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Ram is urging the province to adopt a non-refusal policy similar to that of other jurisdictions.
They take walk-ins and same-day appointments, and they may spend between 40-50 per cent of their time at the hospital.
But what happens in Drumheller is just half the equation, the Camrose native said, citing the call centre physicians navigate, RAAPID, or the Referral, Access, Advice, Placement, Information & Destination system.
“Now if you’re asking me if our ability to get those patients to the right specialty in Edmonton and Calgary through RAAPID, which is the system that we have to call to get patients through, that is a whole different blockage. That is a whole different wall. That is a whole different advocacy that we have to go through for patients,” he said.
“Any kind of delay in patient treatment is not because it wasn’t recognized by the right generalists. It’s because we have to spend a lot of time advocating to the tertiary care through RAAPID that, ‘Yes, this patient actually does have a stroke. You need to see them.’ That’s usually the delay,” Ram said.
“It’s not because there was a delay in how we found them, there is the delay in trying to convince those other areas that they should see the patient.”
“If a patient shows up in my rural emerge, and I decided this is a patient that for whatever reason, needs to be seen in Calgary or Edmonton, that when I call to get that done, I’m not wasting minutes or hours trying to convince other places that you need to see this patient because I don’t have an MRI this patient needs.
“If I’m calling that automatically means that this patient is out of scope for the services we have available. Therefore this patient needs to go. There is no convincing. There’s no like ‘Oh, do this instead,’” he said.
Over the past year, he estimates, he had fewer than a half-dozen outright refusals.
“But definitely a few dozen delays, meaning ‘We’re not sure, we’re going to delay the patient and have them sit in your hospital or your emerge for sometimes days on end,’ even though they have an acute presentation, or they have sepsis or they have something else — simply because we don’t have the outright non-refusal system where transport gets booked and off they go,” he said.
“We don’t have that.”
Unrecognized specialists
From border to border to border, from Saskatchewan and Montana to Northwest Territories, and British Columbia, the vast majority of Alberta’s far-flung regions — spread out over 662,000 square kilometres, where a fifth of the population lives — is served by under a tenth of its physicians, the rural generalists.
That’s roughly one rural generalist for every 800 to 900 country square kilometres.
With tools Alberta’s traditional country doctors never dreamed of having in their leather medical bags, the new generation handle everything from the emergency room and internal medicine to palliative care, addictions, maternal medicine and pediatrics — not to mention fulfilling the orders of referred specialists.
“We basically do everything,” said Ram.
“Everything” takes Ram daily on a journey through all of the realms of health, one patient at a time.
In Drumheller last week, with a population of roughly 8,000, the emergency room faced immediate short-term closure when an unusual number of physicians were out.
But there is no ‘I’ in Emergency.
Instead of taking down their shingle, team members stepped forward to keep the lights on.
Just in case someone got struck by lightning.
Or suffered burns when their combine caught fire.
Or had that baby a month early, right then and there.
“Because we live in our communities, because we know the importance of having the hospital open, we had physicians that actually changed their entire airplane flights and scheduled to actually be here to maintain and make sure that the hospital was running,” Ram said.
Recruiter’s dilemma
Small communities further away from big city conveniences represent a physician recruiting challenge.
“I can say that it’s very difficult in a lot of those places to have sustainable physician care,” Ram said, citing Milk River, a town of about 800 some 300 km south of Calgary, which has struggled for years to keep a dedicated full time physician group.
“They have managed over the years to maybe get one person. It’s hard to run an entire practice in area with just one person forever right? What happens when you (the doctor) get a cold or you’re sick yourself?”
A couple decades ago, there were more than 1,000 rural generalists across Alberta. That number has dipped to 700 physicians “and slowly dwindling,” Ram said.
Ram said rural generalists are very passionate about full scope medicine.
“It’ll be a cold day in hell before I want to go practice medicine in Calgary … I’d rather go back to school and pick a whole other career. l wouldn’t be able to stand the medicine they do in the cities,” he said.
When one walk-in patient had experienced chest pain for a few days, Dr. Ram saw the man immediately.
“I realized ‘This isn’t anxiety. This isn’t something that we can ignore, something that’s chronic or muscle or skeletal related. I actually need to get you in and get you blood work and an ECG and get a CT scan, most likely, and I need all that done now.’
“As a rural generalist, I can get all that done immediately,” Ram said.
He called the hospital, got a CT scan that morning, an ECG and lab work. The tests were done before noon. Over the lunch hour, Ram clocked the results: a blood clot in the patient’s lung.
Within a few hours, the patient was seen, tested, diagnosed, treated as an outpatient, and booked for follow-up.
Immediacy makes a difference, Ram said.
“I wanted to be able to help my patients in an efficient reasonable manner and I can do that as a rural generalist,” he said.
