Concerns have surfaced over how physicians in Flin Flon, Man., are making their schedules, with doctors working in multiple roles during a given shift and charging multiple fees.
The CBC News I-Team has gained access to numerous schedules of emergency room doctors at the Flin Flon General Hospital, the only hospital in the Northern Regional Health Authority where doctors manage their own schedules.
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The schedules, which cover a period between the summer of 2011 and February of this year, show physicians working in three to four capacities in each shift.
For example, one doctor would act as the emergency room physician, the on-call obstetrics doctor, the on-call neonatal doctor and the hospital physician of the day in one shift.
Some members of the community say they're concerned that one doctor carrying out many roles would not be able to do as good of a job as a doctor acting in one capacity.
"It's crazy," said Randy McCallum, who has been a patient at the Flin Flon hospital.
As well, doctors who schedule themselves to work in more than one capacity per shift are double-dipping, triple-dipping or even quadruple-dipping when it comes to on-call fees.
The practice can add $1,300 or more to a doctor's daily pay.
During the period covered by the schedules, a doctor working in obstetrics over a 24-hour shift earned a fee of $468.
If the same physician was working as the neonatal doctor as well, $350 would be tacked on, while another $468 would be added if the doctor was also the surgeon on call for that shift.
Higher annual earnings
In terms of total earnings — including salaries, on-call fees and fees for service — several doctors in Flin Flon earned a total of between $700,000 and $900,000 in the 2011-12 fiscal year.
In another northern Manitoba community, The Pas, one doctor earned a total of $1.84 million in the same fiscal year, according to documents.
Of the emergency room doctors in Winnipeg who were required to disclose their earnings, the highest-paid physician made $578,000 in 2012.
Helga Bryant, the chief executive officer of the Northern Regional Health Authority, says the current situation in Flin Flon is not ideal, but she argues that the money still has to go to someone.
"The double, triple stipends — from the system perspective, we're going to pay them to somebody regardless," Bryant said in an interview.
"We still need that role done. There is a fee for that role. Whether it's to Doctor A or Doctor B, it's going to cost me the same."
Bryant said she would prefer to see more doctors filling each role, but she added that recruiting has been tough.
"If we could recruit, if we could have a body for each one of those assignments, I would be in seventh heaven," she said. "We continually try to recruit to that level."
24-hour shifts to end
Many people in Flin Flon, located about 630 kilometres northwest of Winnipeg, have been opting to drive for hours when they require medical attention in order to avoid accessing the local hospital.
There have been at least a dozen complaints about the care being provided at the Flin Flon General Hospital from patients, their families and even from some staff members.
Several patients and family members told the I-Team about misdiagnoses and people feeling ignored by staff at the emergency room.
Another concern in the community is doctors working 24-hour shifts in the ER — a practice that Bryant said will be discontinued in November.
"I have questions frequently from the community around the 24-hour shifts," she said.
"I am a registered nurse by profession. I worked 12-hour shifts for much of my clinical practice."
Bryant said she has tried for two years to get rid of the 24-hour shifts, but she did not have the co-operation of doctors.
She added that while the 24-hour shifts are not optimal, the physicians working those shifts are not constantly on their feet and providing clinical care the entire time.
The Flin Flon General Hospital is the only one in the Northern Regional Health Authority that still has 24-hour shifts.