For Darren Markland, an intensive care physician in Edmonton, there are now two distinct types of dread.

“You know that feeling of dread you have every morning when you check the news cycle and see the number of cases that are out there in the world?” he says.

“I have that. But I also have this dread that the system that I’ve worked in is being purposefully undermined and destroyed,” he says. “And that scares me.”

Like their counterparts around the world, doctors across Alberta are gearing up for an expected battle against novel coronavirus as its silent spread across the country morphs into a growing number of gravely ill people. But they’ll do so surrounded by what they say is a cloud of uncertainty, as a new funding framework for doctors kicks in at the end of the month.

Some are worried provincial response to the biggest public health crisis in living memory could be weakened by the months-long battle over compensation and cost-cutting, or stoke uncertainty in frontline services when they’re most needed.

The question is, will patients be caught in the crossfire?

Since coming into office last spring, Premier Jason Kenney and his United Conservative Party have been eyeing union workers for cuts and changes as they’ve charted their path to balancing the province’s books over their first term.

Sweeping changes to things like how doctors billed for service and where they could practice came early and fast. The government maintained the changes were needed to improve services and hold the line on total pay at $5.4 billion a year, but doctors were furious.

By February, the relationship between doctors and the province was at a boiling point. Talks to negotiate a new agreement fell apart, so the province terminated the old one and announced a new slate of changes that were set to roll out at the end of March. This week, tensions were inflamed again when Alberta launched a private app that critics say removes local practitioners from the picture entirely.

Enter coronavirus.

Alberta now has north of 300 confirmed cases, and two people have died. Kenney has repeatedly said his government will spare nothing in the fight againt the pandemic. The government hastily passed its $56 billion budget last week with a $500 million boost to health spending. When Kenney declared a state of public health emergency, he called it a “serious moment” in our history. “COVID-19 will test all of us,” he said.

Health Minister Tyler Shandro has echoed that coronavirus decisions will be made based on evidence and advice from public health officials, “not budget, and not by political considerations.”

Questioned about the ongoing feud between the province and doctors, Shandro said he was open to any proposal put forward by physicians, whether it was related to COVID-19 or not.

The province has also made concessions to doctors in recent weeks. Physicians are now allowed to bill more for virtual visits as many of them move to phone appointments. Changes to how doctors bill for more complex appointments have also been axed.

But the fact remains that doctors are heading into the trenches without a negotiated contract.

“We need to have certainty about the conditions under which we are working as physicians in this province,” says Dr. Christine Molnar, president of the Alberta Medical Assocation (AMA).

While she was “very happy” to see changes to virtual billing, Molnar said the lack of an agreed upon contract means a “dog’s breakfast” of issues still remain. Things like how much doctors are getting paid for certain services, how many patients they can bill for in a day, and how much they’re getting for liability insurance all remain up in the air, she said.

“We are concerned that many physicians in Alberta do not feel supported, they do not feel valued, and they do not feel empowered by this government,” she said, adding that she’d like the government to hit the pause button on changes until the pandemic has abated.

“We are at this point in time focused on fighting the pandemic for Albertans,” she said.

Dr. Matt Henschke, a Calgary-based family doctor, says his pratice has laid off four staff members in recent months because of the fee changes. Due to coronavirus concerns, he and his fellow doctors have changed most of their appointments to phone calls, but their remaining office staff are still run off their feet, he said.

While Monday’s changes to virtual billing will definitely help, Henschke says all the recent changes have damaged the relationship between doctors and the province.

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“They’re making small concessions, but it kind of feels like they’re making these concessions temporarily and out of necessity,” he said. “I would say that generally, physicians really have zero trust in the government.”

Nurses are also feeling the pressure. They’d been negotiating their own contract up until last week, and Alberta Health Services (AHS) had been pushing for freezes and other roll backs.

Heather Smith, president of the United Nurses of Alberta, says that contract negotiations with employers, including AHS, have been put on hold until June with an agreement that no layoffs would take place.

But she says that concerns about layoffs and further privatization persist, and many nurses have been left with the impression that they’re not very valuable to the government.

Smith called it a “terrible irony” that union workers who felt targeted by the Alberta government were now “most critical in terms of public and patient safety” during a pandemic.

But despite the uncertainty and what they see as a lack of support, doctors stress that their focus is on patients as coronavirus cases increase.

Dr. Liana Hwang, a doctor at a practice in the mountain town of Canmore, says family doctors will play an important role during the crisis in supporting the patients they know and see regularly, and helping them stay out of the emergency room as much as possible.

She says a lot of doctors feel frustrated and demoralized — distractions that aren’t needed during a pandemic.

Doctor’s offices are just like any small business, and the margins can be thin, she says, but for now, she’s saving her bandwidth to worry about her patients.

“Doctors go into medicine because we want to help people. So I really just want the tools to be able to do that,” she said. “To be honest, I’m just trying to put (the fee issues) out of my mind and ignore it for now and focus on my patients. But in the back of my mind, I know that if this goes on for some time, there will be fallout.”

In Edmonton, Markland says right now is likely the calm before the storm, and health-care workers are using the time to prepare for what’s coming.

“I’m going to go in. I am going to look at one of the largest surges of patient (we’ve ever seen), I’m going to choose who lives or dies,” he says.

“But there is a community here like I haven’t seen since we had our first SARS outbreak, or since we had the tornado (in 1987 in Edmonton.)”

“We are going to do our best.”

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