Edmonton could begin seeing surgical cancellations and other impacts to patient care in the next few weeks, a group of physicians warn in a letter to two of Alberta’s health ministers.
The letter, obtained by CBC News, was sent on Feb. 11 to Primary and Preventative Health Services Minister Adriana LaGrange and Hospital and Surgical Health Services Minister Matt Jones.
It was sent by surgical hospitalists in Alberta Health Services’ Edmonton Zone, a group of doctors that provide support and care for surgical patients.
The letter warns that the doctors believe the end of the funding model currently in place for hospitalists will cause “immediate, unavoidable surgical cancellations” at hospitals in the Edmonton Zone. Those cancellations would need to begin in mid-March “for patient safety reasons,” the doctors write.
“Patient care would fragment into ad hoc, site-specific arrangements, increasing reliance on already overburdened ER, surgical teams, internal medicine, and ICU (intensive-care unit) services.”
The authenticity of the letter was confirmed to CBC News by the three hospitalists who authored it on behalf of their group, but they declined further comment.
CBC News sent a list of questions to the press secretaries for LaGrange, Jones and Premier Danielle Smith.
“Alberta’s government remains committed to collaborating with physicians to maintain stable, continuous patient care as legacy stipend arrangements and related inequities are addressed,” Maddison McKee, LaGrange’s spokesperson, wrote in a statement.
The statement did not address questions about the hospitalists’ concerns regarding compensation or the potential for health-care disruptions.
Dr. Paulose Paul, an orthopedic surgeon who has worked in the Edmonton Zone since 2002, said he and his colleagues are reliant on hospitalists to do their work.
“As physicians, our group is always committed to providing and delivering safe, effective care for patients that need orthopedic surgery,” said Paul, who was previously the zone lead for orthopedic surgery.
“It seems hard to imagine that that job is going to be easier when you remove such a significant portion of our day-to-day workforce.”
Stipends critical for hospitalists
Surgical hospitalists attend to patients who are in hospital for surgery. This support allows surgeons — who often work at multiple hospitals — to focus on surgical duties rather than post-procedure care or time-consuming tasks such as patient discharge.
In their letter, the hospitalists say they are predominantly family physicians, although their group has “always included internists, surgeons, emergency physicians and other specialists.”
Hospitalists have for more than a decade been compensated through a combination of a stipend and the ability to bill for services (known as fee-for-service).
In a 2017 brief during arbitration with AHS, the Alberta Medical Association wrote that stipends accounted for “an estimated 40-50 per cent of total earnings” for most Edmonton hospitalists.
WATCH | Edmonton doctors warn surgeries could be cancelled over hospitalist pay issue:
Edmonton doctors warn surgeries could be cancelled over hospitalist pay
A letter sent by a group of doctors to two Alberta cabinet ministers last month, which was shared with CBC News, warns of possible surgery cancellations if a deal isn’t in place by April 1 to compensate hospitalists. Natasha Riebe has the details.
But the provincial government has sought to move away from this funding model and towards “alternative relationship plans,” or ARPs.
“We are hearing from physicians who have received letters indicating that their stipend contracts will terminate by March 31, 2026,” AMA president Dr. Brian Wirzba wrote in a public letter to members in December.
“AMA legal counsel has previously confirmed that once such contracts end, physicians are not obligated to continue providing services that were previously compensated by stipends.”
The result may be a situation where most of the roughly 65 Edmonton Zone hospitalists — each of whom is often responsible for dozens of patients on a given shift — are no longer doing that work.
“Come April 1,” write the authors of the letter, “ in the absence of a contract or reasonable alternative, the majority of surgical hospitalists do not intend — and under the terms of their existing agreements are not permitted — to continue working.”
Hoffman challenges government on issue
The issue was raised last month in the legislature when Opposition NDP health critic Sarah Hoffman pressed LaGrange and Jones on the impending April 1 deadline.
“What assurances can the minister for hospitals offer patients that their surgeries will proceed beyond April 1 in public hospitals as scheduled when it’s clear that the plan in place is going to cause chaos?” she asked.
Jones responded by citing the “record number of surgeries last year — 318,000.”
Hoffman noted that “some of the impacted doctors are sitting in the gallery today. They helped me write these questions.”
She asked Jones if he would meet with them during a break. He declined.
That exchange took place on Feb. 26, two weeks after Jones and LaGrange received the letter from the hospitalists.
Program should be ‘put on a pedestal,’ doctor says
The prospect of surgical cancellations at multiple hospitals because of the end of hospitalists’ contracts comes as one Edmonton facility enters its 20th month of such disruption, stemming from a different issue.
When resident physicians were withdrawn from on-call shifts at the Royal Alexandra Hospital in July 2024, scores of surgeries were cancelled or postponed. That situation remains unresolved, as listed on the AHS website.
A solution proposed by a working group of surgeons and hospitalists that would have cost $240,000 per year was rejected by AHS leadership in 2024, as reported by CBC News.
That proposal was to add more hospitalist coverage.
Speaking about the unresolved issue of hospitalists’ pay, Paul suggested that the role hospitalists play in the health system is something Alberta should celebrate as opposed to just something to find a way to keep.
“This is a program that should have been highlighted and put on a pedestal as a cost-effective way of maximizing the skills of all the physicians involved in the care of these patients,” he said, noting the program has been around since 1999.
“It’s going to be a real shock. It’s going to take some getting used to if it’s truly going away completely.”