The emergency room at Crowsnest Pass Health Centre sits quiet on a Tuesday afternoon, a stark contrast to the scenes I witnessed last month at Calgary’s Foothills Medical Centre. In the mountain community’s modest facility, two patients wait while a nurse checks charts at the station. No stretchers line the hallways. No patients sleeping in chairs.
“We see about 8,000 visits annually,” says Dr. Cassandra Hoggard, a rural physician who’s practiced here for eight years after training in urban centers. “That’s roughly 22 patients daily, compared to hundreds at city emergency departments.”
This difference in volume translates directly to wait times, according to a new study from the University of Calgary that analyzed emergency department data across southern Alberta. Researchers found rural patients typically see a doctor within 40 minutes of arrival, while their urban counterparts often wait three to five hours for the same level of care.
The findings challenge common assumptions about rural healthcare quality, particularly as smaller communities face physician shortages and service reductions.
“We were somewhat surprised by the consistency of the data,” explains Dr. Margaret Thompson, the study’s lead author and emergency medicine researcher. “Across all five rural sites we studied, median wait times were significantly shorter than at urban facilities, even when controlling for patient acuity and time of arrival.”
I spent two weeks visiting emergency departments across southern Alberta to witness these differences firsthand. At Medicine Hat Regional Hospital, where approximately 40,000 ER visits occur annually, staff described a middle ground between rural and big-city experiences.
“We’re busy, but we still know our patients,” says Elaine Kowalchuk, a triage nurse with 22 years of experience. “Many of us live in the same neighborhoods as the people we treat. That connection matters.”
The connection Kowalchuk describes represents both a practical and emotional difference in healthcare delivery. Physicians and nurses in smaller centers often report treating their neighbors, former classmates, and community members they recognize from local events.
This familiarity creates efficiency. Patient histories are better known. Follow-up compliance improves when providers have established relationships with patients. The study found that patients at rural sites were 27 percent more likely to complete recommended follow-up care than those treated in urban emergency departments.
But these advantages come with significant challenges. Rural facilities lack specialists and advanced diagnostic equipment readily available at urban centers. Critical cases still require transfer to Calgary or Lethbridge, adding potentially dangerous delays for time-sensitive conditions.
“The wait time is only one metric,” cautions Dr. Hoggard. “If you’re having a stroke or major trauma, you need the specialized teams and equipment at larger centers, even if it means waiting a bit longer to be seen initially.”
Statistics Canada data shows approximately 18 percent of Albertans live in rural communities, yet these populations tend to be older and experience higher rates of chronic conditions than urban dwellers. This creates a healthcare paradox where those potentially needing more complex care live furthest from specialized services.
The Alberta Health Services South Zone stretches from the Rocky Mountains to the Saskatchewan border, covering approximately 44,000 square kilometers. Within this vast area, fifteen communities maintain emergency departments with varying hours and capabilities.
Fort Macleod Health Centre represents the study’s most dramatic success story. The facility serves approximately 3,000 residents plus surrounding agricultural communities and sees patients within an average of 22 minutes after arrival—the shortest wait time in the study.
“Our team knows exactly who’s coming through those doors before they arrive,” explains Dr. James Williams, who practices at the Fort Macleod facility. “When someone calls ahead about chest pain, we’re already preparing for them. That simply isn’t possible in a city ER where dozens of similar cases arrive hourly.”
This small-town advantage disappears, however, when rural facilities become overwhelmed. Temporary closures and reduced hours have plagued several southern Alberta health centers in recent years due to staffing shortages.
Raymond Health Centre has experienced seven overnight closures this year alone, forcing residents to drive 30 minutes to Lethbridge during those periods. Such inconsistency undermines the wait time advantage the study identified.
Health economist Dr. Emily Carpenter from the University of Alberta, who wasn’t involved in the research, suggests the findings highlight potential lessons for urban facility management.
“Rather than viewing this as a rural versus urban issue, we should ask what specific elements create efficiency in smaller settings that might scale,” Carpenter says. “Is it the continuity of care? Team composition? The absence of certain bureaucratic processes? These are valuable questions.”
For residents like Martin Crowchild from the Piikani Nation near Pincher Creek, the study confirms what community members have long observed. “When my father needed emergency care last winter, we were in and out in two hours,” he tells me as we speak outside Pincher Creek Health Centre. “My cousin in Calgary waited nearly seven hours for similar symptoms.”
The research team acknowledges limitations in their analysis. Wait times, while important, represent just one aspect of emergency care quality. The study didn’t measure patient outcomes, provider burnout rates, or diagnostic accuracy—all crucial factors in comprehensive emergency services.
Alberta Health Services responded to the findings in a statement, noting that “all emergency departments prioritize patients based on medical need, not arrival time” and that “comparing facilities with vastly different volumes and capabilities requires careful interpretation.”
As I drive back toward Calgary along Highway 3, past the windswept prairies and distant mountains that define southern Alberta’s landscape, I reflect on how geography continues to shape healthcare experiences. The tradeoffs between immediate access and specialized care remain a fundamental tension in our system.
For residents of southern Alberta’s smaller communities, shorter wait times offer a significant quality-of-life advantage—provided their local emergency departments remain adequately staffed and open when needed.
