Rural Health & The Cracks in Our System with Dr. Parker Vandermeer

About the Episode

Dr. Parker Vandermeer, a local Albertan family physician and rural ER doctor, joins Dr. Jordan Vollrath in a conversation about the recent changes and challenges in the healthcare system.

They discuss the government's lack of action and support for primary care, the potential push for privatization, and the impact on rural communities. They also touch on the proposed changes to the family medicine residency program and the need for more doctors in rural areas. The conversation highlights the burnout and frustration among healthcare providers and emphasizes the importance of being kind and supportive to one another.

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Objectives and Discussions

• Lack of support from the government for primary care
• Selfish viewpoint of physicians in private clinics
• Alberta's reputation and challenges in attracting physicians
• Difficulty finding physicians in rural communities
• Healthcare providers forced to provide subpar care due to lack of options
• Ways to attract more doctors to rural settings
• Importance of kindness and advocating for change

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More Resources:

LinkedIn: https://cherryhealth.co/linkedin

Facebook: https://www.facebook.com/cherryhealthinc/

Instagram: @cherry.health

Twitter: @cherryhealthinc

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Have questions? We want to hear them!

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Transcript

Speaker Identification:

[Host]: Dr. Jordan Vollrath

[Speaker]: Dr. Parker Vandermeer

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Jordan (00:02.868)
All right, today we're joined by my friend, Dr. Parker Vandermeer, local Albertan family physician and rural ER doctor and power locum as well, I guess. He's probably visited more sites across the province than any other doctor. How are you doing?

Parker Vandermeer (00:18.69)
I'm doing great, happy to be here, happy to join. I think we'll probably stir up some feathers today.

Jordan (00:25.332)
Looking forward to it. Yeah. So for anyone who's not familiar with Dr. Vandermeer der Meer, he's definitely a moderately outspoken healthcare critic so he's very plugged in and has a lot of opinions You know really rooted in that ground level up boots on the floor type of perspective So super interested to hear what you're thinking today in terms of all the recent updates and everything that's been going on

Parker Vandermeer (00:48.314)
Yeah, there's been a lot of changes recently. I think the most recent one was the, I guess, a re-announcement, for lack of a better thing to call it, from the government about maps and changes to family medicine and their ongoing promise to support primary care through doing absolutely nothing it seems. On paper, it's good to have them talking about it again, but I can't help but feel that a lot of the things they've announced are things that they've announced three, four, five times already.

And ultimately, their immediate call to action seems to just be an immediate call for more meetings, more committees, and nothing actually happening that's going to support those on the ground.

Jordan (01:30.204)
So for anybody listening, one of the top line items that they announced was creating a task force dedicated specifically for primary care. Now it sounds like you're not super confident that that's going to yield much good. Why is that?

Parker Vandermeer (01:43.338)
No, I mean, I've been on some task forces. I know a lot of people who have been on the task forces that already exist for this exact issue. You know, the word on the street from what I've heard in chatting with people, my personal experience is, you know, suggestions are made and they're either blatantly ignored or these people are kind of just, you know, roadblocked from being able to submit or contribute further. It seems like there's...

a path forward that the government wants to take and then there's a path forward that they're going to present to the public. And those aren't congruent, right? So when we see these big announcements for, you know, these dollar values, and in reality the dollar values, they sound big, they make a good headline, but they're a lot smaller than what's actually needed. They're a lot smaller than what was actually discussed and put forward. And they're, you know,

ultimately probably never going to be paid, right? We continue to see this lip service paid to family medicine, to primary care, additional supports coming, more doctors, more nurses, more funding, but as soon as it takes the time to actually write the check, the check disappears. It's never actually written, so I'm not optimistic that any of these things that were announced are actually going to take place in a timely manner, if at all.

I mean a great example that is the good faith billing that was something we agreed to in our last agreement and it was something that was taken away when Shandro ripped up our contract so it wasn't even a new concept like it was something that we had was taken away and they decided I guess to bestow upon us again with our last contract and yet here we are you know over a year since that was signed and it's still there's no system in place there's no plan for re-implementing something that's already existed.

and the docs are just left holding the vague in the meantime. So I'm not optimistic that anything they say actually has weight as far as a real-world application of it happening.

Jordan (03:42.952)
What do you think is actually the mindset behind the scenes on the side of the government? Like why with the showmanship and dragging feet then and not kind of delivering on those results that have been promised? Do you think it comes down to a budget, not a debate and just you only have so many dollars? I mean, oil's doing pretty good right now. So you think maybe there'd be some extra dollars in the system, especially here in Alberta. Like what is their ulterior motives or a different agenda? You think that there are...

Parker Vandermeer (04:08.567)
Yeah.

Jordan (04:11.612)
trying to move along in the interim or what are your thoughts there?

Parker Vandermeer (04:14.83)
I think it's a mixed bag. I mean, money is always going to be the hot topic, right? And when I see them committing, I think it was 57 million for this program for family docs and NPs and everything over a couple of years. You know, it sounds like a lot of money. When you look at the health budget, it's less than a quarter percent. So it's really not in this context. And when you look at things like the stupid poor room that they put 20, 30 million a year into.

you realize that these are amounts that the government will just throw around without much of a plan. So I wouldn't say that's a serious investment on their part. I do have to say though, I think it is a complicated process. You know, the people up top are not in a position that they could possibly know all of the nitty-gritty of these things. They're really relying on the people that are advising them and those people probably relying on people advising them and so on. So you do wonder at the top levels.

how much from the front lines actually gets communicated. Now, in some work I've done with the AMA and just speaking with people, I do know, and I believe and trust in some of my colleagues that I know have face-to-face meetings with these people that some of that message is getting through. So we can't just give them a pass and say, well, it's complicated, who knows what they're actually hearing? Because I know at least a portion of what they're hearing is what they need to hear, and they're not taking action on that. But I think when there's budgetary constraints,

are mixed messages being sent. It's not so much that they need to be evil people and just wanting everything to fail and crumble as much as it can be. They're getting a lot of information. They have a lot of constraints put on what they can do. With that said, if you look at the things that do seem to get enough government support to actually get pushed through, there is a increasingly vocal, I guess, thought process or publicly vocal thought process.

about, well, it's the government really just wanting everything to go private. And we see this, you know, in where the support's going, right? We see companies like TELUS being able to get away with these essentially private medical clinics with no one saying anything about it and then agree or disagree with it as soon as there is a family physician who tries to do something similar like that clinic in Calgary recently that really on paper doesn't seem all that different from these other clinics from the public perspective.

Parker Vandermeer (06:36.434)
and they get slapped down, right? So I think if we look at where the government support's going, if we look at the willingness to pour money into, you know, locums like myself and travel nurses, these things that are, you know, owned by other corporations, if we look at the lack of willingness to support your family physician who has a solo practice and always wanting to give the money to other groups to then trickle down to them, you do have to question, are we being set up to fail?

to allow more and more corporate and private involvement with these healthcare systems. I imagine in the mind of the government, try to offload some of the cost into the private sector, but it doesn't work.

Jordan (07:18.844)
And so the recent debacle with this clinic here in Calgary has been kind of interesting, just the amount of media attention that has drawn to the issue of these like semi-private kind of private medical clinics. I mean, what are your thoughts on that model in general?

Parker Vandermeer (07:34.994)
Yeah, I mean, well, I'm personally very uncomfortable with the idea of basically a pay for access model. And I think the difference, if there was truly a difference between the clinic in Calgary and some of these, you know, bigger corporate models that already exist, is that they were double dipping to an extent, right? There was going to be a fee to access the clinic and then it was also still going to be building the public system. And there was no, yeah.

Jordan (07:58.372)
Yeah, there was no gray area there. It was fully black and white by the sounds of it.

Parker Vandermeer (08:02.838)
Exactly, and well essentially that's what these bigger clinics are still doing. You know, they're saying their fee at least on papers for other services that aren't covered. So I think that's part of the reason they were able to justify slapping that down. So from a personal standpoint, I'm very uncomfortable with the idea of having to pay for access, especially fees that your average family isn't able to afford. However, if you put on your thinking cap and do the math, you...

quickly start to realize that a physician charging fees, similar to what that clinic was proposing, could have a panel, a 10th size of your average family physician be taking home more money. Like from a very selfish viewpoint, why would you not do that? If we're really gung ho into the whole capitalist, let the value of your work decide what the bill is. Why would you not take a panel of 100 patients, make twice what a family physician is making who's doing...

the public game, have a tenth of the responsibility, a tenth of the headache, actually be able to offer appropriately length appointments because you can see two patients a day instead of 30. Like on paper it makes so much sense that the fundamental issue though is that, well, if you're not personally making six figures, good luck finding access to a family doctor if everyone goes this way.

Jordan (09:26.872)
Well, and then, I mean, you can almost make the similar argument when it comes to the new proposed changes for the complex care model, right? And having the rostered panel assigned to yourself. And the thought process there is that family doctors are going to be able to see lower volumes of patients while still making the same or hopefully potentially even higher volumes of income over the year. Like what are your thoughts on the push towards that in concept? It seems to make sense. But

Sometimes I do wonder about the, you're now disincentivizing seeing more patients. Obviously there's a big gap and a need for people to see these complex patients and patients with more issues, but how do you really reconcile that?

Parker Vandermeer (10:08.426)
Yeah, and longitudinal care is 100% the way to go in an ideal system. I think the problem is we're far from an ideal system right now. And if we look at the rural communities as an example, uh, you know, these are docs who have, by the goodness of their own hearts, often accepted panels of, you know, thousands of patients, because there just are no other options, right? And it's not realistic. I mean, there's not enough hours in a year for them to

commit the amount of time to every single patient they have paneled to do the hour long visit in a day, right, to really get into the nitty gritty of all these things. But the idea of having a family physician with a sustainable panel size who is quick to get into, follows you kind of from cradle to grave, is obviously best for the patient. Probably the most enjoyable way to practice family medicine. It's a great thing to aspire to.

But at the end of the day, when such a high percentage of the population doesn't have access to a family doctor at all, well, it's something to aspire to. I think the focus really needs to be on how do we get more family physicians? How do we actually retain them? How do we get people into practices in the first place? And then once we have a suitable amount of the population who actually has a family physician, well then let's really change the focus to how do we switch to more longitudinal care.

And I don't think those things need to be entirely separate. It's not an A and then B. We can do both at the same time. But I do worry a little bit about how the focus seems to be almost entirely on the medical home, when the reality is the medical home is not a solution to, you know, when I'm working rural these days, it seems like 50, 60% of people don't have a family doctor and recently lost a family doctor in many situations.

Jordan (11:55.84)
Yeah. So the medical home model expands the capacity of the family physician by you know, drawn on that team-based care and having more allied healthcare in there. But if there's just no family doctor in the first place, I guess that's only going to get you so far, right? You know, now we're looking at a marginal efficiency improvement, whereas we need like a step wise change in the right direction. Well, what, what is the secret to success in your opinion then in terms of having more family physicians, how do we actually bridge that gap? I recently with the

the Karm's match that happened this year and just like the record setting number of unmatched spots that were open here in Alberta, that was unprecedented. I mean, it just doesn't seem like people are wanting to train here or move here.

Parker Vandermeer (12:39.634)
Yeah, and I mean Alberta has a horrible reputation. We went from I think being a very desirable spot to match only, you know, maybe five or six years ago uh to now I think learners are actively avoiding us uh, and who can blame them? I mean you want stability you're at a point in your life where you have the most debt you're probably ever going to have. You've just finished these years and years and years of training to get to the point that you are You don't really want to shut up

shop in a province where you can't trust the government, your fees are continually being slashed despite what's being presented to the public, right? There's continued stressors being put on you. You realistically don't have a college that's very supportive of you. Like, there's so many barriers and so many stresses to practicing in Alberta. And it's not that it's perfect elsewhere in the country, but I think the argument, and I mean we've had shared friends that I think have drawn this conclusion, is...

Well, if you're going to not be making all that much money, I might as well go live in BC, live in Vancouver, where it's nice or, you know, Kelowna, where it's beautiful weather and great environment, then Alberta, right? You can enjoy the forest fire smokes in the summer and the frigid winters all for the rest of the year. So we need to really focus on, I think, one, stabilizing the existing population of physicians. And that means actual funding changes, actually putting money into the system. None of this...

BS that the government is presenting it well, you know, to go to the PCNs get paid out Oh, it'll go to this group. Oh, you can apply for this like we just need to address the billing codes now We need to get money into family doctors pockets now to make community practice viable again because right now it's a it's a loss leader It's not worth the time to do and there are physicians who are actually losing money practicing in the communities Then we can focus on well, how do we?

increase medical student engagement in founding medicine, how do we increase number of physicians, but that's a long term or a medium term goal, right? It takes 10 years to train a doctor. So we're not making changes in med school today and then our problems solve tomorrow. Like that is something that needs to happen, but that's an intermediate step. And then in the long term, yeah, and then I view more of these longitudinal, you know, medical home things as more of a long term thing to aspire to, but we need to stop the hemorrhage now.

Jordan (14:44.712)
It's not gonna be an overnight fix, yeah.

Parker Vandermeer (14:56.982)
Then we can work on how do we shore up the supply of people who are coming in. And then we can focus on, you know, what's our ideal healthcare system. But at this point, it seems we're approaching it backwards.

Jordan (15:09.888)
Well, it's almost mind blowing how deeply rooted some of these systemic issues here in the province of Alberta are working against our family practice system. Like you look at the other provinces and cost of living is going up, people are moving out en masse. Like Calgary recently voted one of the top places in the world to move to, city continues to like grow disproportionately to the rest of the country.

Yeah, when you look at the medical community, it's shrinking. You know, we're losing doctors. Doctors are canceling their licenses and their, uh, you know, partial practice permits and like there's less residency matching spots and like, do you think it is that like political uncertainty and like just government relations or do you think it is truly like at the end of the day, like the billing codes, not quite matching up and like, it's just more lucrative to move to another province. Like I know most physicians have moved.

Right? Like they don't have deeply ingrained roots wherever they did their training. You know, often they move cities, provinces, if not even countries to do their training. And then you present them some greener grass and it's not difficult to get them to up and go elsewhere. Like, what do we got to do to actually get Alberta back on the map as being a desirable place to live again for family practice?

Parker Vandermeer (16:29.734)
Yeah, I think that's an interesting point that a lot of people don't realize is the nature of medical training is you are very mobile throughout it so you get quite comfortable being on the road. And again, I think you and I both, we probably have multiple friends in every city in the country at this point because of the nature of people moving for training. So you are right at a barrier for physicians to leave maybe lower than others.

Um, and, and yeah, as Alberta's population grows, the problem's only going to get worse because we're certainly not keeping up on the position side of that. I, I think we are seeing people move. And the other thing that's much, much more difficult metric to track is I think we're seeing people really pull back from what they were doing in the past in their practice, right? And this takes a couple of different forms. I mean, for myself, it's trying to actually strive for work-life balance. I know we were talking about

you know, before we started recording here, I'm probably about a 2.0 FTE right now and I'm trying to get that down to a 1.0. Yeah. So you're going to see people like me who are trying to get more realistic work schedules because in all honesty, it's just there's no incentive, it's not worth it to be killing myself working insane hours. You're going to see people who are doing 1.0s and wanting to cut back further from that for a variety of reasons.

Jordan (17:27.426)
Putting the team on your back here trying to get that care delivered.

Parker Vandermeer (17:50.118)
And then there's this attrition of the older physicians, right? I mean, I think another thing that's missed by the government and some of our medical leaders and the public is you have a lot of these physicians who are becoming elderly, for lack of another word for it. And the old guard, I think, would work until the grave. You know, the 70, 80-year-old doctors. And that's not the new generation. And you can't count it. A doctor retired is replaced by a new grad because that doctor who retired had a realistically

efficient practice with a panel of 2,000 patients and was providing care for all them. That new grad is going to be starting with a panel of three or four hundred, probably aiming for a goal of you know 800 to 1200. They're not going to be as efficient in the first couple of years and even once they've hit full stride they're probably not taking on the full patient load that older last generation physician had. So as we see more physicians retire, as we see more physicians leave,

We're not a one-to-one ratio for replacement. We need even more than that. And at this point, we're not even getting the one-to-one. So as our population grows and as more people move here, the healthcare issues are just going to get worse. Any other band-aid solutions of, well, we'll throw a couple million in here, but not really, we'll never sign the check, are not going to be sufficient.

Jordan (19:05.328)
So if you're suspecting that at the end of the day, it's potentially linked to like a push for privatization, like what would that even look like you think in terms of rolling that out at a systems level? Like it can't just be individual private clinics as the solution that the government's pushing for. Like, do you think it's got to do with like bigger corporates rolling things out en masse like we have in the States, like these, like the Kaiser permanentes and stuff like that.

Parker Vandermeer (19:27.938)
Yeah.

Parker Vandermeer (19:33.074)
I mean, I imagine that has to be the path that's envisioned if there is a formal plan. I mean, it could all be very naive in the sense of, well, they just figure it all sort itself out and there's offers. But if we look at the surgical initiative, if we look at how many, and it is becoming more common in patients basically asking the question of, well, can I just get this done privately for my knee replacement or whatnot, right? So if we look at initiatives like that, if we look at the...

recent debacle with them trying to switch everything over to Dinalife and that going horribly and spending millions of dollars and I was spending millions of dollars I'm sure to switch it back to the way it was. Like there is an effort to take things out of the public hands, give them to private corporations. And I imagine big groups like TELUS, who have already shown that they're wanting to buy up a lot of, you know, medical EMRs, they're involved in virtual health, all these other things. Really...

moving in and opening up. I mean they already own clinics so the idea of them buying additional clinics is not far-fetched and yeah I could see the transition being you get your cell phone plan and a family doctor right.

Jordan (20:42.716)
Well, so fill me in there. It sounds like there's a track record evolving here. What was the actual situation with DynaLife? Like it looks like everything is now Alberta Precision Laboratories. What was the, fill me in there. What actually happened and what was the budget implication?

Parker Vandermeer (20:52.714)
Yeah, APL.

Parker Vandermeer (20:58.27)
Yeah, so for anyone not aware, and I think a lot of family physicians are very aware because from what I've been seeing is there was no end to problems with recs and investigations not being done properly. But Alberta Health in conjunction with Alberta Health Services to some degree.

had last year decided that basically Dynalife was going to get this contract and be doing all the investigations for the province. So they started this very awkward and cumbersome process of basically transitioning where the labs were going to be run to these Dynalife facilities. That process did not go well by any stretch of the imagination. There is, from a workforce standpoint, there was a lot of people that were very stressed for their jobs and how they're going to do a lot of lab techs and whatnot, how they're going to integrate into this new thing.

There was many missed investigations, things that were ordered, not done, things that weren't ordered that were done that made no sense in the clinical context. Everything transitioned over, you know, wait times for investigations that used to take a day or two to get back or weeks or just disappearing. So it went horribly. And then it wasn't that long ago. I think it was probably only maybe two months or so. They just pulled a total 180. Everything's going back to APL.

And DinoLife is kind of just opting out. And I mean, whenever we're working on scales like this and making system changes, there's money associated with all those changes, right? And aside from the stress to the healthcare workers involved with all these rapidly moving targets and processes, and the actual employees working in these labs not knowing what their job is gonna look like tomorrow, there's costs to be...

develop reorganized pathways processes, to be sending these samples over the province, to be shutting down facilities, opening new ones. So to have a little one-year experiment, it seems, that just went dissonantly. It's poor finances, but it also just caused a lot of stress and headache that was not at all necessary. But is a good example of the government saying, here's something that's done in the public system, let's move it over to the private system and see how it goes.

Jordan (23:04.464)
Yeah. Well, it's interesting that they're going for that like central unification of that whole lab system, right? It's like same thing that's going on with connect care right now, right? Like trying to standardize and centralize everything on the same platform because it's interesting, right? Like when we look at electronic health records, for example, one of the biggest complaints is that, you know, we have just so many different systems going on versus like the one patient, one record mentality where there's just like a.

standard and one location, one software, and integrations get less complex at that point. Efficiency starts going up. But of course, then you have less choice and less ability to actually pick things and tailor it to your practice. So it's kind of interesting that Alberta really seems to have a predilection for pushing for that standard central system. Same thing with Netcare back in its day, the provincial wide service that would show lab reports and

consultant reports and everything and images, right? That was like pretty ahead of its time and was quite useful. I imagine there was a lot of growing pains back when they went for that, but it's interesting to see that they're like trying these things out, you know, in the interest of boosting that efficiency of the system. Do you give them any credit for that?

Parker Vandermeer (24:21.146)
Yeah, I don't know if you've had a chance to use Connect Care, if any of your sites are on it. Yeah. I would say the pattern with Connect Care is there's a lot of dread and apprehension. The first week is pretty rough, as you would expect, it's such a big change. But all the sites that I work and I've been involved, kind of arm's length, but involved in numerous launches just as a locum at this point. And I'd say almost universally people do like it. Once they've...

Jordan (24:24.696)
I have not had the privilege yet.

Parker Vandermeer (24:47.81)
gotten through that first couple of weeks of growing pains and just getting used to the system. It certainly has some problems, but the problems it has are much less than that of paper charting. So, you know, well, I do kind of wonder why we went with a big American firm for this rather than kind of a more Made in Alberta approach for it. I do think the move to a unified EMR, at least in the hospital, like the acute care facilities, is great, right? And I mean, we're...

I think one of the last waves is planned for November as far as the facilities go there. So we're hopefully just a matter of months away from having a province-wide or essentially province-wide rollout and we'll see where it goes and if it ever makes its way more into the community, how smoothly that process goes. I'm sure that's going to be some growing pains and a lot more battling over who ultimately controls those records and has influence over it at that point. But I think that has been a positive change and it is one of the

very few selling features available that is Netcare and Connectcare.

Jordan (25:49.076)
You're one of very few people who've actually voiced a positive opinion on the Kidd Act care situation that I've talked to so far.

Parker Vandermeer (25:57.726)
Yeah, I think my age probably helps. I think as a locum, I also probably have more to gain from it because I am so reliant on being able to access records remotely and I don't have a set place of practice and probably didn't have a very ingrained system as far as paper charting and whatnot goes. But I found, you know, at least among the nurses, who realistically I think for most of us, that's who we spend a lot of our time chatting with when we're at these sites.

Jordan (26:00.676)
a little more tech savvy.

Parker Vandermeer (26:28.086)
Once those initial growing pains are over, there always remains frustrations. But I mean, even with a perfect system, I think there's going to be some frustrations with it. But I found people, all in all, at least in the periphery, do like it once they've gotten integrated into their workflow.

Jordan (26:45.54)
Is that did or didn't? Did like it, gotcha. As a for context here, how many different sites have you worked at? Cause you're like the super locum who's been everywhere. Give me a ballpark.

Parker Vandermeer (26:46.786)
Did, did like it, yeah. Yeah, the first month is rough, but.

Parker Vandermeer (26:58.378)
like total lifetime, at least 20, I would guess. I usually, like my little spiel is usually that I have at any point probably half a dozen sites that I'm rotating through, and that's probably what it's at right now. I probably have six to eight sites that I have, you know, on my schedule coming up at some point in the next six months or so here. I'm trying to part of that down a little bit because I think it's, you know, naturally occurs throughout anyone's practice as it starts to evolve. But yeah, I've been...

all over the place, primarily in the northern half of the province, but I think I currently have privileges for every zone except Calgary.

Jordan (27:37.052)
Come on down, it's nice here. Okay, and so what are these sites saying? You know, like you're working all across the province, like what's all these different communities thinking in terms of the healthcare system and like the changes that are coming up? Like what have you seen the other doctors talking about? Are they positive or are they still pessimistic?

Parker Vandermeer (27:56.114)
Yeah, I'd say it's a universally negative view of the government and probably quite a pessimistic view of the future. I think especially in rural communities you have the advantage of, you often have a mix of newer grads that are, you know, more similar in their stage of practice to myself and some older docs who have been, you know, very experienced and involved with many different governments, many different system changes over the years. It is concerning for me when I...

Jordan (28:00.828)
Hehehe

Parker Vandermeer (28:23.834)
hear comments from the older physicians who have been in this longer, that this is worse than the client years. A lot of these physicians who have been through the good and bad in the past, I haven't really met one yet who thinks that this is not the worst moment in Alberta for health care. When we see in primary care just you know the continued deterioration of support and in this context you know even

keeping things as they are, I would still say is deterioration in compensation and support because I mean, all you have to do is go to the grocery store and realize that inflation is real, right, and costs are going up. So as a family physician, you are essentially also a business owner, and I'm sure most people can appreciate how difficult it would be to run a business when your income and potential income is essentially fixed and all your expenses are perpetually going up year over year.

So that is a very real stress to a lot of these communities. The need to find additional providers for either time off or covering people who have retired or in some cases, you know, passed away is a continual stress in all these communities. And while you have the odd community that celebrates getting a new physician every once in a while, I'd say for everyone that gets a new doc, there's six that are absolutely desperate and looking and unsuccessful in finding anyone. And the problem is becoming worse. Like I've noticed...

even over the last three, four years in the emergency department where in these rural communities it was more often than not someone, even if it wasn't their family doctor, they had a physician in the community who would follow up with them and they could book in to see. Whereas now a lot of sites, we just honestly, we stop asking if they have a family doctor because the answer is almost always no. Like it's just no one has access, no one has a way to get in. Even the walk-ins are impossible to access in some of these bigger cities. Like it's just...

just out of luck, like there's not answers to these patients who are asking how to follow up, how to get other chronic issues addressed, other than, well, I guess, come back through the emergency department.

Jordan (30:29.936)
So what's gonna happen? Like things are clearly coming to a head. It sounds like things are accelerating in the wrong direction from what you're hearing across the entire province, all the doctors in the different communities. Access to care is getting worse. Wait times are getting poorer. Doctors are burning out. They're quitting, tapering back their practice. Residency programs are becoming less and less favorable. And then it sounds like the proposed changes coming from the top down are-

insufficient or definitely not quite living up to what needs to happen. Like assuming we continue on this trajectory, then what, like what, what actually happens for a healthcare system to crumble then?

Parker Vandermeer (31:10.45)
Yeah, and I don't know, you know, there's been a lot of times over the last two years that I have had this feeling of, well, this truly has to be the worst, right? Like we just, we have to have hit the bottom. And then we pull out some shovels and we find a way to get deeper. I think the healthcare system over the past couple years has really been surviving on the goodwill and, you know, the honestly, the years of life of the workers in it. And this isn't just physicians, you know, anyone working in the healthcare system has been...

burning themselves out at the cost or as the price of trying to keep the health care system running. Eventually, that just has to run out. And I do think that probably plays into a bit of the growing sentiment that, well, the government just wants privatization because I think a lot of us, including myself, struggle to see what does total health care system perhaps look like. What does it look like when there are just literally like, it's not striking, it's not job action. It's just...

people cannot show up to work because we do not have nurses to staff the hospitals. We do not, you know, the money's run out. There are no more travel nurses. The locums all have, you know, fled the country for trips because they're just exhausted from working 100-hour weeks and the local docs are just done. And, you know, the human resource side of this is not infinite. So if that's basically what we're throwing into the fire to keep things running right now, that does have to run out at some point.

I don't know when that point is. I don't know if this is simply a situation of it needs to get so bad that there is enough outcry that the government actually steps in and maybe we salvage things at the last minute. But it certainly isn't a very optimistic outlook and I imagine it has to contribute to people's decision to come to Alberta when they do the similar mental exercises of knowing you're the one being thrown into the fire to keep things afloat until the government gets off their ass and actually decides to do something.

Jordan (33:09.548)
It's interesting of like a thought experiment of where is rock bottom for that. Like, you know, if doctors had a union and we're allowed to strike, I imagine we'd be well past that point where they'd be up in arms picketing currently. Yeah. And so they usually, you know, are often that would kind of be the bottom and then there's forced into action on the top end, but because we don't have that, you know, it just like continues to deteriorate until it gets to the point where patients are up in arms and complaining. And

Parker Vandermeer (33:20.26)
Oh, years ago.

Parker Vandermeer (33:37.699)
Yeah.

Jordan (33:38.368)
advocating enough that voice gets louder that the health systems actually change.

Parker Vandermeer (33:41.682)
Yeah, and what I worry is, you know, the system is so complicated and the people who actually make the decisions so insulated from the patient, that those frustrations, and we already see this, are getting directed to the nursing staff, the allied health, the physician. So on top of, you know, basically being the one sacrifice to keep things afloat,

you're also the one that has to deal with the complaints. And I mean, sometimes those complaints are, you know, people just being grumpy in the waiting room of either your office or the hospital. Sometimes those complaints become more formal and sometimes justified, sometimes not. But, you know, as someone who is doing more and more acute care as part of their practice, it is a big stressor for me of, while you're basically asking me perpetually to do more with less,

there is going to be balls that are dropped just by nature of, well, it's a flawed system and there's issues with it and we don't have proper supports. And then just the fear of, well, if complaints come in, the college is not forgiving and does not account. They don't care that the system is shit. They don't care that there's all these issues. They will crucify a physician without giving it a second thought and not care about the context of the health that they've lived through in the last three years trying to keep things afloat and providing good patient care in that time. So

I really feel for new grads who are both having to go through this whole process of figuring out how do I become an attending physician, which is already a very busy and difficult part of life, but then also needing to do it in a system that is just failing them in every imaginable way right now. So I don't know what rock bottom looks like. I would hope that we can't hit it. I would hope that in such a wealthy and well-off country as Canada, that it would be impossible to actually see just system-wide collapse.

But our government has never failed to impress with how low they can go and how poorly they can function, so maybe we'll get there.

Jordan (35:43.512)
Well, how are you doing it? You know, if you're working a 2.0 and like just going to the absolute ends of the earth to keep the system running, how do you manage that? Like, how are you not burnt out? What kind of vitamins are you taking? How much water you drink every day? What's your secret?

Parker Vandermeer (35:58.282)
Yeah, and I mean, I think the truth is I am burned out and I think a lot of my colleagues are right. And I mean, the people who see me regularly can probably point to periods where I just kind of drop off the face of the planet for, you know, a week or a month at a time, and just like sleep and try to recollect. What I have been doing is not sustainable and I've been, you know, actively trying to cut back. And I would say I am better off than most because as a locum or

in many of my capacities as a locum, I have the option to cut back. A doc with a busy practice in a small town or even in the cities these days does not always have the option to cut back. A lot of that is because of the college and risk of complaints and difficulties with access and all these things. I think you run the risk of in the very process of trying to save yourself, keep your practice afloat, of bringing on more work.

and more stress through complaints and angry patients and things getting missed. So it's really an impossible situation and I won't speak for others in this, but I would say over the past couple of years, I've had multiple periods where I just feel like I'm perpetually walking on eggshells over concerns of knowing I am burned out, not in a good head space to be practicing, kind of have to though, for numerous reasons. And just that, you know.

impending sense of doom that dread of like, well, is it just a matter of time until I miss something and then there's yet another massive burden on me. So, you know, it's a personal project to work on that and try to force some more balance into my life. But at the same time you always feel like you're letting people down as you're having to start to say no to locums, no to additional shifts, all these other things because the need is perpetually there. And

Again, it's not a solution for all physicians. I'm fortunate as a locum that I can say no, but it's not all docs are in that place.

Jordan (37:57.72)
Well, so really it's like a rock and a hard place. Like, what do you do at that point, right? It's like you burn yourself out or you keep going. And then at some point you kind of have to say no. And every time that you are taking on more and more responsibility, it's just more liability, right? So if you do decide to taper your practice back, now you have to deal with patient records and closing accounts and notification and patient complaints. So it's really a tough spot for physicians. What are the...

Parker Vandermeer (38:02.359)
Yeah.

Jordan (38:24.224)
ER doctors do, you know, now that you have your position in the Grand Prairie ER, like what's been the sentiment from them? I mean, obviously they're frontline first, you know, primary care providers as well. They're seeing it in the, in their waiting rooms, in their patient beds. What are their thoughts on the whole situation?

Parker Vandermeer (38:35.606)
Yeah.

Parker Vandermeer (38:42.034)
Yeah and I mean Grand Prairie is similar with a lot of sites is you know a constant recruitment drive and trying to get more hands on deck. I think they've done a pretty good job at trying to balance you know when they do get new hires not just burying them instantly acknowledging that we need this to be sustainable. And again you know I won't be able to speak for any other physicians but

I am getting to know them and from speaking with patients and the other physicians there, you know, I think a lot of them has been a, well, cutting back on or ending community practices and transitioning to full-time hospital work. Again, just to basically keep things afloat and speculating, but...

probably that they're no different from a lot of other physicians that just found it was impossible to maintain both the workload was just too much, the liability, the stress, the commitments, all just too much to keep sustainably for any longer.

Jordan (39:40.236)
And then the CMAJ, I don't know if you follow their podcast along at all, but they recently had the episode on the crisis in the ER. And then even the ER doctors were talking about, you know, our specialist colleagues in the hospitals seem to have been operating at 110% capacity for a long time now. It seems like there's just crisis across the entire system.

Parker Vandermeer (39:56.225)
Yeah.

Parker Vandermeer (40:01.522)
Oh, it's everywhere. And I mean, the inpatient bed situation is horrible. And I think there is a lot of similarities between emergency medicine and family medicine. And I mean, if we look provincially, there are a lot of family physicians, myself included, that are working in emergency departments. I mean, there's obviously that connection. But at the end of the day, if it's not in the community, it's falling to the emerge and they're seeing a lot of those stresses and we're seeing a lot more.

chronic family medicine problems coming through the emergency department because it's people who recognize they need to see a doctor but have no other option. The amount of work and patient load getting thrown into hospitals right now is just, it's also not safe and we could go on a whole tangent about this. But for myself, I think one thing that was really quite shocking.

was as I've been working at the Royal Alex a bit more recently, and I hadn't been there for quite a while, like probably since residency. So it's been a few years and seeing that they had taped out hallway beds in their emergency department, which is we would never have hallway beds, you know, five, six years ago when I was a resident there. And I thought, yeah, yeah.

Jordan (41:13.488)
That was like a COVID thing, right? Like we were like, okay, pandemic, we gotta get drastic. We're gonna have beds in the halls. Yeah.

Parker Vandermeer (41:18.654)
And now it's just the norm, right? And I think for me, it was just that realization, and that must've just been a day when whatever lead team made that decision that we just have to accept this isn't going away and actually like make the call to put the tape down on the ground. And we see it in the impatient words too. I mean, it's horrible.

to have hallway beds on a ward, especially in the older wards, but you know, they're basically getting office dividers and shoving the stuff that's already taking up room in the hallway out of the way, shoving a bed in there and then putting up some dividers and like, well, that's your room for the next week. Like the hospitals are bursting at the seams right now.

Jordan (42:01.54)
Well, and then that's spilling over to the community. I was talking with a rural pharmacist just a couple of days ago, and she was saying that, you know, patients will come to her and they're like, you know, my ear hurts and it hurts a lot and I, I can go and sit in the ER for eight hours or you know, miss work, you know, there is no doctor, there's no walk-in clinic. Like there's nobody with a patient panel. And then the pharmacists are now kind of in this awkward position of like, well, okay, we can prescribe you some.

Parker Vandermeer (42:22.07)
Yeah.

Jordan (42:31.748)
moxicillin, but we have like not really any actual training. We don't have an otoscope to look in there. Like there's an entire chance that this is just like completely missing the mark. And it's just a chunk of wax twisted up sideways, but then, you know, that guilt of just the neglect to the patients and how the system has let them down, you know, so now that's spilling out into these other areas where other healthcare providers are, you know, they kind of, I don't know if I want to say force, but like really feeling like they have to.

Parker Vandermeer (42:36.739)
Yeah.

Parker Vandermeer (42:41.442)
Yeah.

Jordan (43:00.284)
do you go out of their comfort zone and provide care that's probably not very good in the first place, right? Just because there's no other options at that point.

Parker Vandermeer (43:02.114)
Yeah.

Parker Vandermeer (43:09.066)
Yeah, and there's certainly an emotional component, right? I mean, whether it's pharmacist or nursing or physician or any other allied health, I think the vast majority of us get into this line of work because we want to help people. And then to be put in a position where you feel you have to give subpar care or no care can be extremely draining. And if there is, I mean, one thing I would hope that the public could take from this is, yeah, you know, you probably are not getting the optimal experience.

from the healthcare system right now, but please just be gracious with your healthcare providers because we've been through absolute hell for years now and we are the candle that, it's not even burning from both ends, we've just been thrown in the fire and that doc you're seeing or that nurse you're seeing who maybe seems a bit dismissive or a bit grumpy, they're probably hours into a miserable shift on a week of miserable shifts in a year of miserable months. It's just...

They probably don't look like it, but they're probably very burned out and just at its end and keeping it together for you. So just grace from all sides would be so appreciated right now.

Jordan (44:21.764)
Be nice to your doctor, yeah. What do you think about the proposal for the three-year family medicine residency? Good idea, okay idea, terrible idea, where do you fall on that?

Parker Vandermeer (44:23.382)
Yeah, yeah.

Parker Vandermeer (44:33.938)
I can say that the only people I've seen in support of it have been program leaders at universities and the college, like the National College themselves. I thought it was quite interesting that there's been some outrage about it recently and it was added to the AGM as a voting point whether or not that should be suspended for further discussion and transparency. I haven't yet met a single community provider who thinks it's a good idea.

And it seems like they really don't have a plan. It seems like the plan was let's make a three year residency and figure out what we're gonna do at that time after the fact. So I am pretty firmly against it until they can actually show that it's going to be helpful and have more than just pipe dreams and aspirations of, well, three years, doesn't that sound good? But I would be open to hearing the other side if they can actually formulate it.

Jordan (45:24.376)
kind of get it. Like it sounds like there's just a lot of like deeply rooted changes that they want to make to the training of physicians to practice in today's day and age and like given the state of just the failing healthcare system pulling apart at the seams like maybe there is just some deeply seated. It's you know, it's almost like the burn it to the ground and revolt and start fresh again, you know, page one rewrite with the training, you know.

does that have any potential to improve the efficiency or alleviate some of the burden currently facing our healthcare system?

Parker Vandermeer (45:59.894)
Yeah, when I always just question like what do they plan to achieve with that, right? Like I think it's natural when you finish your residency to be uncomfortable with the idea of becoming an attending. And I don't think one year or 10 years is going to get rid of that entirely. I think it will certainly make things worse initially. I think to be in.

entirely honest, it's not going to have a benefit at any point. I think it'll be neutral in the long run, but initially when we have that gap, you're producing no family physicians. And I think...

Jordan (46:32.86)
So they're gonna be rolling it out, I guess, in a graded fashion. So it's not gonna be like one year of no doctors is what I'm told.

Parker Vandermeer (46:38.983)
Yeah, it won't matter. Like it's gonna be collectively like a year from each site. You're gonna, I can only imagine those sites that are transitioning through three year programs are going to have very low match rates that year because who's going to volunteer for an extra year? Yeah.

Jordan (46:44.677)
Yeah, yeah, overall.

Jordan (46:52.624)
Yeah, we thought match rates were bad enough already, let alone you had another third year into the mix. Now it's even less alluring.

Parker Vandermeer (47:01.71)
Yeah, so I think in the, you know, medium term we're going to see fewer family positions because of that and it's going to take longer to train them. Whether there's any benefit in the long run, I'm not optimistic about it. I know the sentiment I've heard from some program directors as well in the two years we have trouble meeting all these criteria that we want for a new grad. But from what I have seen, probably the issues of criteria not actually meeting them like...

One of the criteria was fitting a pessary, which I don't know if you've ever done, but I certainly have never done and have no intention to ever do, even if it's in my scope. And then, yeah. And then another criteria was being able to manage any patient in the emergency department, which I think is, first and foremost, extremely insulting to our emergency medicine, Royal College-trained colleagues, to make it a single point in a family medicine residency that you can essentially do their entire job that they're training years for.

Jordan (47:37.392)
Not yet, but never say never.

Parker Vandermeer (47:59.278)
And two is just entirely unrealistic. Like, you know, maybe add eight years on to your residency if you want that to be the goal. But, you know, if, and I'll admit, I haven't gone through all the criteria, but if those are some cherry picked ones, like there's probably needs to be a reassessment of those. And before I would add a third year on, I would say in my own residency experience, there was rotations that were not helpful for my career going forward. Like you really.

to get my vote would need to demonstrate that those first two years are high yield. Like they are optimized as optimized can be and every month of that two year residency is being used to create the best family doctors we can. And until you've done that, I think adding on extra time is the same reason the Royal College residencies are extended, it's a cheap doctor for the system and it's a money saving measure.

Jordan (48:51.024)
Well, and then it's interesting your comment on the, you know, just kind of diminutive to our emergency room colleagues, but you know, kind of language and verbiage on that aside, maybe that's what they're looking for is, you know, just more family physicians to feel comfortable in that acute care setting, which would trickle down to more doctors practicing rarely. Do you think there would be like a shift of doctors just going towards the city centers because of that?

Parker Vandermeer (49:15.143)
YAAA

I don't know, like I think from the colleges perspective, again, the national and not the provincial colleges, they want these fully fledged, like full practice family physicians, I think is their goal. In their mind, they're maybe still a little bit stuck in the 1800s of, you know, every family physician goes to the hospital in the morning, rounds for an hour, sees their patient, goes a couple hours of clinic, and you know, picks up an emergency shift a week, and then goes and rounds on their long-term care patients.

That's just not the reality we live in anymore, right? The reality is if you are in a large urban centre, the majority of your family physicians are going to be community-based practices. They're going to have a limited number of procedures that they feel comfortable doing themselves, that they will do within their own facilities, and the rest they'll refer out. The vast majority of family physicians outside of rural settings are not providing care in acute facilities.

I think the plus ones, the plus one programs like the additional year of training and residency are a good measure for those physicians who do have more interest in providing additional emergency coverage or inpatient coverage that are not comfortable with the amount of training they had throughout their two year residency program. But I don't see the point of training every family physician to that level of being able to do.

the full scope of medicine and not family medicine, the full scope of medicine, because if you're not using those skills, you lose them. So what is the point of being comfortable in an emergency department? If you know when you are done, you have no desire to practice in an emergency department. What's the point of doing, you know, six months of obstetrics and mum care? If you know your experience once you've graduated is gonna be follow your pregnant patients up to, you know.

Parker Vandermeer (51:09.518)
20, 25 weeks and then refer off to the moncare teams or obstetrics. Like there's just got to be a practical stop here. It is impossible to practice full scope medicine and be an expert in all areas. The system's not set up for it. And thus you have four patients on your panel. No one has the time to do it. Like you need to train to the reality of what family doctors are doing in the community, not some aspirational goal that is just impractical to expect of anyone.

Jordan (51:39.504)
How would you just sway more doctors into those rural settings then? Cause you know, as bad as the system is, it's even worse for all the rural communities. I mean, you see it, you live it every day, right? It's like, I imagine maybe having more of that training would help with that. I mean, perhaps there's a less roundabout way to get to that. Like just changing the billing codes and making it like more of a monetary incentive. People were talking about geographically restricting billing codes for a while. That was not particularly a...

Parker Vandermeer (51:49.858)
Yeah.

Parker Vandermeer (51:59.946)
Yeah.

Parker Vandermeer (52:07.81)
No, no, that's a horrible idea. I think a lot of it is exposure, right? I think people self-select pretty quickly and if they have a good rural experience, I think people are good at figuring out this is something I want to do. I enjoy this lifestyle, enjoy this form of practice, or they decide rural's not for them. And if they decide rural's not for them, that's fine, right? And I mean, that's, I think the biggest reason I'm opposed to

Jordan (52:08.368)
popular suggestion.

Parker Vandermeer (52:36.694)
the idea of restricting billing codes or your BAs to certain regions is you do not want a doctor practicing in an area that they do not want to be in. And that's all that forces. So I think exposure and just finding the people who want to do it and then supporting them the best you can to get into these rural communities is the best solution. For myself, one of the biggest reasons I...

have never really committed to a practice in a rural area is the idea of, well, once I'm here, I'm trapped because there's never going to be local coverage. It's never going to be, you know, someone to take over my practice. If I, if I want to have a big change in life or even if I want to travel. Right. So it's a kind of a chicken in the egg of, well, we desperately need more rural doctors, but the best way to get more rural doctors, I think, is to have rural doctors so that the commitments are not as insane so that you're not wanting to call. So there is actually.

someone to cover for you when you want time off. So it's probably gonna need to be financial incentive or something to shore up those numbers initially. And then once you have the numbers, I think it is a problem that will be able to solve itself as long as we have an appropriate number of family doctors in the province. You'll have that proportion that like rural and just self-select for that stream.

Jordan (53:50.48)
Why do you do it? What was the draw to rural practice? It's like, it's a hard job, right? It's like you've got so much on your plate and the responsibilities and the scope of practice is enormous. Like, what drew you to it?

Parker Vandermeer (54:03.498)
Yeah, and for myself it was the scope, it was the acuity. You know, I like the emerge side of things, I like the inpatient side of things, but I also, especially earlier in my career, didn't want to give up on the clinic portion of it. So I liked the variety, and the only place you can find that kind of variety in medicine is in rural communities. So that was kind of the deciding point for me, despite being a city kid and every other meaning of the word. I spend more of my life these days out in rural communities than I do.

in urban centers because of work. Yeah, I did, yeah.

Jordan (54:35.912)
caught the bug. It is fun though. I did quite a bit of rural locaming right when I first graduated. My wife is very much a city gal so that was incompatible with a happy marriage, unfortunately, but it's fun being out there and practicing and doing all this stuff.

Parker Vandermeer (54:48.822)
Yeah, it's great. And that's why I think if we had a sufficient number of family physicians, it would not actually be an issue because you would have whatever percentage it is. I do think you'd have enough that would just be like, yeah, I have that rural bug, I like that form of practice and they would self-select and do it. And you do, I mean, especially with the rural and remote areas, like you do have some financial incentive for going out there and I think that is a necessary part of it because...

That calculus does change a bit if all of a sudden it's, well, why am I basically 24-7 every call and they have all these other commitments and I'm doing all this extra work supporting this entire region, but I could live the same quality or better quality of life in Edmonton or Calgary or make the exact same. So there is a financial component to it, but as far as selecting physicians who are actually gonna be successful in these communities, you know, you know if you wanna be a real doctor or not.

probably pretty quickly, upon getting into one of these communities.

Jordan (55:49.68)
Yeah, the old test drive method to get them out there. All right, well, I mean, we're coming up on our hour here. Any final thoughts, anything else you wanted to shout out or go over?

Parker Vandermeer (56:00.222)
Yeah, I mean, I guess I come off as a pessimist, but I do try to be nice as well. So I do, yeah, I got a point for that. I guess I would just say that one of the big, not even professional, but just life lessons I've really been learning over the last year is, and it's gonna sound stupid, but most people are not inherently evil or out to get you or out to just wreck things, right? These are complicated systems and...

Jordan (56:05.444)
You liked Connect Care though, you get a point for that.

Parker Vandermeer (56:29.39)
Kind of like I alluded to before, you know, with the health ministers and deputy ministers and what not, there's a lot of people giving a lot of input. There's a lot of factors at play. I think by far and wide, most physicians, most healthcare workers, nurses, allied health, everyone involved, and even the decision makers, do want to see system improvement. They are focused on patient care. I think there's a lot of different ways to get there and a lot of different factors that kind of pull people one way or the other.

And there are some people that are just making the wrong calls. But all in all, I do think the people that a member of the public would be interacting with on a day-to-day basis, they do want the best for patients and they want the best for the system. So I think just kind of a call for us all to be gracious to each other, whether it's colleagues or patients or two patients or front patients, just kind of giving everyone the benefit of the doubt that it's a hard time for us all right now. And just an appreciation that

you know, the admin you're frustrated with or, you know, whoever it is in the system. I think we all want the same thing. There's just there's different paths to getting there. And there's obviously some big barriers and some big challenges to overcome right now. But that it's maybe not as bad as everyone's out to kind of screw over the system and against us, which unfortunately, and maybe this is just a me thing, but I think on the front line often is the feeling that no one

except, you know, the people on the front line that are slogging through the pits.

Jordan (58:02.468)
Yeah, everyone's getting tired, burnt out, a little bit jaded, but a little bit of compassion goes a long way when dealing with others in the same situation.

Parker Vandermeer (58:08.64)
Yeah.

Yeah, so just be kind to each other.

Jordan (58:15.1)
Is there any recourse or action that your average physician should be taking, or even for the members of the public out there listening to this, like advocating? What do you think is the actual most effective method to go about speaking up or enacting systems change?

Parker Vandermeer (58:32.938)
Yeah, I mean it's so hard to ask because everyone is so exhausted and has so much on their plate these days, but really just doing what you can to be vocal, right? I think it is a numbers game at this point and you know, as much as it's kind of a stereotype suggestion, you know, the calls or letters or whatnot to your MLAs and whatnot, like if they get enough of those, I still do have to believe that has to have some impact.

And yeah, your call or your letter is just one call or a letter, but if you and 10,000 other people do that, well then all of a sudden that is a pretty unified voice. So I think it's just, you know, find the areas where you can kind of stir up a little bit of shit and make a little bit of noise and do what you can, but don't burn yourself out more in the process.

Jordan (59:21.84)
Yeah, we need more Dr. Parkers out there in the media. No, awesome. Okay, right on. Well, thank you so much for joining us. That was a fantastic conversation. Have a good rest of your afternoon.

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