacting residency training?") and the answer I have gotten from programs and residents is that the changes don't really effect residents. I know the changes don't actually have anything to do with the PARA contract, but I still can't help but worry that training might be impacted, especially with the amount of animosity between the government and doctors right now. It's hard to tell if the programs are just saving face, I'm wondering if there are any other AB residents that want to (anonymously) weigh in on the situation? Especially family med residents! 

[throwaway_33]

16 hours ago, birdy21 said:

This has been something that has been on my mind lately and I have actually asked about it in my Alberta interviews (something along the lines of "do you foresee any of the government changes impacting residency training?") and the answer I have gotten from programs and residents is that the changes don't really effect residents. I know the changes don't actually have anything to do with the PARA contract, but I still can't help but worry that training might be impacted, especially with the amount of animosity between the government and doctors right now. It's hard to tell if the programs are just saving face, I'm wondering if there are any other AB residents that want to (anonymously) weigh in on the situation? Especially family med residents! 

I think it's disingenuous for them to say that the changes won't impact residents... it absolutely will. It will impact your ability to find jobs in the future, especially in a 2-year program like family medicine. Residency is a time to build connections, perhaps for some even to settle down. The uncertainty of not knowing if there will be  a job for you in the place you've trained is really disheartening. 

I don't know if you've been following this, but since last week, there's been a new tentative agreement between AMA and the Alberta government (https://www.cbc.ca/news/canada/edmonton/doctors-alberta-province-agreement-ama-1.5944609). Basically, it is made clear that the Alberta government is limiting physician supply as the primary way to rein in the physician budget, which means the government will be looking very closely at creating new jobs.  

 

[birdy21]

4 hours ago, throwaway_33 said:

I think it's disingenuous for them to say that the changes won't impact residents... it absolutely will. It will impact your ability to find jobs in the future, especially in a 2-year program like family medicine.

Thank you for saying this. I feel like my concerns have been dismissed by some of the programs/residents I've talked to, and tbh I would feel more at ease if they said something like "yes we are aware this may impact training, so we're doing xyz to ensure the impact is minimized" or something

[bearded frog]

I think if someone was open to working anywhere, they shouldn't worry about it, if they liked something about the Alberta programs. I think if you want to work in Alberta as their goal, doing residency there is still the best bet, even if new jobs are restricted. I hate the current Alberta government as much as anyone, but governments come and go, and policies change. Who can say what Alberta will look like in 10-20 years as fossil fuels continue to decline, they will certainly need to find more than one basket to put all their eggs in.

[shikimate]

22 hours ago, birdy21 said:

This has been something that has been on my mind lately and I have actually asked about it in my Alberta interviews (something along the lines of "do you foresee any of the government changes impacting residency training?") and the answer I have gotten from programs and residents is that the changes don't really effect residents. I know the changes don't actually have anything to do with the PARA contract, but I still can't help but worry that training might be impacted, especially with the amount of animosity between the government and doctors right now. It's hard to tell if the programs are just saving face, I'm wondering if there are any other AB residents that want to (anonymously) weigh in on the situation? Especially family med residents! 

Sometimes you have to take what academic physicians and resident says with a grain of salt, especially if your goal is community practice.

Not until you go shadow/do elective in community do you realize governmental policies impact community practice much more directly.

For example a lot of academic physicians are on salary/AFP, and they shadow bill half heartedly. Well if you bill half heartedly in the community the government will say thank you very much for saving us $ but you might regret it later. Also universities provide a lot of resources to back up academic physicians that simply doesn't exist in the community. For example if your local radiology lab or bloodwork lab closes that can have significant impact on your ability to provide care. In an academic center, when was the last time you worried that there aren't anyone to draw bloodwork for you?

Again residents, depending on their own experience but many have never step outside academia, negotiated a rental contract, hired an account, or got ripped off by a supplier, etc. So some are bit too optimistic or idealistic in their view.