With just one day left until hospitalists’ contracts expire on April 1, the effect the development will have on orthopedic surgeries in Edmonton remains unclear.

In a March 24 letter, orthopedic division leadership for Alberta Health Services’ Edmonton zone warned Acute Care Alberta and Covenant Health that “inpatient elective surgery will not proceed at any site” as of April 1.

But in a statement on Tuesday, ACA told CBC News “we do not expect significant disruptions to services.” The statement added that only two surgical cancellations or postponements are expected at this time.

The situation is due to changes in how hospitalists are compensated.

Surgeons and other health workers have previously warned that disruptions to patient care are likely when stipend contracts for surgical hospitalists expire April 1. Surgical hospitalists manage pre- and post-operative care, allowing surgeons — who often work at multiple hospitals — to focus on surgical duties.

Surgical hospitalists warned the province in February that “in the absence of a contract or reasonable alternative, the majority of surgical hospitalists do not intend — and under the terms of their existing agreements are not permitted — to continue working.”

But the ACA statement said that as of March 31, “11 of the over 280 surgical and primary care hospitalists currently receiving stipends have submitted the formal resignation documentation required under Medical Staff Bylaws to end their orthopedic support privileges in Edmonton.”

The Edmonton zone’s orthopedic leaders’ letter, written by division head Angela Scharfenberger, notes that physicians’ “first and foremost obligation is to ensure patient care and safety,” and that continuing to provide services with insufficient resources or staffing may compromise patient safety.

“In such circumstances, physicians are expected to use their professional judgment to determine how best to manage their practice,” she writes. “This may include limiting services, modifying scope or adjusting practice capacity.”

Scharfenberger had not responded to a request for comment as of publication. Covenant Health referred questions to ACA.

The letter says minimal acute care coverage has been arranged at the University of Alberta Hospital and Royal Alexandra Hospital, relying on surgical residents and associate physicians. Inpatient trauma services will be directed to those facilities, according to Scharfenberger’s letter.

In a statement provided to CBC News on Tuesday, a spokesperson for the Ministry of Hospital and Surgical Health Services said “a multidisciplinary group continues to meet regularly” to try and solve the impasse with hospitalists.

“Appropriate care remains in place, including through the use of qualified health-care professionals such as associate physicians, physician assistants and nurse practitioners,” the statement reads.

“Clear contingency plans are in place to maintain patient safety and service continuity.”

In the legislature on Tuesday, Opposition NDP hospital and surgical facilities critic Sarah Hoffman questioned Jones about the situation.

“Tomorrow, there’s going to be chaos,” said Hoffman. “Why won’t the minister admit it, and why won’t he do something to stop it?”

Jones replied that hospitalists have been offered reasonable alternative compensation options, and “we expect the vast majority” to accept them.

Scharfenberger’s letter points to the Misericordia Community Hospital in particular, noting that the division has not received any direction regarding “predictable and comprehensive acute care coverage” past March 31. 

“I’m a little stressed,” said Dr. Paulose Paul, an orthopedic surgeon and former zone division lead who works at the Misericordia.

“You’d like to go into work having some measure of predictability in terms of what your day is going to hold. I know that’s not always the case in medicine, but … right now, even that measure of predictability doesn’t seem to be there.”

Paul said he received the letter and confirmed its authenticity to CBC News.

Even less than 24 hours before the April 1 deadline, he said there wasn’t much clarity on how things will unfold.

“It’ll be a reduced level of services,” Paul said. “I will take care of the patient in front of me to the best of my ability, but we may see more transfers, inter-hospital transfers across the zone.

“[But] I really don’t have an answer for you in terms of what tomorrow’s going to look like.”