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PAT CULLEN: Addressing the doctor shortage

The doctor shortage at family medicine clinics in the area is about to improve.

A physician and nurse practitioner, both paid by Eastern Health, will begin practice at T-C Medical Associates, Dr. Christopher J. Peddle confirmed.

At time of writing last week, Peddle was the only practitioner at the clinic and he did not know the start date of the others. In a statement released April 5, Eastern Health, which is responsible for health-care needs of this region, said it has also asked other family clinics in Conception Bay North if they want additional medical personnel to help with workload.

While applications were being considered from them, only Peddle’s had been selected, although according to him, a similar offer has been made to another clinic in the area. While he is enthusiastic about the offer – describing it as a fine “short-term solution” by people “earnestly trying to help” – his enthusiasm is tempered. There’s also caution with having government-paid employees working in a fee-for-service practice. Factors come into play, including agreements concerning overhead (the cost of running and supplying the clinic), start date, work hours and work commitments, the length of time they would be employed there and performance.

“What happens if there’s some issue with performance, what are my options if I’m concerned about that?” he asks.

Despite reservations, he’s generally satisfied with the arrangement.

“It’s just the logistics of it need to be ironed out a little bit further, that’s all.”

Peddle’s long-term goal is admirable. He wants to create another generation of family physicians and is anxious to staff the clinic with doctors who will spend their careers here, just like their recently retired predecessors. Although modifications to workload and style are needed.

“I would like to see people come here for careers, for continuity of care, like the previous generations of physicians that came out here and worked for 40 years.” he said. He also wants the clinic eventually designated as a teaching site by the Memorial University faculty of medicine so resident– in this case family medicine doctors completing their studies – can do rotations.

Getting family practitioners is the hard part. Although the MUN medical school graduates a minimum of 80 students a year, fewer are deciding on family medicine as a specialty, Peddle says, because of the long hours, huge demands and the “enormous amounts of paperwork.”

Millennials also want a life outside the practice and that means less hours and fewer patients, the new normal. Attracting them becomes more difficult.

According to figures released by the Newfoundland and Labrador Medical Association (NLMA) there are 516 full-time permanent family physicians practising in the province, 267 of them practising in rural areas.

And while 277 of the 516 are MUN graduates, only 99 of these graduates, much less than half, are serving a rural population. These numbers exclude part-timers and locums (fill-ins).

So, what can be done to change it? Having medical students, even those in the early days of their studies come here, take a look at what we have to offer and talk to our health-care professionals may sway their decisions in our favour.

According to Peddle, persuading a resident to do a locum is another positive. He also knows a few who are interested in practising in Carbonear and their presence here should be encouraged.

If they are looking for amenities then we have them, including the biggest amenity of all – a general hospital right on their doorstep. Moreover, a Family Practice Network, which he hopes will be established in the region by year’s end, will improve patient care. This includes recruiting and retaining doctors and could do a lot of bridge-building between students, residents, area practitioners and the health authority.

Eastern Health has recently hired a physician recruiter to attract more doctors to eastern Newfoundland including Conception Bay North and this person plans to build a strong rapport with residents and medical students at Memorial. The method of practice also has to change. According to Peddle, today’s residents want blended practices. They don’t want to spend five days a week in the office, but wish to split their time among in-clinic patients and duties at Carbonear General and the nursing home adjacent to it. Eastern Health supports this, wants to discuss it and could see it happening on “…a case-by-case basis” according to the “…skills and needs” of the doctor.

The health authority providing residents with “monetary incentives” such as “retention bonuses” to come here and work would also be a nice perk, he said. On this, Eastern Health was vague in its April 5 email.

“Monetary incentives,” it read, “are determined by the Provincial Government with certain incentives being determined through negotiations with the NLMA. There are also various Bursary Programs sponsored by the Government of Newfoundland and Labrador that are targeted towards medical students and residents.”

While the provincial Department of Health does provide monetary incentives for residents and medical students, it is questionable if they are available particularly for residents, who wish to start their practice in a fee-for-service clinic.

Recent polling figures released by the NLMA show 15 per cent of this province’s population did not have a family doctor. Translated into numbers, that is roughly 78,804 people, far too high for a population of just over 525,000. Eleven per cent were in the St. John’s-Avalon region which encompasses Carbonear and area. Because we are lumped in with St. John’s and because of the vastness of the region, it would be unfair to translate this percentage into a reliable figure. We can only conclude that we need more doctors and we need them badly.

Knowing we are part of a national and international trend is cold comfort. The …“urgency clinic” still functions at Carbonear General where, according to the Eastern Health email, “…there is no guarantee of ongoing care by the same physician.” There is also no “…end-date planned” for this clinic, so obviously our health authority expects us to be lacking for quite some time.

We are not getting the best care that is possible and we can only hope this will soon change. Dr. Christopher J. Peddle is interested in filling his clinic with the region’s next generation of family doctors and in so doing “revitalizing” family medicine within the area. Admittedly, the revitalization will be different with this concept of the blended, shared practice. Doctors will do some work outside the clinic and one will probably see the other’s patients. But it is the family medicine methodology of the future and it is up to us to make the adjustment.

One can only wish him well.

Pat Cullen is a journalist who lives in Carbonear. She can be reached at 596-1505 or cullen.pat1@gmail.co

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