2024-36 Letter from Physicians Page 1 of 5

GIM/Critical Care Crisis at Prince County Site

July 22, 2022

This letter is to follow up on the previous email on behalf of Dr. s. 15 , Dr. s. 15 , Dr.
s. 15 , Dr. s. 15 in regards to upcoming critical shortage for General Internal
Medicine/Critical care services at PCH with the upcoming s. 15
not returning until s. 15
Dr. s. 15 ending practice s. s. 15
We 15
appreciate Dr. s. 15 upportive
comments that 1:3 GIM/Critical care is not felt appropriate or sustainable in this era.
Our group believes that s s s. 22(1)(g)

Our complement is currently set at five providers for GIM/CC services but we will be
down to four s. and three on s. 2022 with no long term or
15
short term locum for s. 15 15
and no permanent replacement for our fifth
position. Our group has already expressed that with current call volumes and
outpatient workload, s. 22(1)(g)

Our immediate concerns to be addressed:

1. Provision of Acute Care and On Call GIM/CC coverage: s. 22(1)(g) ,

s. 22(1)(g)

The Master Agreement “1:3 in times of need” is vague and does not address the
complement coverage and call volume/workloads of individual groups and the
appropriateness of underservicing such groups without a defined time limit for
said group to fall below complement. s. 22(1)(g)

2. Provision for Outpatient care: our practice volumes are based on a 1:5 GIM/CC
complement. We still have a professional and legal obligation to provide
appropriate, timely and safe care to the same patient volume that we are
incurring under a 1:5 complement. s. 22(1)(g)

.
 2024-36 Letter from Physicians Page 2 of 5

3. Vacation, CME, Sick leave and Bereavement requests: with a 1:3 complement
vacations, sick leave, bereavement and CME requests may be declined if no
locums are available. Each internist is entitled to 4-6 weeks vacation per year
depending on their years of experience. Sick leave and bereavement leave
requests will require a plan of action. CME is also vital to our licencing and
regulating authorities. There is an expectation that we will complete an annual
volume of CME and a 5year cycle volume of CME. We hope it would be deemed
unacceptable to decline vacation, bereavement or CME requests during a period
where the group is 1:3.

4. Call days uncovered: With pre-approved vacation, CME, and there are currently
4 days in October, 5 days in November and 1 day in December that will not be
covered at PCH. There needs to be a plan to attend the admitted GIM/CC
patients with safe onsite delivery of care.

5. Post call services: s. 22(1)(g)

6. Remuneration for overtime: The three remaining GIM/CC providers are all
Salaried for 37.5h/week. It would be unreasonable for Health PEI/Department
of Health to believe that dropping our complement from 5 to 3 will not result in
overtime hours. Under the current Master agreement, overtime hours must be
approved at our current hourly rate or remunerated as time in lieu. Thus moving
forward, we will be recording on our time sheets our daytime hours and we ask
that Health PEI /Department of Health acknowledge to us that we will receive
the appropriate compensation at our current hourly rates of service for the
overtime hours accrued as a direct result of the complement shortage effective
September 4th 2022 until such time that we are back to a full complement of 5.

7. Remuneration for underserviced complement:

Per Master agreement when a complement falls below quorum there are additional
remunerations to be divided amongst the remaining group. This is to continue until
such time that the complement returns to normal (5 FTE providers).

- Critical Care Retention Payment: Currently 5 providers x $36,400.00 payable in

equal biweekly instalments (~$1,400 q 2weeks per provider). Dr. s. 15
stipend effective September 4th 2022 until s. 15 should
be divided amongst 4 GIM September 4-15 and then Dr. s. 15 nd Dr.
 2024-36 Letter from Physicians Page 3 of 5

s. 15 Critical care Retention payments should be split amongst the 3

remaining GIM/CC providers effective September 15th onward = $2,800 q
2weeks dived by 3 people.
“An internist who provides more than his/her equal share of on-call coverage to a
Critical Care Unit shall receive an additional retention payment in proportion to the
additional days of on-call coverage that is provided by such physician in the event
of a physician vacancy or vacancies which are not covered by a locum physician.”

- On call per diem. Our group normally provides ~6 call each per month. We will
now be providing up to 10 call per month and should receive additional per diem
for call days in excess of 6 per month
“If a physician is required to provide additional on-call coverage as a result of such
physician shortage (i.e., is required to be on-call on those days that otherwise would have
been covered by a locum), the physician shall be paid, in addition to the applicable on-
call retainer or per diem, the same locum support payment ($150 per day at the signing of
this Agreement) that otherwise would have been paid to a locum to provide the on-call
coverage.”

As a direct consequence of the reduction of our complement, Dr s. 15 Dr.

s. 15 and Dr. s. 15 s. 22(1)(g)
the
st
1 of August 2022. s. 22(1)(g)
Given our responsibilities to our current outpatient rosters and wait times that
were already >12mo for routine referrals we feel this is a necessary step to manage our
practices safely. Once Health PEI has successfully secured a long term locum and
permanent FTE position for GIM/CC at PCH such that our complement returns to five,
we will re-evaluate the referral process.

Potential Actionable Solutions

I understand there was a recent meeting within the last two weeks to review the impact
and propose solutions for the upcoming GIM/CC shortage for Western PEI but we have
not heard of any solutions to date.

As a group, some potential solutions we are proposing the following for your
consideration:

1. Dr. s. 15 Recruitment – s. 15
s. 15

. s. 15
 2024-36 Letter from Physicians Page 4 of 5

s. 15

s. 15

2. s.
22
(1)
(g)

3. Recruitment to reach out to every GIM training program

4. Recruitment to reach out to GIM groups providing locum coverage to Northern

sites and any available GIM within Health PEI.

5. "One Island One health". s. 22(1)(g)

his would relieve 4-6 call days and go a long way to
easing burden providing patient care and physicians well being giving us some
weekends with our families. They would need to be responsible to follow up on
patients they had seen and discharged but of course patients that remained
admitted on Monday morning would be consulted to the incoming Internist. If
the number is high, the three of us would split the consults on Monday. This
helps to provide uninterrupted sleep and protected time for our current 3
GIM/CC providers but will not offload workload volumes as we will be picking up
the patient load once they finish the call day.

6. “One Island One Health”: When there have been Critical Care nursing shortages
that impact patient care and safety, there have been bed closures which have
necessitated offloading overflow patients to Charlottetown IMCU and ICU/CCU.
We are currently at 6 CCU/ICU/IMCU beds and frequently overflow into 1-4 of
the 6 Critical care ER beds. s. 22(1)(g) ,
 2024-36 Letter from Physicians Page 5 of 5

s. 22(1)(g)

7. "One island one health". s. 22(1)(g)

s. 22(1)(g)

8. ER coverage for onsite Critical Care services: In Woodstock NB, our colleagues
provide 1:3 call for GIM. However, their Health authority recognizes this as
unsafe and unsustainable for this groups’ workload without accommodation/
modification. The ER physicians thus manage all ER patient referrals to GIM and
takes phone calls from the ICU from 7 pm to 7 am. The internist is on call if the
ER doctor requires help. This was the only way 1:3 call was felt manageable with
the incumbent sleep deprivation and burnout that 1:3 rota for busy call group
would entail.

We hope this letter has impressed upon you the urgency we are feeling to have these
issues addressed by Health PEI/Department of Health and some workable solutions. We
unanimously feel that allowing 1:3 on call is not a safe or sustainable option for our GIM
group. It would be nice to have a meeting with our group and the Health PEI
representatives within the next few weeks to review the above concerns, actionable
items and see what solutions are being explored.

Sincerely,

Dr. s. 15 , Dr. s. 15 Dr. s. 15 , Dr. s. 15