The Vulcan Community Health Centre Expansion:

1.  Why aren't the doctors building their own clinic if it is a private business?

The expansion of the Vulcan Community Health Centre has reached the budget discussion stage. We anticipate having the architect’s drawings finalized in the next few weeks. A few of you have been questioning why the doctors are not building their own medical clinic. The Trustees of the Foundation would like to address this issue.

Overall Project – The Big Picture

  • The expansion of the Vulcan Community Health Centre is far more than just building a new clinic for the doctors. The medical clinic is only one piece of this project. The addition to the Vulcan Community Health Centre will be the new home of the Physiotherapy/Rehab team, the Adult Day Support Program, AND it will house a Wellness Centre.
  • The Wellness Centre will be a place where you will be able to connect with programs, services, information and support to help you on your path to health and wellness and to live a healthier lifestyle.
  • The new foyerwill become a welcoming space, where you can visit over a beverage and snack, review the resources in the wellness library, host a meeting in one of the new meeting rooms, or use the available computers to research and access wellness programs.
  • The existing building needs major upgrades which will be paid for by Alberta Health Services. The renovation will allow the lab services to be expanded. The palliative care area will be much more comfortable for patients and their families. Mental Health Services will have a much larger space to work in plus they will have access to meeting rooms in the new wing.
  • The Vulcan County Health and Wellness Foundation is looking 30 years down the road. We believe that a larger medical clinic is required to better accommodate the medical needs of the citizens of Vulcan County today and in the future.
  • The physicians will be paying rent on the clinic space.

Vulcan Community Health Centre – Health Delivery Model

  • The Vulcan Medical Clinic is part of the Calgary Rural Primary Care Network.
  • For those of you that are new to Vulcan, the medical clinic moved from its former location on Main Street (it was in the building which now houses the art gallery) into the Vulcan Community Health Centre approximately 25 years ago. If you were a patient in the “old” days and your doctor wanted you to get an X-ray or lab tests, you had to get back in your car and drive to the hospital.  Once you were finished at the hospital, you would either drive back to the clinic to see your doctor or you had to wait at the hospital for the doctor to show up. The doctor may not have had the time to run to the hospital during office hours so you would wait until the end of the clinic day for your results. If the doctor had to go to the hospital, then clinic patients would get backed up. It was a very inefficient system.

  • Housing the medical clinic in the medical centre has many more benefits than just being more efficient.
    • The doctor on call can attend to life-threatening emergencies during the day in a very timely manner. In fact, the response time of doctors in our health centre is one of the best anywhere in the province.
    • If the condition of an inpatient in the hospital changes, a doctor can respond in a matter of minutes.
    • The communication between the doctors and nurses is facilitated by the close proximity of the doctors. If a nurse has a question they can stop by the medical clinic and can speak directly to a physician.
    • Having the doctors only a few metres away from the health unit and home care staff, along with being only a few metres from both acute care and long-term care patients, helps to provide continuity of patient care.
  • This model saves Alberta Health Services a considerable amount of money each year. During the business day, people who stop in the Emergency Department with non-life threatening conditions, are triaged to the clinic. For example, seeing a patient with a cold in the Emergency Department is about 12 times more expensive than seeing that same person in medical clinic and frees up RN time for patient care.

    * There is an added surcharge for the doctor's fee when a patient is seen in ER.  The cost breaks down as follows:  $335 (hospital fee) + $75.21 (ER doctor's fee) + $37.25 (doctor's regular fee). This can be compared to a clinic visit which is just the $37.25 fee.  IF a patient comes to the ER between the hours of 5PM - 7AM, the hospital fee is still $335 but the on-call doctor's fee increases to $112 + $37.25.  Therefore, an afterhours ER visit is significantly more costly to AHS then seeing a doctor in a clinic visit.  It is not the intent to discourage patients from using the ER for emergencies but if it is being used for non-emergent conditions, it is very costly to the health care system.

  • The health care delivery model that was pioneered in Vulcan is now being copied in major urban hospitals including the Rockyview General Hospital in Calgary.

Prediction of an Increase in the Number of Patients Accessing the Medical Clinic

We believe that the number of patients accessing physicians in the Vulcan Community Health Centre will increase in the future. Reasons for this increase in the patient panel as it is called, is based on the following:

  • The “Vulcan Community Health Centre – Strategic Options Analysis” conducted by Alberta Health Services and published in March 2015.
    • “In 2014 / 2015 the Primary Care Network Medical Clinic in Vulcan had 15,891 visits and that number is projected to grow to 20,052 by the year 2029 / 2030. These number of visits do not take into account Emergency referrals.”
  • We believe that there will be, at some in time, a new Supportive Living care facility built in Vulcan. This is the level of care facility that we need in this community.
  • The overall age of the population of people living in Vulcan County is increasing. Patients tend to have more health-related issues as they age.
  • With access to more physicians and new facilities, we anticipate that more citizens will be able to “age in place” and stay here instead of having to move to Lethbridge or Strathmore or wherever there is space available for them.
  • It is likely that more recreation-based properties will be constructed in Vulcan County.
  • When we only had 1.25 full-time equivalent physicians working in Vulcan, many folks gave up trying to see a local doctor. Our entire health care facility was being kept open by Locum Physicians who, in many cases, were only there for a day or two and then they were gone. The result was a dramatic decrease in the continuity of care of our citizens. However, with more access to a family physician, we anticipate that many of these families will come back and make Vulcan Community Health Centre their healthcare home.

Existing Physician Space in the Clinic

  • The “Vulcan Community Health Centre – Strategic Options Analysis” conducted by Alberta Health Services and published in March 2015 states:
    • “The PCN Medical Clinic in Vulcan is congested and not functional in some parts. Corridors are difficult to navigate in a wheelchair and the Examination Rooms are too small to accommodate a patient and family members and several doorways are too narrow to pass in a wheelchair. In order to attract new, permanently employed physicians, the clinic will require more than eight Exam Rooms that are larger and situated in a well-planned space.”
  • It is our understanding that only four physicians can work on any given day in the existing clinic. We currently have three-full time physicians and four-part time physicians working in the Vulcan Medical Clinic. Even though we have access to seven physicians, only four of them can work on any given day which limits the number of patients that can be treated.
  • The new clinic is being designed to accommodate up to eight physicians, consultants, visiting specialists, complementary and alternative medicine – all working at the same time.
  • If we have more residents of Vulcan County wanting to see a physician at the Vulcan Medical Clinic, then we will have to provide space for more doctors or people will have to wait longer to see a doctor.

Physician Recruitment and Retention Realities

  • If you recall, three or four years ago we were down to just 1.25 full time equivalent physicians. There was fear that Alberta Health Services would close the Emergency Department and that the hospital might lose its acute care beds because there simply weren’t enough doctors available. Through the commitment of Vulcan County and the Town of Vulcan plus the work of the local Physician’s Recruitment and Retention Committee, we now have just over four full time equivalent physicians which is a full complement of physicians for the space available in the medical clinic.
  • Although we have a full complement of physicians today, we cannot assume that this will always be the case. The reality is we will have to recruit new physicians at some point in time. Having a modern high tech medical clinic will certainly be a huge marketing tool when it comes to recruiting new physicians.
  • The new clinic will provide our local physicians with the space to take on young doctors who are fulfilling their “residency” requirements.
    • For those unfamiliar with the residency program, here is a description from the Professional Association of Resident Physicians website: “Following the completion of a Doctor of Medicine (M.D.) program, resident physicians undergo further training, known as residency, which prepares them for licensure under either the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada.”
    • Having young physicians working in our medical clinic and hospital is the best recruitment tool that we can access. Not only do the resident doctors get to know the staff, but they also get to know their patients. In addition, the resident doctors get to know our community.

2.  How much money does the Foundation need to raise to for its commitment to this stage of the expansion project?

   The Foundation committed to raise $4.5 million dollars with its Vulcan County and Town of Vulcan partners.  As of March 31, 2017 the Foundation needs to raise $ 400,000.00 to complete its share of the total for this stage.  Please check this amount monthly as we hope it will drop!

3.  The hospital lab needs upgrades to meet standards.  Why aren't the upgrades part of this stage of the expansion process?

   The lab is in danger of losing its accreditation status as it does not meet the physical requirements of the amount of space needed for the machinery and tasks that are done there. Once it loses the accreditation status, then an argument could be made for closing a lab that doesn't meet the standards- a fine line between losing our status and losing our lab, I know.  But, because the standards are the physical standards and not the lack of accuracy or competence for the work that is being done there, they were granted a conditional accreditation until such time as it can be expanded.  There was no time limit given to expand but there was an understanding that it would be done in a reasonable time frame after the doctors' office was vacated.

So when stakeholders first talked with the needs assessment consultants about what would go in the new expansion, we did talk about moving the lab and x-ray to the new area where they would be close to the doctors' clinic. However, the consultant said that it would be a more costly build to put in the x-ray and lab because of the building code and what level of code they require. That coupled with the fact that x-ray was adequate and didn't need renovating, it was decided to keep the two services in proximity to one another.  Another big reason to keep them together was the fact that both were on the verge of extending their service hours from 4 until midnight and both departments would be covered for those hours by one combined X-ray/Lab Technician (CXLT) who would have to be able to move efficiently between both areas to get the job done.  So the most cost efficient and worker friendly equation was to move the doctors' clinic allowing the lab to expand into that space, which was already coded for that type of expansion and keeps the physical proximity of both lab and x-ray, enabling one technician to work effectively out of both areas.

In summary:
1) X-ray is adequate and does not require renovation. The building codes required to do a new lab are more expensive than renovating it in existing space that meets those codes
2) Lab and x-ray need to remain in close proximity because both departments are run by one person after 4 and on weekends.
3) It provides better patient care to have a lab and x-ray that are open from 8 am until 12 midnight rather than just having staff on call.
4) Therefore, the logical staging for the expansion is to first relocate the doctors' clinic into new space, allowing for later expansion of the lab footprint into some of the then freed space.

Please check this page regularly for answers to questions that may be on your mind.

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