Medical association begins appeals over specialists

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Barb Sweet
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The Newfoundland and Labrador Medical Association (NLMA) began a series of public appeals Wednesday by portraying the plight and dire shortage of general internal medicine specialists in the province.

The general internal medicine specialists say the shortage is the top priority of recruitment, retention and remuneration facing health authorities in the province as the specialists grapple with overwork, long waits to see them and aging patients that require more of their time.

(From left) Dr. Julia Trahey, Dr. Pradip Joshi, Newfoundland and Labrador Medical Association president Dr. Brendan Lewis and Dr. Muhammad Anwar discuss issues facing general internal medicine specialists Wednesday. Trahey, Joshi and Anwar are general int

The Newfoundland and Labrador Medical Association (NLMA) began a series of public appeals Wednesday by portraying the plight and dire shortage of general internal medicine specialists in the province.

The general internal medicine specialists say the shortage is the top priority of recruitment, retention and remuneration facing health authorities in the province as the specialists grapple with overwork, long waits to see them and aging patients that require more of their time.

"You don't want people coming and saying, 'I've been waiting nine months to come in and see you.' That does not make a physician feel good. You're sitting there and you realize, 'You know, you're right.' But you can only walk so fast. You can only dance so fast," said Dr. Julia Trahey, a general internal medicine specialist in St. John's and native Newfoundlander.

"My patients fly in from Labrador. My patients drive four hours from Burin and Marystown. My patients drive in from Clarenville. There is no need for this. These are all patients who should be seen by specialists in their areas.

"It is dangerous for them. It is expensive for them. It is time consuming and it is unnecessary."

The province now has 27 general internal medicine specialists and needs twice as many. Neither Burin nor Labrador have a general internal medicine specialist. Burin should have two to three, and Labrador should have six.

Most of the province's general internal medicine specialists are foreign trained. Because there is a national shortage of the specialists and provincial restrictions have been relaxed on licensing foreign-trained doctors, those with no family ties here have much better options and more colleagues to work with in other provinces.

Working alone or with few colleagues to share coverage and consult with is a major problem - St. Anthony and Clarenville currently have only one each.

Trahey has tried to recruit Newfoundland natives back home and wrote a report and action plan in December 2009. She hasn't been seeking employment, but has been offered double her pay to work in Ontario. The answer from doctors who have moved away is they don't want to come back to the massive overwork.

"It's like you are faced with one of these machines that fire tennis balls at you and somebody's got it turned up on bust and you just can't keep hitting them back," Trahey said. "When you're in that situation, you can sustain that for a period of time, but you cannot sustain that over the long term."

The general internal medicine specialists treat a myriad of diseases that are prevalent in the province - diabetes, hypertension, heart disease, chronic respiratory disease and arthritis. The number of middle-aged and senior patients make their appointments more complex and time consuming.

"For the last few years, I have found there has been a dramatic increase in my workload. It seems I am working harder and longer every year," said Dr. Pradip Joshi, who has practised here for the past 28 years.

The NLMA vowed to launch the information sessions in the last few weeks as a response to a feud with the provincial government over negotiations. Premier Danny Williams has said the doctors' demands were "through the roof. Too high. Can't be dealt with. Can't be satisfied. Can't be answered."

"We feel now the public is entitled to know where the deficiencies lie, where the problems are," NLMA president Dr. Brendan Lewis said.

The NLMA asked for binding arbitration and is waiting for a reply from Finance Minister Tom Marshall to its proposals, including a plea for parity with doctors' salaries in the other Atlantic provinces.

General internal medicine specialists are among the worst-paid specialists in the province. Achieving Atlantic parity - which is at the centre of the NLMA's contract proposals for all doctors - would require boosting the general internal medicine specialists' salaries by roughly 27 per cent.

Trahey said prior to a December summit on the national need for general internal medicine by the Royal College of Physicians and Surgeons in Canada, she tried to get a meeting with Health Minister Jerome Kennedy. All ministries of health had been invited to the summit and Trahey said she wanted to discuss the plan for Newfoundland and Labrador.

"I called. I e-mailed. I called again. Unfortunately, I was told the minister of health was too busy at that time to meet with me," Trahey said.

The shortage around the province puts pressure on rural family physicians and on hospitals in St. John's to take up the slack, said Dr. Muhammad Anwar, who works in St. John's but spent time practising in Carbonear.

He said the problem with recruiting and retaining the general internal medicine specialists, which he called the backbone of rural hospitals, plus support staff, has put pressure on family physicians to deal with sick patients beyond their scope.

"This problem is going to get confounded as the years go by. Something must be done immediately to overcome this lack of manpower."

"The lack of properly trained internal medicine specialists in this province has led to conditions that make delivery of this fundamental health care service untenable and impossible," Trahey said.

She said the province still has no systematic plan to fix the problem.

"In the last 10 years, the government of Newfoundland and Labrador recruited only one general internal medicine specialist that was trained here - just one," Trahey said.

"Into the future, I am very concerned, very worried," Lewis said.

Kennedy was not available for comment Wednesday.

In a news release, NDP Leader Lorraine Michael called the report on internal medicine shocking and disturbing.

"The report highlights huge deficiencies in the number of general internal medicine specialists in the province, noting areas with poor service and others where there is none," Michael said.

"It paints a bleak picture and shows the reality of how much stress the health care system and those who work within it are under."

Michael said the government must step up its efforts to train more internal medicine specialists and keep them in the province.

bsweet@thetelegram.com

On the web http://www.nlma.nf.ca/

Organizations: Royal College of Physicians, Newfoundland and Labrador Medical Association

Geographic location: Newfoundland and Labrador, St. John's, Burin Clarenville Marystown St. Anthony Ontario Canada Carbonear

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Recent comments

  • Manuel
    July 02, 2010 - 13:24

    Well if you guys could stop making mistakes and then cover it up when you do or stop fighting like 2 year olds maybe we could get other people here to help you people.
    As it stands you guys have about the wrost record and act like a group of teenagers when caught covering up your mistakes.
    I say cut there salaries in half and start using the rest of the money to pay a decent mature doctor to come here.

  • I C Clearly
    July 02, 2010 - 13:15

    It angers me that our government has focused their negotiations with the doctors to be a battle over money. Our lives and our healthcare system are at stake, yet the view of the government is 'too much, over the moon etc. etc.'
    Those words were not uttered by Danny Williams when his own health was at stake. If this were his health being affected, no price would be too high. Health care is our #1 priority, ahead of hydro dams, equity stakes, paper mill bail outs and other 'business minded' initiatives. It's time that this government recognizes that fact and starts giving our health care system the attention that it deserves. Thank you to the doctors who have bravely spoken up on this issues, and how our non-competitiveness is affecting both their lives and the lives of their patients.

  • Manuel
    July 01, 2010 - 20:10

    Well if you guys could stop making mistakes and then cover it up when you do or stop fighting like 2 year olds maybe we could get other people here to help you people.
    As it stands you guys have about the wrost record and act like a group of teenagers when caught covering up your mistakes.
    I say cut there salaries in half and start using the rest of the money to pay a decent mature doctor to come here.

  • I C Clearly
    July 01, 2010 - 19:55

    It angers me that our government has focused their negotiations with the doctors to be a battle over money. Our lives and our healthcare system are at stake, yet the view of the government is 'too much, over the moon etc. etc.'
    Those words were not uttered by Danny Williams when his own health was at stake. If this were his health being affected, no price would be too high. Health care is our #1 priority, ahead of hydro dams, equity stakes, paper mill bail outs and other 'business minded' initiatives. It's time that this government recognizes that fact and starts giving our health care system the attention that it deserves. Thank you to the doctors who have bravely spoken up on this issues, and how our non-competitiveness is affecting both their lives and the lives of their patients.