Central doctors say team clinic will solve nothing

Dr. Dawn Turner says she enjoyed her family practice near Stratford, Ont., where she put out her shingle in 2004 after she and her husband moved to Ontario from Newfoundland so he could do his medical residency.

Feeling the need to be near family and friends — and cousins for their three children — the family moved back to the province in 2019.

“I had a lovely practice and we were very happy there, but we decided that we might regret it if we didn’t move home,” said the Springdale native.

She started at a family practice in Grand Fallswindsor in August 2020, and soon felt regrets of a different sort.

“I knew it would be harder. I knew I wouldn’t get paid as much,” she said in a recent phone interview. “But I don’t think I realized just how demoralizing, how weary, how exhausting it would be.”

Central Newfoundland is one of the hardest-hit areas in the provincewide doctor shortage.

Not enough doctors are coming on stream to make up for the number of doctors who are either retiring or leaving the province, and the situation seems to be getting worse.

The Newfoundland and Labrador Medical Association (NLMA) estimates the number of residents without a family doctor has climbed from 90,000 to about 99,000 in the last few years.

“It really does something to your well-being when you get asked six, eight, 10 times a day, ‘Are you taking new patients?’ And I have to say no,” Turner said. “And everyone needs help. It’s not like these are people that don’t need help. People have problems and they need access to care.

“I have people that show up in my office, and they have things that they should have probably gone to the emergency room with, but they don’t because of the wait, or they’re not sure it’s an emergency.”

STRETCHED TO THE LIMIT

On Monday, Oct. 18, Health Minister Dr. John Haggie announced a gaggle of new measures to help alleviate the doctor shortage in the short and medium term, and one of them was to introduce more collaborative team clinics in the three health regions on the island — two in St. John’s and one each in Central and Western.

The NLMA endorses the idea of team care, but says given the current shortage, such clinics only serve to rob Peter to pay Paul.

“I think they’re beautiful. I think they can work really well. The problem is there are no people to have on the team,” Turner said.

“If you get physicians and nurse practitioners to staff these clinics, they’re leaving people that they had already agreed to look after.”

Dr. Lynette Powell knows the phenomenon first-hand.

Powell, past-president of the NLMA, made headlines earlier this year when she announced even she had lost her own family physician.

As well as running her own practice, she also works in a collaborative clinic in Grand Falls-windsor, one of two in the Central region. The other is in Gander.

“I do the scheduling for the one in Grand Falls. Currently it’s a seven-day-a-week service, because the demand is there for seven days a week, but we’re having to bring in locums from Gander to cover some of the weekends. There are gaps in our schedule you can drive a bus through,” she said.

The clinic was originally opened at the beginning of the pandemic in order to consolidate supplies of personal protective equipment (PPE) in one place so doctors could see patients in person.

But demand has kept it running.

EXTRA DUTIES

Powell says she believes Central Health was caught off guard by Monday’s announcement, but she’s heard murmurings from doctors in St. John’s who are thinking of applying to salaried positions at those new clinics.

“So, if they apply for the job in the collaborative clinic, they shut down their family practice. How does that make sense? You orphan, like, 1,500 patients to go take care of a different 1,500 patients,” she said.

When contacted, a spokesperson for Central Health said the authority has formed a committee to decide how to staff the new clinic.

On top of staffing the clinic, Powell said doctors in the region also have to handle obstetrics, and are also seconded to work emergency shifts, occasionally having to double up on the latter if there are no doctors to handle emergencies in towns hours away, such as Harbour Breton and Baie Verte.

One doctor has to handle virtual emergency calls, offering remote guidance while a nurse practitioner or advanced-care paramedic looks after the patient.

Powell doesn’t do that. Helping staff the collaborative clinic takes enough of her time.

“I had to do five days straight there last week … which meant that I was not in my own clinic at all that week. Now I’m backed up for about a month,” she said.

“My own patients were furious.”

The NLMA recently walked away from contract talks with the government, saying the government was offering no tangible solutions for physician recruitment and retention.

“I think you can offer less money, but you have to offer something. And right now, we’re really not being offered anything, other than disrespect and continually being gaslighted,” said Turner.

Doctors have been without a contract for four years.