I am an emergency medicine physician who splits time between the Foothills Medical Centre and the Alberta Children’s Hospital. After working for 15 years in this role, I have never seen the conditions in the emergency rooms in Calgary in a worse situation.
Patients in the emergency department are frustrated, sick and very tired — often waiting up to eight or nine hours to see a doctor. I often get asked by exasperated patients, and by my own family members, why the wait is so long?
The average patient doesn’t understand the complexities of the health-care system — nor should they. They don’t understand why our departments appear to be non-functional and why they can’t be seen in a timely manner. I aim to explain, in simple terms, why our ERs are not meeting the standard of care that patients and health-care providers have come to expect.
Imagine for a moment that you run a popular restaurant. Your goal is to get people in quickly, get their orders promptly, deliver quality breakfast, get them the bill and clear them out so that you can seat more people. You run an efficient business and your staff are well trained and provide exceptional service.
Let’s say you have 50 tables and 15 staff. Your restaurant is always busy but, when fully staffed, you are able to keep pace with the demand.
However, due to difficult working conditions, pandemic-related burnout and feeling overworked, five of your staff retire or move on to less stressful jobs. Now you have 10 staff serving 50 tables and this seriously affects your ability to provide quality service. You can hire more but you will need to train them up to standards, and they are not going to be as efficient as the staff you are losing. Because of this, you realize you have to reduce your tables to 40.
Even with only 40 tables, the ratio of staff to tables is still challenging and adds stress on your remaining staff who may quit themselves — further exacerbating the situation. The number of customers stays the same, but the lineups are now longer and people have to wait to be seated.
But wait, the situation gets worse. Imagine there are customers in your restaurant who are seated and served, but when they receive their bill they refuse to leave. They sit in their seats all day drinking coffee and still need to be served by your staff. These customers are blocking your ability to get new customers into those tables. Some of these customers stay for a few hours and some stay for days, with an average of eight to 12 hours. On a good day, these customers might block a handful of tables; on a bad day they may occupy up to 80 per cent or more. On average, they occupy about 25 per cent of your tables at any given time.
Now you have the same number of customers coming, you have lost 10 tables to staffing issues and a further 10 are occupied by customers who won’t leave. Your remaining 10 staff still have to serve these people but also have to run the rest of the customers through 30 tables instead of 50. People are getting frustrated and they are starting to take it out on your workers. The staff are working as hard as they can, but they are unable to keep up. The job conditions are deteriorating and two more wait staff just submitted their resignations.
Just when you thought things could not get any worse, you learn that many of the other smaller restaurants in the city have decided to close, reduce their hours or move to another province. Now, the already high demand for your restaurant is even greater. You have become the only game in town.
How long do you think you will be able to successfully run this business? How long do you think your remaining staff members will stick around under these working conditions? Do you feel that this business model is sustainable for the long term?
This is the situation in which we find ourselves in the emergency departments in Calgary. The family business is the ER, the customers are patients, the tables are the emergency beds, and the wait staff are the highly trained and extremely compassionate ER nursing team.
In our real-life scenario, the customers who refuse to leave are patients who have been admitted to hospital but, due to capacity being more than 110 per cent, there is no bed available for them upstairs. They sit in our departments and need a high amount of care from nurses who should be seeing new patients.
The “other, smaller restaurants” in the city are our colleagues in family medicine. They have been hit with increasingly more complex patients who are being treated in the community with a lack of support, resources and access to specialists. They also have the added burden of escalating costs of running a business in the face of inflation with poor remuneration from the government. Is it surprising that many of them are closing their doors, or moving to other areas of medicine or other provinces?
What is the solution? If you are the owner of our restaurant, the answer is easy: You hire and train many more quality staff so you can keep all your tables open and ready to serve. You pay your employees well and you treat them with respect for all the hard work they are doing to keep your business afloat. Next, you move out the customers sitting around all day blocking your tables, so you can serve customers who are waiting.
Health care is unfortunately not that simple. I do not pretend to have the answers to how we can fix a system currently in a state of crisis.
I do know that the status quo is not working.
We need to find answers or we risk further loss of health-care workers and further deterioration of the critical care emergency system that Calgarians rely on for their health and well-being.
Dr. Marc N. Francis is an emergency medicine physician, clinical assistant professor at Cumming School of Medicine and a STARS flight physician.