A gastroenterologist who left Saint John, prompting the loss of the after-hours on-call service provided by digestive system specialists in the region, says his reasons for going were not quite what a Horizon Health Network official said they were.

Dr. David Marr, cardiologist, medical director, Horizon, Saint John area

Dr. David Marr, Horizon's medical director for the Saint John area, said he is actively recruiting to fill the gastroenterology vacancy and is seeking permission to add a fifth position. (Horizon Health Network)

Dr. Chad Williams, who was based at the Saint John Regional Hospital for six years, recently took a position at Dartmouth General Hospital.

Last week, Dr. David Marr, medical director for the Horizon Health Network in the Saint John area, told CBC News Williams left for personal reasons.

"Both he and his wife have family in Dartmouth and it was an opportunity to move back closer to their families, which was the reason why they chose to leave," Marr had said.

"It wasn't for professional reasons, it was for personal and family reasons, to be a little closer to home."

​But Williams later contacted CBC News not to "stir the pot," but to "clarify."

While it's true the new job in his hometown provided an opportunity to be closer to family, "the big thing" for the 42-year-old married father of two children, aged one and three, was it gave him "a much better ability to spend time with family and not in the hospital after hours [on call]," he said.

"It was to have a better quality of life."

Gastroenterologists are specialists who deal with the diagnosis and treatment of a wide range of conditions related to the digestive system, such as stomach bleeds, blocked esophagus and abdominal pain, as well as inflammatory bowel diseases, such as Crohn's and diverticulitis.

Williams was one of four gastroenterologists covering the Saint John region, which stretches between Sussex and St. Stephen.

Heavy workload

On top of his regular office hours and in-hospital procedures, he was sharing around-the-clock on-call services for gastrointestinal, or GI, patients across the region with his three colleagues.

One of them has been off on maternity leave and another works a reduced schedule, leaving Williams and one other specialist to shoulder "the bulk" of the on-call, each providing 24/7 coverage every two or three weeks, seeing anywhere from three to 10 patients per day.

'If my quality of life had been better with regard to after-hours work requirements, that would have made a big difference.' - Chad Williams, gastroenterologist

In addition, under the Horizon system, gastroenterologists are also part of an internal medicine call rotation, providing 24-hour coverage every 20 days or so, and the internal medicine teaching rotation, spending a week at a time seeing hospitalized patients with medical students, said Williams.

"That's the way that it's done there in Saint John â€” mainly specialists cover the internal medicine service. They don't have very many what we call general internists."

Voiced concerns

Williams said he and the GI department expressed concerns to Horizon more than once over the past several years about the on-call demands the gastroenterologists in the region faced.

And "there was no plan to make accommodations for that workload at that time," he said.

"I'm happy to see that there are now," with three remaining gatroenterologists no longer providing primary around-the-clock on-call services, "but at that time, there was not."

'Actively recruiting'

Horizon officials did not respond directly to questions about Williams's allegations.

Instead, they emailed a statement to CBC News, thanking him for his years of service and dedication to his patients. "We wish him all the best in his future endeavours," it said.

"Our team is working to ensure all patients requiring care from of a gastroenterologist can be seen by one within Horizon.

"We are actively recruiting to fill the vacancy and are currently in discussions with a potential candidate."

General internists, surgeons help 

A recent internal email obtained by CBC News informed physicians that "for the foreseeable future there will not be a GI specialist available beyond 8-5 M-F."

Marr confirmed last week the round-the-clock GI on-call service became "unsustainable" after Williams left.

Instead, local general internists and general surgeons, who are "comfortable in managing most of the GI problems," have stepped up to help bridge the gap until Williams's vacant position can be filled, Marr said.

If the internist or surgeon providing primary call is not able to adequately deal with a patient, which Marr contends will be "uncommon," the three local gastroenterologists will provide "secondary call."

If they are unavailable, the patient can be transferred to a gastroenterologist in Moncton or Fredericton, he said, adding that he is actively recruiting a replacement for Williams and is seeking permission to add a fifth GI position.

Williams hasn't started his new job yet, but said he'll be working "a lot less" than he did in Saint John.

He couldn't say whether he would have stayed had the changes been made sooner.

"If my quality of life had been better with regard to after-hours work requirements, that would have made a big difference," he said, noting he "loved" Saint John, "loved" his department and "loved" his colleagues.

"I can't say, 'Yes, I would have certainly stayed.' I can say I would have had to consider things much more carefully."

Retention problem

Earlier this week, the New Brunswick Medical Society said the net gain of eight doctors in Saint John is a step in the right direction but the government needs to do more to address the chronic problem of physician recruitment and retention in the province.

Since September 2014 in the Saint John region, 52 physicians (21 general practitioners and 31 specialists) have been hired. During that same period, 44 doctors have left.

Dr. Dharm Singh, president-elect of the New Brunswick Medical Society, said the recruitment and retention problems stem from poor working conditions and lack of training centres.