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Younger doctors exhausted by new practice demands
Fighting to find a family doctor: ‘The whole process is undignified.’
What we learned, what you said about doctor shortage in Atlantic Canada
Challenges, solutions to Atlantic Canada's doctor shortage
Family doctor shortage a threat to health care
There’s been a doctor shortage here for some time. How is that affecting people? The marginalized? Families? Doctors? Other health-care professionals? You? Over the next four Fridays, we’re diving deep into the issue, outlining the challenges and trying to identify solutions.
Add up the estimates of those waiting for a family doctor in Atlantic Canada and the sum is just shy of 175,000.
Doctor shortages on the East Coast date back at least a quarter century, even longer in some provinces.
The Atlantic provinces would need to attract 146 new doctors willing to see 1,200 patients to clear the wait-list.
Source: Governments of P.E.I., Newfoundland and Labrador, Nova Scotia
Family doctor shortage a threat to health care in Atlantic Canada
Your family doctor retires or moves on. Suddenly, unexpectedly, you feel alone and unprotected.
Calls to family medical clinics blend in with the reams of calls from others like you. The answer is always, “Sorry, we are not taking new patients.”
Weeks turn into months. Anxiety kicks in. Visits to walk-in clinics or emergency rooms are often frustrating experiences.
Everest Howse, 62, knows that feeling.
In 2016, Howse, who lives in Steady Brook, N.L., found himself without a family doctor for the first time in his life.
And he needed a family doctor more than ever with complications cropping up from past health conditions — two aneurysms, heart surgery and a back injury.
Howse says he contacted about 20 family doctors in his area, visited clinics and made hundreds of calls, to no avail.
Finally, in desperation, he made up a double cardboard sign displaying his displeasure, attached it to his shoulders with clear packing tape, and began a one-man protest at Western Memorial Hospital in nearby Corner Brook.
The protest drew attention from hospital staff and the local health authority, and he was eventually linked with a new family doctor.
Not everyone can, or is willing to, take their frustration and channel it the way Howse did.
In Atlantic Canada, it is estimated that between nine and 13 per cent of the population doesn’t have a family physician.
While the issue is not limited to the Atlantic provinces — there’s an international shortage — Nova Scotia, P.E.I., New Brunswick and Newfoundland and Labrador have a particularly difficult struggle with aging populations and a problem with recruiting family physicians for rural areas.
In New Brunswick, according to that province’s medical society, there are about 50,000 people without a family doctor.
“Recruiting new family physicians is harder than ever before,” the society states. “We need a flexible strategy for the recruitment and retention of physicians in the province.”
According to the P.E.I. patient registry program, there were 12,213 people looking for a new family doctor as of January.
Nova Scotia’s patient registry, as of Jan. 1, 2019, recorded 52,680 people waiting to be placed with a family physician — representing about 5.7 per cent of the province’s population.
Newfoundland and Labrador doesn’t have a provincial patient registry, but it’s estimated that up to 13 per cent of the population doesn’t have a family doctor — more than 60,000 people.
As if these numbers weren’t challenging enough for the health-care system, family doctors in all provinces are managing patients who are older and have more complex medical conditions.
This means more time is needed with each patient, further limiting the number of patients a doctor can take on.
Dr. Lynn Dwyer, a family physician in St. John’s, says she’s seen the burden of work increase over her 31 years of practice.
She believes government needs a human resource plan developed to identify how many family physicians are needed and where.
“(Family doctors) know the current system is not sustainable,” she says.
According to Canadian Medical Association data from 2018, that’s how many practising doctors were 65 and older in Atlantic Canada, with 40 in P.E.I., 172 in N.L., 235 in N.B. and 387 in N.S.
The average weekly hours worked by a GP or specialist in P.E.I., according to 2017 CMA data. Numbers for the other Atlantic provinces were 52.7 for N.L., 49.18 for N.S. and 48.1 for N.B.
Percentage of GPs or specialists in 2017 CMA survey who felt overworked in their discipline in N.S. The number was 39.3 for N.L., 34.3 for P.E.I. and 34.1 for N.B.
Source: Canadian Medical Association
WHO'S FEELING THE IMPACT?
Doctor shortages are affecting everyone connected to the health system, from patients to practitioners, prompting tough decisions, choices both personal and professional.
Former health-care “orphan”
There's a term sometimes used in the medical community for patients who lose, or are without, a family doctor — orphaned.
The word conjures of feelings of being deserted by the health-care system. Everest Howse described it as the “weirdest feeling.”
“If I happened to get sick I had no one to turn to,” he said. “It’s like all of a sudden you were left out in the cold.”
Searching for a new family doctor was one of the most frustrating things he has ever done. It’s something in this day and age he believes people shouldn’t have to do.
“I think a patient should be able to choose their doctor,” he said. “That’s the way I see it.”
Howse says he’s lucky to have been linked up with a new family doctor. He advises people who are still searching for a family doctor to “parade around the hospital” like he did. He said governments may need to change their approach to attract new family doctors.
Patient without doctor
Alexis MacKinnon doesn’t have a family doctor and says that scares her to death.
The 60-year-old and her husband retired to her native Cape Breton — to the community of Albert Bridge — in October.
“I didn’t realize it was going to be this brutal, moving from Ontario,” said MacKinnon, who has a rare chronic disease called mastocytosis.
Diagnosed in 2016, she says she received excellent care from Ontario specialists. They’ve contacted specialists in Halifax, but are unable to make out-of-province referrals. A Nova Scotia doctor needs to do that on her behalf.
“They’ve agreed to see me once I get routed to them … once I get a damn family doctor to refer me. The missing link is ground zero — having a family physician.”
MacKinnon has registered with 811 and spends part of every day online looking for a physician or nurse practitioner willing to see her.
DR. TIM HOLLAND
Doctors Nova Scotia president
Holland says his province's family physicians are among the lowest paid in Canada, a key detriment to recruitment and retention.
His group, along with Maritime Resident Doctors and Dalhousie Medical Students Society, have made recommendations to the Nova Scotia government to address the “chronic physician shortage” and deal with doctor burnout and stress.
He says the shortage is a major threat to Nova Scotia’s health-care system, that a patient without a doctor is being left out.
“It ranges from your complex elderly patient with multiple chronic diseases like diabetes, hypertension, COPD (chronic obstructive pulmonary disease), who can’t get their current diseases properly managed, to the younger patient who would prefer their own doctor (rather than a walk-in clinic).”
Holland suggests nearly every emergency physician in Atlantic Canada could tell multiple stories of patients being diagnosed with diseases like cancer in the ER, conditions that would likely have been caught months earlier by a family doctor.
DR. KATHERINE STRINGER
Chair of Family Medicine at Memorial University
The shortage of family physicians could soon be greater.
Katherine Stringer is chair of family medicine at Memorial University, home to one of the two medical schools in Atlantic Canada.
She says many family doctors in the region are approaching retirement, so the shortage will grow unless recruitment and renewal goals are realized.
The College of Family Physicians of Canada (CFPC) suggests the number of residency seats in any medical school should be 50 per cent for family doctors.
“At present MUN has 80 residency seats so the CFPC would advocate that 40 of those went to family medicine. We are at 34 right now.”
In dire need of family doctor
Ralph Coughlin of Prince Edward Island has been eligible for a kidney transplant since the spring of 2018. Even if a kidney becomes available soon, he may lose out on the opportunity if he doesn’t find a family doctor.
“I’ve done all of my testing for a kidney transplant, but one of the stipulations that the transplant team in Halifax requires is that transplant recipients have a family doctor because there is a lot of followup work after the transplant,” said Coughlin, who lives in Borden-Carleton on P.E.I.’s south shore.
“I have gone to seven clinics now looking for a family doctor and nobody is prepared to take me on because they are all booked up. The word I’m getting is to put your name on the (provincial patient) registry. Well, I put my name on the registry and they indicate it’s going to be a two- to three-year wait.”
He feels “disillusioned by government” for not doing more to find family doctors.
Number of Canadians in 10 who would take advantage of virtual physician visits, according to 2018 Ipsos survey.
Number of students admitted into the Dalhousie University (112) and Memorial University (80) medical schools in 2018.
Percentage of Canadians who could get an appointment on the same or next day with their family doctor or regular place of care, according to a Canadian Institute for Health Information survey.
Source: Ipsos, Canadian Institute for Health Information, Dalhousie University, Memorial University
Our journalists have told hundreds of stories about doctor shortages. A few headlines from the past 20 years:
- Search for doctor frustrating for pregnant woman, The Telegram, May 26, 1999
- Doctor shortage ‘critical’, The Guardian, Sept. 25, 2003
- Doctor shortage forces department closure, Cape Breton Post, May 6, 2005
- Doctor shortage putting strain on family, Cape Breton Post, July 4, 2015
- LETTER: Family physician shortage has ill consequences, The Guardian, July 22, 2016
- Doctor shortage hits ERs, The Chronicle Herald, Jan. 18, 2018
- Number of doctorless patients swell in first six months of 2018, The Chronicle Herald, July 26, 2018