Alberta's rural doctors plan to close their offices tomorrow, the first move in an extensive job action that threatens to cramp the province's health-care system.
The shutdowns are to be followed next week by a withdrawal of after-hours services by most city physicians -- a strategy aimed at pressuring the provincial government to increase doctors' salaries.
"We just really wanted to send a signal," Dr. Clayne Steed, head of the Alberta Medical Association, said.
"The physicians wanted to be able to let government and public know that this is important."
The Alberta government, which has been negotiating new fees with the AMA since October, condemns the doctors' intentions and points out that they have four months left in their contract.
"I find it very disappointing," Health Minister Gary Mar said in an interview yesterday. "My intuition tells me that it will potentially jeopardize patient health."
The physicians' organization stresses that the job action is designed to protect patients since doctors will work in emergency wards as usual.
Most of the province's 600 rural doctors plan to lock their offices tonight and not return until Monday morning, meaning the cancellation of tomorrow's office hours and any evening or Saturday clinics.
Their decision not to work means hundreds of patients will be forced to join long emergency-room lineups or wait to see their family physicians. Rural hospitals are bracing for a flood of visits this weekend and have increased staff.
Then, starting on Monday, urban doctors have been asked to avoid evening work, including after-hours surgery, for the entire week.
Medicentres, which operates 15 walk-in clinics in Edmonton and another six in Calgary, is supporting the move by shutting its doors the weekend of Dec. 9 and 10.
The province's nurses union is not taking part in the job action, but says its members are already overextended and are ill-equipped to answer the call to work extra hours to deal with the expected crunch.
Indeed, city health authorities are making plans to call in more nurses and doctors to staff emergency wards to counterbalance the reduction in services.
"It will be a genuine inconvenience. We're already extremely busy, even though winter's not fully upon us and even though flu season hasn't arrived," said Steve Buick, spokesman for Edmonton's Capital Health Authority.
While the doctors' association is not releasing details, the government says it is demanding an extra $525-million for the medical services budget over two years, an increase of 55 per cent.
The government is offering an additional $263-million, a boost of 28 per cent. A portion of the increase would go to salaries, increasing the average physician's billing to $221,000 from the current $195,000, according to the government.
The doctors say the size of their paycheques is not the only issue. They worry that without hefty fee increases, and opportunities for professional development, Alberta will not recruit and retain adequate levels of family doctors and specialists given the strong allure of the United States. An AMA report projects a shortage of more than 1,000 physicians over next five years.
"The feeling very strongly, especially amongst general practitioners, is if this doesn't happen this time with this fee negotiation there's a tremendous downward spiral that will result," said Dr. Michael Caffaro, a general practitioner in the small town of Hinton, near Jasper National Park, and head of the AMA's rural medicine section.
Mr. Mar, who believes the public does not support the AMA's plans, says Alberta has been hiring new doctors at a rate faster than the province's growth. He also pointed to a survey that found two-thirds of the province's fees for the 250 most commonly performed services are the highest or second-highest in Canada west of Quebec.
Premier Ralph Klein has offered to meet with the physicians' organization, but not until it cancels the job action. Dr. Steed, who has recently met with Mr. Mar, said he is willing to meet with Mr. Klein at any time, but that preconditions for discussions are inappropriate.