Family physicians are at the heart of Canada's healthcare system, yet many face burnout amidst mounting challenges like long hours, low salaries, and inadequate support. Dr. Pauwlina Cyca, a pharmacist turned physician, shares insider insights on Albertas healthcare challenges, from inadequate stabilization funding to the lowest resident physician salaries in Canada. She explores collaborative solutions like comprehensive-based care and highlights the urgent need to retain doctors, support IMGs, and prioritize wellness amidst Alberta’s high cost of living.
Key topics include:
- Why $10,000 in stabilization funding per physician falls short of addressing Alberta’s healthcare challenges.
- The inclusion of international medical graduates (IMGs) in the first round of the CaRMS match as a step forward.
- The financial and emotional toll of high living costs and low PGY-1 salaries on Alberta’s resident physicians.
- PARA’s priorities: negotiating better salaries, improving duty hours, and fostering resident wellness.How comprehensive-based care can stabilize primary care and attract new doctors to the province.
Dr. Cyca also shares practical wellness tips, including staying organized with daily to-do lists and prioritizing physical activity. Whether you’re a healthcare professional, policymaker, or concerned citizen, this episode offers a clear-eyed view of Alberta’s healthcare challenges and the collective efforts required to overcome them.
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Transcript:
Jordan (00:02.328)
Today we're talking to Dr. Pauwlina Cyca pharmacist turned physician. She was a former pharmacy operations specialist at Shoppers Drug Mart, President-elect for the New Brunswick College of Pharmacists.
Pharmacy Brands Canada. She was one of the founding executives where she's now the senior advisor for pharmacy services where they now have a footprint across Canada of more than 200 pharmacy locations. And now just recently in the last few years, she is a family medicine resident here in Calgary where she's the chief resident for the Northwest Division. And also recently was decided as the president elect for PARA, the Professional Association of Resident Physicians of Alberta.
mother of three and former triathlete. That was a mouthful. Dr. Cyca thank you for joining us today. How are you doing?
Pauwlina Cyca (00:48.058)
I'm very well. Thank you for having me. I appreciate it very much.
Jordan (00:52.872)
Awesome.
Why don't we start a little bit with just the government negotiations and sort of how primary care is going in Alberta. So Recently it's been all over the news. The government and the family physicians are a little bit at odds. Everybody's getting tired of the wait times and the lack of doctors in the province. The government decided to put together a task force. The task force decided that the longitudinal family model for family practice was going to be necessary. And then part of what the government took out of that
decided to put together a second task force to now consult on how that should look. You have been appointed as part of that task force and that was called what again?
Pauwlina Cyca (01:34.934)
It's the stabilizing access to comprehensive primary care in Alberta.
Jordan (01:42.22)
Thank you. How's that going? How are things evolving? I know this is still like early stages, things are starting to come to a conclusion there. How has it actually gone, you know, from your perspective on the inside and also just as a new family physician doing your training?
Pauwlina Cyca (01:58.746)
Yeah, certainly it's, I mean, it was an interesting process. It's not new to me to serve on these committees. However, this particular task force, it was struck with a level of urgency, as you have already alluded to. And the work was quite volumous. Is that a good way to describe it?
initially and it's just started to taper off with some resolution and some decisions from the government. I'd say in terms of how it went, so initially a huge rush. There were lots of questions, more questions than answers. There were certainly more requirements, requests, if you will, from the family physician's standpoint. I served on the task force as a
a representative for PARA or the Professional Association of Resident Physicians of Alberta so that resident physicians could also provide our voice and our opinion. Certainly the decisions that are impacting family physicians will impact the family resident physicians as well because a lot of us will be transitioning to practice very shortly. In fact, the R2s will be transitioning in the next two months. They're writing their exams now.
Any decision that's made now would impact them, which is why we were asked to also have our voices heard on this task force. So super appreciative that we were involved. And I would say initially things were quite escalated, right? There are a lot of we need this, we need this now, we need this in a week, we need this in two weeks. And the objective was to very urgently and acutely stabilize primary care in Alberta so that
more family physicians didn't feel the need to leave or didn't feel financial pressure to close their practices. And certainly I didn't appreciate until starting residency how severe the situation was in the community. I had heard of people not being able to access a family doctor, but I didn't understand really the business side of why it was so significantly strained. And it wasn't until after I started in residency and practicing in these clinics that I'm like,
Pauwlina Cyca (04:19.61)
Oh my gosh, this is dire. Like it's borderline catastrophic. In fact, I would say it is catastrophic. I don't think that is an exaggeration. And so the work that was being done by the task force, which included representatives from AMA, the Alberta Medical Association, from PARA, from Alberta Health, and then there was a third party who also helped facilitate things.
lots and lots and lots of collaboration, a lot of big emotions as you can imagine. And what ended up happening was that proposals were put forward and each of the different organizations put forward a proposal and we did our best to come to consensus as to what would be the best and most appropriate proposal to bring to the Minister of Health urgently to have
some resolution quickly. And I'm sure that you've heard that there was funding that was committed already and how that's disseminated equates to a hundred million dollars. So 92 million goes to the doctors, eight million goes to residents. This is the first time that resident physicians will have funding to help stabilize our practice as well. I can get into why that's important in a bit, but it's kind of a big deal.
And then that would roll over into the following year with another $100 million being dedicated with the same breakdown. And that funding to family physicians, the intent is to stabilize the practice until the Longitudinal Family Practice Funding Model or the LFP that was initially created, proposed by that first task force. Until that comes to fruition, the stabilization funding is supposed to help.
So where things got a little bit hairy is who gets the stabilization funding? How do you measure how much each person gets? Because of course, one of the pillars and one of the mandates of the task force was to increase patient access, which makes sense. So I think that there were a lot of heavy emotions around this because there's a significant number of practitioners whose panel size perhaps
Pauwlina Cyca (06:45.686)
don't equate to what the, call it subjective, or the opinion of certain individuals thought that maybe that should qualify for the stabilization funding. And that's where there were some big emotions. And certainly the Minister of Health, from what we understood, was also receiving information outside of the task force. So when she was doing her rounds in Alberta and meeting people, there were...
other physicians who were presenting their case to her. And at some point, there must have been some either conflicting information or some very animated discussion around the subject. And that led to some controversy with the work that was being done. So all that to say it was an eye-opening experience. It was very rewarding. It is very fulfilling.
I'm very happy that resident physicians are sitting at the table and providing our voice in the matter. Certainly, resident physicians in Alberta right now are the lowest paid among all physicians in the country. We don't compare ourselves to Quebec because they are paid in kind. So they have funding that is over and above or in addition to and different from a yearly salary. But resident physicians in Alberta, lowest salary. So...
And Calgary, as you probably are aware, increased to be one of the highest, if not now, the highest cost of living city in the country. So to have the lowest salary and the highest cost of living with no rent control and soaring energy prices and soaring prices for insurance for your car and the whole thing, it became, is becoming almost financially impossible to either pursue or continue a medical degree in this province. So we were just thrilled to have that.
be included in the stabilization funding.
Jordan (08:41.816)
Yeah, that Alberta advantage that used to be talked about so much is just slowly eroding away through all these different channels. I mean, in terms of the stabilization funding, that's part of the conclusion the government's coming to. I mean, what do you think personally of that outcome? I mean, just back of the napkin calculating $100 million. If there's 10,000 doctors in the province, that's like 10 grand per doctor.
does a 5% one-time bonus to their annual salary. Is that gonna save primary care? Is that enough? Is that a big part of it? Like, what are your thoughts?
Pauwlina Cyca (09:19.934)
I feel, so I can speak from the resident perspective, certainly, and I can also offer my opinion from what I've observed in the clinics that I've worked in. Certainly I have no financial responsibility in those clinics, so it's a little bit different, but my personal opinion is $10,000 per physician will not make a dent. I don't think that would be, That is not a sufficient number to maintain the physician in the province.
it wouldn't even cover their overhead for a month, right? So I don't think that it's significant enough to save or stabilize primary care. It certainly needs to be more than that. And I think that's also where the conversation was going in the task force is that would not be significant enough of a number. So then how do we recalculate the monies and make sure that it's going to where it needs to go?
and that was part of the controversy and it's still not completely teased apart from what I understand and that makes it complicated. I know that from a resident physician's standpoint that was actually one of the proposals also put forward 10 grand per resident and our response to that was in our unofficial surveys where we solicited the opinions of the family residents in our cohort nobody would
be able to stay for 10 grand, especially when you have other neighboring provinces that are unofficially offering significant sums of money and having no geographical ties whatsoever to the funding. As long as you open a family practice and you hold a panel of a specific size, that's all that matters, right? So we're being poached in essence.
Jordan (11:04.004)
Mm-hmm.
Jordan (11:10.752)
Why everyone's competing with each other to find doctors. I mean, it's pretty cutthroat out there right now. And I can see how the provinces would be going at each other in terms of the task force and sort of the suggestions that are put forward. Is there anything else that you've seen actually come through on the government side from the recommendations? Are you allowed to talk about this stuff or is it still under NDA and in discussions with the government?
Pauwlina Cyca (11:40.054)
Some of it is still under NDA because it hasn't been fleshed out. And certainly the AMA have been working tirelessly. I will say that. I was surprised at how collaborative the government has been. Certainly being an outsider for so long and just reading the news and getting the lay of the land or the perspective from a media standpoint, I certainly initially was under the impression that there was a breakdown in negotiations, that there was...
you know, a nice little iron curtain and nobody understood the other person's perspectives. That has not been my experience on the task force. It has been really collaborative, um, and, and incredibly professional despite the high emotions and despite the high stakes, everyone seems forward thinking and working towards the same goal. Uh, you'll often see people stuck between a rock and a hard place where this is the pot of money we have to work with. So how do we,
make the right choice. How do you do the right thing right when you have these confines? Ideally, every family physician in the province would be granted an extra hundred thousand dollars, for example, to stabilize their practice, which would give them about six months worth of stability in order to give us time for the LFP to kick in. And again, these are just my observations from working in the clinic this past year as a resident physician.
and seeing some of the business numbers be moved around and highlighted. In terms of proposals, there were different tiers that were proposed. And I will say that our partners at AMA alongside PARA made the recommendation that physicians, even with smaller panels, should be eligible for the stabilization funding, because many of those physicians with smaller panels also do work outside of the clinic.
they might teach more frequently. They may have a small practice for lactation or maybe low risk obs or I mean, pick anything. Like oncology would be another example. And those individuals may have smaller panels, but those panels likely are more complex with people and patients with significantly higher needs that take more time to take care of.
Pauwlina Cyca (14:04.63)
So their billings will be very, very low if they're fee for service, which makes this funding model that much more important for them. But if they're excluded because their panel size is not quantified either appropriately, because their EMAR isn't connected to CPAR, or it's not quantified appropriately in CPAR, or they legitimately have a smaller panel because they provide more complex service either elsewhere or within the clinic.
I mean, those are the folks that really need help too. So I think that's really where the pushback is and how to get around that. I certainly don't know the answer, but I know what's fair. And I also know that people are stuck.
Jordan (14:50.036)
What did you think about the process? Because I think that's a big part of why, you know, primary care and the government are at odds with each other so much, is the family doctors just feel like unheard. What did you think of the actual process in terms of the task force? You said, you know, they seemed like the government and the other individual collaborators were actually like,
fairly open-minded and willing to talk about a lot of these things and you're sort of surprised about that. I don't know if you can speak more about the actual how it went down in the logistics or how it is currently operating.
Pauwlina Cyca (15:22.75)
Yeah, so like I said, it was very collaborative, even from the very get-go. There was not a meeting that went by that didn't have a component of the discussion that was incredibly heated. And in some cases, people needed to take a break. So the process was enlightening in that respect.
one of the key things that I learned was it's the professional that makes the, it's the person behind the profession that makes the professional, not the profession. Does that make sense? So you're, you comport yourself as a professional if you are that person, not because you have a specific title. And that's something that was very enlightening during this task force process. Um, in some cases, comments were surprising and made
made some of us wonder what the motivation is. And in some cases, the comments were incredibly altruistic and made you appreciate the selflessness of being a physician. So if I had to summarize the process in one word, it would be enlightening.
Jordan (16:41.88)
How many different people were actually involved in the process? Is this like five people? Is this 50 people?
Pauwlina Cyca (16:49.936)
So if I had to count, I'd say more like 20 people.
Jordan (16:54.62)
Okay, so reasonable sampling, I guess. And then are the people on the task force, like seeking out stakeholder feedback from other physicians and getting other input, or how does that actually work for putting systems together for a whole province? How do you get all of that perspective?
Pauwlina Cyca (16:55.286)
Yeah.
Pauwlina Cyca (17:11.526)
Yeah, absolutely. So this is why there was such a frequent cadence of meetings, because the individuals who sat on the task force each represented a section of family medicine and also reported into other working groups and committees in AMA and to AMA executive themselves. So the information from, do you want to call them constituents, from the members of AMA, so all of the physicians in Alberta.
Those opinions were collected quite formally and then was fed up through the representatives, fed into AMA, and then that was used to create these proposals and provide the feedback to Alberta Health on the task force. The same thing was done through PARA. So whatever the information was that was required for the task force. So would resident physicians be okay with 10 grand, right? That's a question. So...
I brought that back to PARA. We created a survey. We created some, in some cases they were informal surveys. In some cases we had data already from very formalized surveys. That information was then consolidated through the association via PARA or AMA and then brought back to the task force. So the turnover was really fast, days.
Jordan (18:35.688)
And then in terms of the LFP model, you know, what was sort of the outcome of that, I guess, or what was the recommendation going forwards? How do they think that should actually be put together?
Pauwlina Cyca (18:49.398)
So the LFP model, as you probably remember, was created by that first task force or proposed by the first task force. And it was based on an algorithm or a calculation and they came out to a number. It's intended to be sort of like an ARP, right? So guaranteed income for a family physician and with the opportunity to also bill additional services over and above what would be considered
your primary care. And it's meant to be competitive with BC and Saskatchewan, mainly because those are the two provinces that seem to be poaching right now. And the data suggests that they're poaching successfully because of their LFP model. So in terms of outcomes, we know that the government has committed to a model of the same nature. However, they haven't yet committed to
what does the algorithm look like and who would qualify. And that's where the pushback was because the proposal was that anybody practicing family medicine that has a panel size of at least 250 should qualify for this funding model. And the pushback seemed like it was quite arbitrary. So we're in a bit of a standstill now to understand the government's data perspective. Where did they come up with their number?
And then of course AMA is providing some feedback as to where they came up with their number. I don't think either number is anecdotal or frivolous in any way. I think that there is data behind each. It's just presenting it and making sure that evidence is well understood. So that's where we are at the moment. Of course there was commitment that payments would start in April. So we hope that in a week
at the end of March, I guess that's not a week, that's less than a week, that there will be like a full formalized announcement of the breakdown, but it's sort of in the minister's hands at the moment.
Jordan (20:58.78)
throughout the process, I imagine, you know, this was sort of enlightening, what did you discern in terms of what is the actual outcome or the agenda of both sides, you know, you've got the AMA, and then you've got the government and they're, you know, in charge of this gigantic healthcare system with a lot of complexity, a lot of like different voices, people advocating for different things, I don't did it become more apparent of
what each side was truly trying to optimize for.
Pauwlina Cyca (21:30.482)
Again, the mandate was to increase the stability of comprehensive care in Alberta. And what is that? Yeah, exactly.
Jordan (21:37.428)
What is that? Is that just doctors practicing or what the heck is stability?
Pauwlina Cyca (21:43.318)
I think if you want to break it down into very layman's terms, it's make sure that no more family docs leave the province. Make sure that no more family docs close their practice. Find a new way to attract and retain these new family physicians who are transitioning to practice so that they pick up a primary care panel. I think fundamentally and in its most simplistic terms, that's what it meant.
Jordan (21:53.176)
Yeah.
Pauwlina Cyca (22:12.926)
And then when you translate that to how do we do it, I think it was essentially we need to throw money at this, but how much money is good enough and how do we spread it out with the bucket that we have? And that became the point that
In some cases, there was opinions that perhaps crossed the line of professionalism on both sides. And that was the part for me that I kind of went, ooh, you know, that was the enlightening part for me. And, you know, when you're in that situation and you feel so compelled to advocate for something so important.
and that importance is making sure that Albertans have access to primary care. How do you then tease that apart from the income of a family physician? Cause they're tied together, right? And teasing that apart is impossible, but how do you advocate without looking at the family physician's income as being like the primary driver? It's, it's difficult to do that. So you can see how the flavor of some of the meetings
might have felt kind of icky if you were a lay person just observing it without the context or without the understanding of how we got here. It's been four years getting to this point.
Jordan (23:44.632)
Well, it sounds like, you know, it really was boiling down to a recruitment and retention issue. And I guess both sides, you know, the AMA and the government are aligned that they want to recruit and retain as many physicians as possible. So that's a good thing. But then, yeah, I guess how do you actually distill it down to those individual measures, right? When it comes to any job, be it a physician thing or not, you know, obviously the pay and remuneration is top of the list or often top of the list, but there's
that go into that too.
Pauwlina Cyca (24:17.418)
100% like for example, The administrative burden of family physicians and how many doctors face hours that are completely uncompensated that it creeps into their personal time. So there's an entire element of that task force focusing on reducing the administrative burden for family physicians. So that was also incredibly helpful because there were solutions that were proposed to reduce
filling out forms, for example, or simplifying criteria for certain programs that people so desperately need access to, like Alberta Works or AGE, or even workers' compensation. These forms take forever. Disability form. I filled out a disability form for a long-term care patient the other day. It took me 22 minutes. 22 minutes of time. So.
you know, these things, reducing the administrative burden gives you time back in your day to see more people. So it directly translates into increasing access for patients, again, going back to the mandate. And but these solutions also aren't turnkey. In some cases, we needed development or expansion of IT infrastructure. And in some cases, you need funding to disseminate that among the
among the clinics, among the practitioners. It's not free. You can't just log in. It's not like Cherry where it's free and you can make a profile and network with all these great people. You actually have to, you know, you have to pay for these systems. So it always boiled down to where do we find the money to do this? So we can propose solutions. We can reduce the burden in some cases by making forms less cumbersome to fill out.
making it so the government accepts forms that are more basic for example but you still have to have those solutions in place in order to increase access so it certainly was more comprehensive than where do we put the money there's the administrative burden piece there was the longitudinal family practice funding model for later on in the road there was how do we keep physicians in their practice right now until that LFP model can take place
Pauwlina Cyca (26:34.186)
And then how do we make sure that residents who are graduating now come and fill in the spots in primary care and either don't leave the province or don't just decide to loo locum everywhere without taking a panel.
Jordan (26:48.496)
And so let's chat a little bit more about the residents side of things. So, I mean, retaining them obviously is also paramount to the province's, you know, primary care system functioning properly. It's interesting that the $10,000 bonus, you know, in the resident world was sort of scoffed at back in my day, 10 grand was a lot of money, but then again, that was before inflation started eroding away at the purchasing power.
And I guess, you know, I already lived in Alberta. Would 10 grand be enough to make me want to move here from Vancouver or make me want to stay here if I was from Toronto? That's a good question. It doesn't sound like it though.
Pauwlina Cyca (27:27.166)
No, that was the flavor. The residents that did respond to that survey, 10,000 was, it didn't meet the threshold. And mainly because it equates to the average of five months worth of interest for most of their student loans that they've had to borrow in order to pursue this degree and this training. And so five months of interest to stay for two years when things don't look that...
great for the practice. When you see physicians leaving, that just didn't seem like it was stable. So there was a minimum threshold. There is a minimum threshold where people said, yeah, I'd consider staying. And it was $50,000. That was, they were like, okay, that would cover, you know, my interest for the next, say, a year and a half, two years.
Jordan (28:05.524)
Yeah, no doubt. Okay, well. Sorry, go ahead, go ahead.
Pauwlina Cyca (28:25.982)
and it would also give me the money I need to write my exams and pay for my mandatory courses out of pocket that are in addition to residency that we must fulfill. So it was enough to cover those costs but 10 grand wasn't. So when they surmised essentially how much they needed in order to cover just those basic things like your exams, your
ATLS and ACLS and BLS and PALS and NRP and ALARM and all the things, you know, that equates to in some cases 10% of your gross salary per year for those courses. So yeah, 10 grand didn't cut it, seemed like 50 grand was the minimum. And then the other issue was that residents didn't want to be forced to go to a place where they had no connections. They didn't have any network. They didn't have...
colleagues or friends or family. And so there is a, I think the appeal from the government side is to connect this stabilization funding for the residents to a specific geography, which is a lot like what the reside program was. And you might have some uptake from some individuals and they may go there for the two to three year time period. But we also know from historical data that
those individuals who weren't from that town or didn't find a way to inject themselves into the community didn't stay after their mandatory time was complete. So how do we make then this stabilization and recruitment funding for residents who are going into practice? How do we get it so that they are practicing in these areas but they're not forced and...
How do we make sure that the funding that we provide to them is sufficient to compete with the other provinces? Because we don't, we're not in isolation. We're not in a bubble. So if BC is wheeling up with a wheelbarrow full of, full of money saying here, we'll pay off most of your debt. And we don't care where you go, just set up a panel. I mean, that's a way more attractive offer for somebody who isn't attached with a family.
Jordan (30:41.94)
What is the main concern from residents? Like What is their primary issue? Is it the funding and just the compensation?
Pauwlina Cyca (30:50.506)
Right now the main concern is the resident salaries being so low. And so we are about 12% below the median across Canada. And so when people are considering matching to a province after CARMS, one of the things they do look at is how much they will be paid. Because you can imagine that
you know, between 50 and 60 thousand dollars actually falls below the minimum wage line. It falls below the poverty line, especially in Calgary. So if you have to consume more of your debt or consume more of your credit and contribute to your debt in order to fund your residency when you are a physician, you're making decisions, and yes, you are still a learner, but you're sort of in that gray area of making very important therapeutic decisions. You're the one that's on call at night.
you're the one that's taking care of the critically ill patient at 3.30, 4 o'clock in the morning and your nursing colleagues are coming to you for orders and direction and so on. And your, your counterpart, um, if you want to compare across, um, professions, say for example, like a fourth year nursing student,
they are still under the tutelage of their preceptor, but they're being paid a salary. And their salary actually is more than a resident salary. And yet, like they're not holding any bag, right? The resident physician is holding a big bag of responsibility. So if you wanna compare provinces and professions and levels of training and so on, that is really the biggest concern of residents right now. We appreciate the fact that
Our current agreement, the stakeholders that are named, are both PGMEs, which is the postgraduate medical education groups for the University of Alberta, University of Calgary, which of course the medical schools in the province, and then PARA. So we negotiate with the two PGMEs and then Alberta Health Services. We at the moment don't have any negotiation power or privilege with Alberta Health.
Pauwlina Cyca (33:03.358)
And it's Alberta Health that has the funding to make it better. So therein lies part of the issue is we actually need a higher salary in order to sustain our, our education and our training, um, until we're finished so that we can practice. Um, but the second thing is that we need to be able to negotiate with the people who make those decisions as opposed to going through the other parties.
So having them named as a stakeholder in our agreement would be a huge benefit to the resident physicians, for sure. And I feel like we're getting there simply from the simple fact that we were actually afforded the privilege to sit on the task force and now on the provincial primary care network committee. So our voice is now being invited.
at all of these different tables. And so I think that there's more awareness as to the importance of human resource planning from the physician standpoint, and that really comes from entertaining what residents need.
Jordan (34:10.912)
I'm surprised that it's set up that way where the actual decision maker is not at the negotiating table. That sounds less like a negotiation and more just like some people hanging out.
Pauwlina Cyca (34:23.438)
that you're not wrong. And this is probably why the last two negotiations went to arbitration, because the people who had the power to make the difference weren't at the table. And the individuals who are at the table are bringing back the message to Alberta Health, but are they really going to advocate strongly if really they're not the ones who are impacted? So can you trust that the information was translated appropriately?
Was there the appropriate in an annotation or intonation in the voice to impress upon the importance? How can you know that, right? I think actually nine years ago, Alberta Health was named as one of the stakeholders in the para agreement. But when Alberta Health Services took over the operations of everything, then Alberta Health actually stepped off as a stakeholder and AHS remained as the sole stakeholder.
And as you are aware, AHS for the longest time, and I think up until recently, didn't have a human resource planning strategy when it came to physicians specifically, because the impression was that physicians are contractors. And so they weren't part of the AHS structure, which was a huge, huge miss. So...
I think we're trending in the right direction. I think the trajectory is that resident physicians are now being heard and understood. We have a ways to go yet, but I do feel cautiously optimistic.
Jordan (36:03.704)
Did you have a chance to look at any of the recent Carms match numbers that just came out from the first round? What did you think there?
Pauwlina Cyca (36:10.686)
Yeah, so this is a great news story actually. I was a bit surprised. So you probably remember historically there's been sometimes 20, 22 seats in family medicine that went unmatched after the first iteration or 40 in some cases, and then another 15 or 10 after the second iteration. And it was like abysmal, right? So we were thinking, how are we going to attract more people into family medicine? Part of sitting.
on the stabilizing comprehensive primary care task force was so that we had an in with the information and we were able to bring some information back to potential family medicine resident candidates. So medical students who are looking to be family doctors, we were able to take some of that information and actually share it. So it became part of a marketing strategy. So this year in the first time.
of the history of the school. We have 100% of medical students who have matched in the first iteration, and we have 100% of our urban family medicine resident spots filled in the first iteration. So this is unprecedented for our program, really great news. And I would say that part of that success is attributable to the fact that we were able to say, look, we're actually speaking.
at tables where the government is present, we're being heard. And yes, our negotiations are coming up April, May, June, but right now we're being heard and understood as to what the most pertinent issues are. And look, they've provided us $8 million worth of funding. We don't know what that looks like yet, but at least they've committed this money to us. So we were able to bring that back to these medical students who were like, I'd really like to do family, but should I go to BC?
Should I go to Nova Scotia? Because these places have an LFP that are in place and the resident salaries are so much higher and they also support us with our extra curricula stuff that we need to have in place to graduate to R2 and then to transition to practice. So huge win, Carms match was a big surprise but also a great celebration this year for sure.
Jordan (38:33.48)
So the people have voted. It sounds like things are looking up here in Alberta for the urban centers for sure. Do you have any thoughts? I heard that they included IMGs now in that first rank.
match? Like does that confound, you know, in terms of variables for that equation? Can we say that, okay, definitely Alberta, Calgary, Edmonton, urban programs for family practice are becoming more desirable? Or do you think there's a chance? I don't know if there is any actual numbers that you can see of like how many of those IMGs that usually come in the second round. Can you speak to that at all? Is it's definitely a positive sign?
Pauwlina Cyca (39:11.966)
I still say it's a positive sign, but you're right. So in the first iteration, this is the first time that IMGs are included in the first iteration, and 15 of the spots went to international medical graduates, which is still a huge win because these individuals are highly trained, highly skilled, highly educated, and to have them as part of our program alleviates the strain on the system as well.
So yes, it does confound the data ever so slightly, but if you look at it apples to apples and you remove the IMGs, there were still more first round pick matches from Alberta trained residents or medical students, Canada trained medical students, I guess.
Jordan (39:56.752)
What do you think about the IMGs being in the first round? I haven't really thought about this at all. I think it makes sense. I use there anything that would be a detriment to that for our Canadian trained medical graduates, then I guess the second round is probably gonna be quite a bit more difficult. Is there any more to that?
Pauwlina Cyca (40:13.762)
So there won't be a second round. So that's part of it. And you know what, if I'm being honest, I never, I didn't reflect on how having the IMGs included in the first iteration would necessarily impact Canadian trained medical students. Certainly I think in areas where there's... Yeah, so because we matched 100% in the first iteration.
Jordan (40:19.656)
Okay.
Jordan (40:35.34)
They've gotten rid of round two though. Like that is now no longer a thing.
Pauwlina Cyca (40:41.878)
there will be no second iteration.
Jordan (40:46.076)
Okay, but for the schools that didn't fill up 100%, there still is a second round.
Pauwlina Cyca (40:49.954)
There is, yes.
Jordan (40:52.112)
Okay, okay, gotcha. Sorry, I thought they like completely changed it around there. That makes sense though.
Pauwlina Cyca (40:56.534)
Yeah. So there's still like two spots in Medicine Hat that are unfilled and one in Grand Prairie.
Jordan (40:59.808)
So what does it fit?
Jordan (41:05.233)
Yeah. A shout out to Medicine Hat if anybody hasn't matched. So backing up then, what is a PGY one? So you've done your undergrad degree, you've done your medical school, and now you are a paid functioning team member in the hospital, in the clinic. What is the provincial salary for that first year resident currently now in Alberta?
Pauwlina Cyca (41:26.784)
It's about $57,000-$58,000 a year.
Jordan (41:32.276)
Okay, that sounds pretty similar to what it was like six, seven years ago when I was doing my training. So, okay, nothing's really changed there. And what does that work out to be per hour, you think, when you include all the 26 hour shifts and overnights and things you do?
Pauwlina Cyca (41:36.458)
It has not changed. Yeah.
Pauwlina Cyca (41:46.254)
Yeah, so when we, when Para actually did the calculation out and took the average number of hours worked per resident over all of the residency programs, the average number of hours worked per resident per week is 80. That's the average. And so you're paid, maybe, maybe I can say this, minimum wage. So if you had a barista that was making minimum wage,
That breeze says making more than you when you're on call. So depending on the number of hours that you work, you could be making only $8 an hour. There was one week that I made $4.34 an hour.
Jordan (42:31.6)
Congratulations, don't spend it all in one place.
Pauwlina Cyca (42:32.85)
Yeah, well, you know, it was like back in 1997, working as a as a housekeeper $2 an hour and I thought that was great.
Jordan (42:45.596)
What is it like in BC then versus Saskatchewan? How does the two compare apples to apples versus working in Alberta as a resident?
Pauwlina Cyca (42:53.994)
Yeah, so those starting salaries are more like 72, 74. Yeah, and then some provinces are, yeah, 68 maybe. So about $10,000 gap or 12% is what, the median is 12%. So Alberta is about 12% lower than the median. And BC and Ontario are some of the highest.
Jordan (43:00.274)
Okay.
Pauwlina Cyca (43:22.442)
Alberta typically usually tries to compete with BC in Ontario because just the status of the province, right? So, you know, should we be successful in the negotiations? Our hope is that we would be competitive with those provinces again. Those are also the provinces that usually take away our medical students and attract them to train as residents in their provinces. So keeping our students that have trained here in provinces sort of...
I mean, it's a priority, right? Because you have individuals who are well-networked, they understand the system. I've worked all over Canada, right? In clinical environments. And I can honestly say that Alberta is one of the, if not the top system to work in as a clinician. As much as we complain about it, the infrastructure that we have available to us in order to care for our patients, well, and it exceeds...
what is available in Ontario and BC. So it's important to have the medical students who've trained here stay here, because they understand it. But it's also really important to have residents who are trained in the other provinces visit here so they can see essentially how great it is. Despite all of the other noise, the system that we have in terms of communication with each other, in terms of the patient information that's accessible when you're...
practicing, that exceeds anything that I've practiced in any other province.
Jordan (44:57.476)
Well, and so the province runs fairly smoothly from that clinical perspective. It's definitely challenging from a fiscal perspective though, and the residents are making that, or the med students are making that decision, you know, 12, 13, $15,000 when you're considering your salary from one province to the other, definitely goes a long way. You mentioned earlier, you know, Calgary has become one of the highest cost of living places. How does that work? I used to think Calgary was sort of this little oasis
desert and this was the one spot that's still affordable.
Pauwlina Cyca (45:31.87)
Yeah, I think part of that is that there isn't rent control, right? So people's rent can be increased month over month, year over year, without any checks and balances. So that's part of it. Property taxes have increased the cost of gas and energy has increased insurance costs. So essentially just the cost of living in general. But if you look at residents or medical students, they,
most of them rent, most of them don't own their own home. And even if they did own their own home, then we have interest rates that are higher than they used to be as well. So the cost overall of housing in general has skyrocketed, you know, 20, 30%, even just from five years ago. So that's a huge, a huge deal. And then you look at food prices and food prices affects everybody.
It's unfortunate, but we do have some resident physician colleagues in the province that do need to use the food bank. There were several that were actually unhoused this past year. So can you imagine being a doctor and you are homeless? Can you imagine that? I mean, it is. It is. And I mean, I think that the public perception is you're a physician, you make millions, and that's... That is not... Certainly as a resident, you don't...
Jordan (46:32.332)
Really? Wow.
Jordan (46:39.716)
That's rough. No, that is wild.
Pauwlina Cyca (46:51.934)
You don't even make ends meet at this point. And then seeing what I see in community family practice, these physicians are working so, so hard to make what I made as a pharmacist, essentially.
Jordan (47:10.424)
That is crazy. Okay. But what else is...
Pauwlina Cyca (47:11.57)
It is crazy.
Jordan (47:13.72)
PARA have on the go, Congrats on the recent appointment, or sorry, election now as the president-elect for the association for the residents here in Alberta. I see you finished medical school, what, like nine months ago, and you're now the chief resident, president for the provincial association, consulting for the AMA and the government on task forces. Your political career here in medicine seems to definitely be taking off. What do you got planned for the province
Pauwlina Cyca (47:18.102)
Thanks.
Jordan (47:43.694)
Residence Association coming up.
Pauwlina Cyca (47:46.37)
Well, so I shared that we're going into negotiations. First of all, thank you. I appreciate it very much. So, PARA is going into negotiations. April, May, June. Yes, it's been busy. It's been very fulfilling. Honestly, I feel most fulfilled when I'm advocating for important things. So, within my wheelhouse and certainly something I'll continue even well into my clinical career. So, what we have on the go.
Jordan (47:55.618)
It's an impressive few months.
Pauwlina Cyca (48:14.926)
from PARA's perspective. We'll enter in negotiations with both PGMEs and AHS this coming spring, so April, May, June. And after that, of course, any changes that are made to our agreement will then need to be implemented. We spoke briefly, maybe a little bit more than briefly, on how important it was that resident physician salaries were looked at.
The other priorities are actually our duty hours. There's a duty hours working group that we're looking at what is fair on call, what is considered a weekend. Is it humane for somebody to work 26 to 30 hours without any sleep and without any breaks and not be compensated for it? You know, looking at those kinds of dynamics within our training program, there's a historic element to residents
going 26-hour shifts without sleep. If you look back at what the origin of that historic relevance is and where it started, it started, I think, in Massachusetts or at least in New England somewhere in the 1800s with a physician surgeon who apparently didn't sleep, so he expected his residents not to sleep. And he created the first formalized residency program in North America. So that became part of the structure.
It was found out after he passed away that he was actually on cocaine all the time and using stimulants to stay awake. So is this really reflect-
Jordan (49:51.716)
This was the founding father for our medical education system.
Pauwlina Cyca (49:55.458)
Exactly. So you have you have people, you have resident physicians who are making really critical decisions on their 24th, 25th, 26th hour without rest. And and then they get ready to go home and the thinking is you're not safe to drive because you've been awake too long. You're legally drunk. So we'll pay for a taxi for you to go home.
And I'm sure you can appreciate how paradoxical that is that I would be dosing Digoxin or phenobarbital, really heavy hitting medications. I would be dosing that half an hour before I was not allowed to drive home. So these kinds of ideas around duty hours, what is appropriate, acceptable and what is compensated fairly, that's another component of what we hope to discuss with the PGMEs and how we can find solutions to improve.
resident wellness. The burnout rate is actually higher now than it was five years ago and it mirrors that or even exceeds that of most practitioners, unfortunately. And part of that is the call shifts, et cetera. But it's also the amount of clinical information that we're taught. So it went from being something like 400 conditions that you learn about to now is 2080.
Anyways, the exponential jump in the last 10 years has been so significant. The evolution of clinical technology that we need to be able to use in the practice, like point of care ultrasound at the bedside. That's just one example. There's a multitude of different injection procedures that didn't exist even 10 years ago that we should be competent in. So the learning itself has accelerated.
And this is part, I think, of why there was a push to create the family medicine program as a three-year program as opposed to two. And then there was pushback. I'm a pushback. I think two years is good. We just need to be efficient with the teaching and the learning. So that's another priority, duty, working hours.
Pauwlina Cyca (52:12.594)
And then the third priority, and probably one of the most important, would be to continue to engage with Alberta Health and with our government officials as resident physicians of Alberta. So they understand that we're the pipeline to creating doctors in this province and providing access to patient care. You can't farm this out. You can't.
sprinkle privilege on other adjunct health care providers and expect that is going to then elevate access. It doesn't really work like that. So that will be another huge priority, maintaining those great relationships and that conversation and the collaboration that we've enjoyed so far.
Jordan (53:01.236)
I mean, in terms of that, you know, the residents are that future of the province's healthcare, it's very surprising to hear that they're just like getting neglected to that degree, you know, like financially and otherwise, right? It's like when we're talking with clinics, when we're dealing with all these different physicians across the province as part of CHERI, you know, the question's always coming up of like,
how do we recruit doctors more successfully? And like one of the biggest things that people are often like lacking on is just having learners come through the residents, having the actual students come through as a teaching unit. And so when you apply that same philosophy of, okay, well having learners come through to this individual practice, you know, on a micro level as being one of the best recruitment and retention strategies, it's absolutely absurd that like,
as a province, we're entirely neglecting that entire avenue to get doctors to come here and do their training. Like that's who's gonna stick here in the long run. And that boggles my mind. And then in terms of Yeah, the duty hours, you know, just to kind of throw in a little
analogy. I remember coming home from one of those 26 hour call shifts one night and I stopped at the mailbox to get my mail and I got out of my car and I had to go through. I couldn't remember which mailbox was mine after like driving back at the community one on the side of the street and I went through all of the mailboxes twice before I found the one that was
Jordan (54:37.83)
Like if any of the neighbors saw me drive up and then get out and try all the keys on the mailbox Twice before being able to find it They would have called the cops for sure thinking I was drunk and that's like how we're in the hospital and you know Just making decisions overnight. It's crazy It's interesting that the guy who came up with this was just snorting cocaine all the time. It makes a lot of sense now
Pauwlina Cyca (54:56.031)
It is.
Pauwlina Cyca (55:00.99)
All the time.
Jordan (55:05.06)
My goodness.
Pauwlina Cyca (55:07.186)
It is an archaic way to learn. And certainly the way residents where their structured training was designed came well before our understanding of consolidating information during sleep and how important sleep is for learning. So it's an archaic practice, we know this. It also takes about 20 years to institute change for historical things.
or from historical things. So we've got a ways to go, but I am optimistic with at least the ears that are now listening to us. So that is positive. And if you also think about it, that it's the resident physicians who are in the hospital taking care of the patients most of the time. And this is something I don't think that the public is aware of necessarily. So you go to the hospital, whether it be eMERGE or...
you know, at an outpatient clinic in the hospital, or say you're admitted, the physician that's seeing you is a resident physician. And you might see the staff, but that staff is gonna see you for two to five minutes, and they have learned about you as a patient from your resident team. So it's the resident physicians that are propping up this system.
And if you don't have resident physicians in the hospitals working, you don't have a hospital. You don't have a healthcare team because those are the individuals who are there. So I don't know that that's necessarily well understood from a public perspective. Certainly even as a pharmacist, I didn't quite understand that. Even working as a hospital pharmacist, sure I saw residents rounding and stuff, but I didn't understand their level of responsibility. It wasn't until I...
started practicing medicine myself that I had that appreciation.
Jordan (57:09.784)
the learners really are the backbone. So hopefully, again, seems like the initial data here from CARMS this year is looking positive. Let's fingers crossed that trend continues. What are you looking forward to the most for this upcoming year then?
Pauwlina Cyca (57:26.186)
Oof, that's a tough question. I suppose I'm most looking forward to hopefully amalgamating healthcare teams into more comprehensive-based care. So I think the old school way was patients would present to a medical clinic, they'd see the medical office assistant or perhaps a nurse and then see the doctor and then go home.
And what I've been exposed to this year are medical care teams that have other adjunct professionals on the team. So nursing and occupational health and mental health, for example, diabetes education, pharmacists, and those patients have a greater circle of care around them with more points. And they are also the individuals who are hospitalized less frequently.
So we have this data to demonstrate that. And I think really my hope is that we'll be able to spring up more of those types of practices in the province with this new funding model and with the greater understanding that it benefits patient care.
Jordan (58:42.372)
It will be cool to see how this all shakes down. Definitely looking forward to, you know, hopefully we'll have the announcements come out any day now. Maybe then we can talk a little bit more candidly about the actual outcomes and perhaps your thoughts there and how things actually turned into practice. We'll have to have you back some other time. We're running out of time here. I don't wanna take up too much of your afternoon. One final question we ask everybody on the podcast at the end, what's your personal wellness tip? How do you actually keep yourself functioning?
what's the number one thing?
Pauwlina Cyca (59:15.894)
Ooh, so I'm pretty busy with three kids, one in hockey and two that play other sports. So a lot of my energy is devoted to kid stuff outside of learning and outside of my other roles. But the one thing that I try to make sure that I always have time for is exercise for myself. Something is better than nothing. Even if it's only five minutes, even if it's only 10 minutes, I make...
sure that I have time for that or make time for that. If I can spend 20 minutes washing my face, I can spend 10 minutes doing some crunches and some push-ups. So exercise is paramount, fresh air is paramount. And then one thing that I have on the go consistently is a revolving chronological list. And on the top of the list are the dates of important things coming up throughout the year.
And then on the bottom of the list is this week and what it is that I need to get done in order to accomplish the goals at the top. I pick six things a day, no more than six, and I make sure that I scratch them off the list every single day. And I usually make a new list or add to the list at the end of each evening. This keeps me on track and it makes sure that I'm not super anxious to try to get everything done.
One of the questions that I often ask is how can you be lead resident and parapresident and a mom of three and a resident physician and your senior advisor of pharmacy services and you're going to exercise and still try to do TRY? Like how do you fit all of that in? You have to be focused and efficient. So the lists keep me focused and efficient.
Jordan (01:00:57.304)
Six things a day, okay. So organization, discipline, and then physical fitness all comes together to be a high functioning doctor pharmacist. Love it. Thank you, Dr. Pauwlina Cyca for joining us today. Really appreciate it.
Pauwlina Cyca (01:01:06.774)
Yeah.
Pauwlina Cyca (01:01:11.19)
Thank you, Jordan. It was nice to be here.
About the Author
Cherry Health
Canada's Medical Network
About the Author
Cherry Health
Canada's Medical Network
About the Author
Cherry Health
Canada's Medical Network
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