Transforming primary care in Alberta

New research chair the culmination of 30 years of work to make UAlberta's family medicine department best in Canada

Janet Harvey - 23 July 2013

Why would a renowned family medicine researcher and physician leave a very successful, established research network at an American university to come to the U of A Faculty of Medicine & Dentistry? For the chance to transform the way health care is delivered to Albertans.

Lee Green was recruited to the U of A last year to chair the Faculty's Department of Family Medicine. He came from the University of Michigan where he had developed a prominent reputation in patient-centred research and care. Why did he choose to come to the U of A?

"It's a leading medical school, a top 50 medical school, at a big-league research university," he says. "You can only base an effort of this size at a top research university, in a setting where there are lots of talented people. That is the kind of intellectual environment you need and the type of infrastructure you need."

The "effort" of which he speaks is nothing less than a large-scale transformation of primary care in Alberta. "I want to help family medicine take the next step," explains Green, who is also a practicing physician at the University of Alberta Hospital Family Medicine Clinic. "We need to do a lot better job for our patients, particularly those with chronic disease, and to do that we have to learn a new way of doing things."

Green adds that Alberta is home to some outstanding examples of the type of care he is talking about with several primary, strategic and family care networks already up and running in the province.

"These are the beginnings of a change in primary care that we can build on: team-based, systems-based care. It means family practices organized around consistent delivery of chronic disease management. It means managing patients proactively, shifting from a model that is physician-centric to one where there is a physician-led team. It means doing more work outside of patient visits, more teamwork. I am very excited about the possibilities of putting something like that together and showing the world how primary care can be done."

Green was recently awarded the first translational health research chair by Alberta Innovates - Health Solutions. The seven-year award will provide funding for his research, while supporting the infrastructure and continuity necessary for this kind of work.

Green's experience, leadership and expertise is adding to the Faculty's profile and reputation in family medicine.

"The Faculty of Medicine & Dentistry is a centre of excellence for family medicine," says D. Douglas Miller, dean of the Faculty. "The type of transformational work Dr. Green is embarking upon can only be done in an environment with the type of talent and infrastructure found in our Department of Family Medicine. Success builds success. The pieces are already here and with Dr. Green's leadership, the Faculty will continue to build the relationships necessary to transform primary care."

U of A medical students are already benefitting from Green's presence at the Faculty. "Being able to learn clinical skills from Dr. Green was a great experience," says Nina Lam who is entering her second year of medical school. "He is a great family physician and has an ease with patients that was very nice to observe. He was able to show us that all patients have their own story, and taught us the importance of understanding patients in this context, as physicians. He also has an obvious passion for teaching. I feel very lucky to have had Dr. Green as a preceptor, especially in my first year, because he has given us a solid foundation on which we can continue to build our clinical skills."

The recruitment of Green to the Department of Family Medicine is the culmination of 30 years of work to build the department into a top centre for family medicine in Canada, says former department chair Richard Spooner. He recalls that when the department was created in 1983 there was zero research capacity and the intervening years saw considerable activity to make it a recognized and respected department. Key to this evolution was the Alberta government's implementation in 2006 of the family medicine Academic Alternative Relationship Plan (AARP), a made-in-Alberta solution which allows academic family doctors to be compensated for teaching as opposed to relying solely on billing for their income.

"The AARP took the shackles off the department," says Spooner. "It allowed a new involvement with undergraduate teaching along with the development of a research focus. We were able to give our staff more time to research and teach, and to recruit significant new research talent. The result has been that we are now in the forefront of educational research in Canada and internationally, and in my view, we are now the premier family medicine program in Canada."

The U of A medical school is celebrating its centennial this year. The first medical school in Alberta, it has graduated more than 7,000 physicians since its establishment in 1913. Graduating students from the U of A have achieved top scores in their licensing exams for the past two years and 41 per cent of graduating students from the class of 2013 have chosen to become family physicians, a fact that will help ease Alberta's current doctor shortage.