Opinion: Blame government neglect for hospital wait times — not immigrants

Successive provincial governments have promised to address wait times and improve health care for Albertans, without acknowledging the causes or taking accountability for their role.

The current crisis of overcrowded emergency departments (EDs) and hospitals is more than just a supply-and-demand mismatch. While the causes are multi-factorial, the cure requires understanding how we arrived at such a state.

In 1988, Alberta built matching hospitals in Calgary and Edmonton, the Peter Loughheed and the Grey Nuns (the last inpatient hospital built in Edmonton). At the time, Alberta’s population was almost 2.5 million and there were almost five acute-care hospital beds per thousand population. In 1997, premier Ralph Klein closed the 600-bed Holy Cross hospital in Calgary, before selling it to private business interests.

The same year, he closed the 1,000-bed Calgary General Hospital before demolishing it in October 1998. This effectively cut Calgary’s 3,000-bed capacity in half. Through expansions to the Rockyview, Foothills Medical Centre, Peter Loughheed, the addition of the new Alberta Children’s Hospital and full opening of the South Health Campus in 2016, bed numbers have yet to match 1990 numbers despite population growth from 710,000 to 1.68 million. Klein’s budget cuts also led to the elimination of 3,000 nursing positions and many other allied health professional positions.

Edmonton’s population was 580,000 in 1988. Today, it is 1.6 million and yet no new adult or children’s hospitals with admitting capacity have been built. During nearly four decades of infrastructure neglect, Alberta’s population has doubled from 2.5 million to five million and the aging population has quadrupled. Medical advances have helped people live longer while simultaneously making their care more complex.

In 2015, Alberta had 1.7 acute hospital beds per thousand population. By 2024, that number had dropped to 1.5 per thousand. Both numbers place our capacity third-lowest among 45 OECD countries, barely above Costa Rica and Mexico.

While Alberta health-care spending per capita is relatively high, the increase in hospital spending from 2015 to 2025 is the lowest in Canada and the percentage spent on hospitals has been decreasing since 2005. This has been accompanied by a shrinking full-time nursing workforce and an increase in hospital length of stay for typical care.

While there is a clear need for additional health-care providers, they need the necessary resources to provide care. For inpatient specialists and nurses, that means increasing hospital capacity. Current ED wait times are a direct result of the failure to build hospital capacity to match the expanding and aging population.

Due to limited hospital capacity, as physicians, we have developed approaches to bridge care. For example, using evidence-based protocols, we now manage individuals with high-risk conditions (e.g. pneumonia, heart failure, venous thromboembolism) safely as outpatients. We utilize rapid-access clinics/clinicians for certain patients with conditions that require sub-acute followup (e.g. neurology, cardiology, orthopedic conditions).

Sadly, despite these efforts, the demands are increasing and we have reached the end of those options. When patients require admission to a hospital already at capacity, they remain in the ED, blocking treatment spaces. This leaves emergency staff without necessary resources to provide waiting-room patients safe and timely care.

Patients with less emergent conditions are not the cause of overcrowding; however, they are subjected to long wait times and finger-pointing by a
health ministry’s flawed understanding. ED wait times and substandard access to care are the direct result of successive governments abrogating their responsibility to ensure inpatient and community resources are meeting growing demands.

While EDs make herculean efforts to provide timely care for patients suffering a heart attack, stroke, sepsis or major trauma, that care is under threat with
current conditions. Many patients with less obviously acute conditions suffer inappropriate delays. Wait times for non-acute surgical conditions and cancer care continue to increase to the detriment of all.

Moreover, new government policies that permit patients to order their own imaging and increased private health-care options do not address equity
concerns; they simply allow the healthy and wealthy to access health care earlier. Many predict these policies will expand wait times in the public system by exhausting imaging services and limiting the time those specialists work in the public system.

Both Edmonton and Calgary need at least 1,000 new acute-care beds, with Edmonton also in urgent need of a children’s hospital. From planning to completion, a new hospital takes five to 10 years. Calgary’s South Health Campus took nine years from start of construction to becoming fully operational.

In Alberta, there are still no plans and only vague promises. All Albertans should engage their MLAs and make this a key election issue. Unfortunately, without immediate attention to these infrastructure deficits, there will be many deserving patients for whom the system will be unable to meet their needs.

Scapegoating Ottawa and immigrants for the government’s failures to appropriately fund education and health care cannot absolve Premier Danielle Smith and her government from accountability. Albertans deserve better.

Michael Bullard, professor emeritus; Brian Rowe, professor; and William Sevcik, associate professor and chair, all in the Department of Emergency Medicine, College of Health Science, University of Alberta.

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