Newfoundland and Labrador residents face long wait times or must travel to the United States for health care because the province can't recruit or retain medical specialists, according to briefing notes prepared for the provincial health minister.

CBC News obtained the Health Department briefing notes through an access to information request. The notes were prepared last fall for Jerome Kennedy, who was sworn in as health minister on Oct. 7.

At the time the notes were written, there was no full-time infectious disease specialist in the province. The last one left in March 2009. There was also no doctor dedicated to performing oral-facial surgery, and there was a shortage of anesthetists.

All these problems affect patients.

Access to treatment deteriorates

In other provinces, HIV/AIDS patients have their treatment managed by infectious disease specialists.

This month, patient access to treatment deteriorated further. Dr. Mazen Bader, who was hired part time to provide some infectious disease services, was only available until the end of 2009.

"Ongoing care to HIV patients is being provided by a nurse practitioner, with internal medicine involvement as required," the briefing notes say. "Due to other work commitments, Dr. Bader will no longer be able to provide visiting clinics in St. John's after December."

Anesthetist shortage

The briefing notes say the province has had trouble recruiting and retaining anesthetists, which has led to the cancellation of some surgeries at the province's largest hospital in St. John's.

"Despite recruitment of three new anesthetists, it is estimated that eastern Newfoundland is short one to two specialists," the notes say.

No oral maxillo facial surgeon

The province had three full-time oral maxillo facial, or OMF, surgeons in the early part of the last decade to treat problems ranging from the removal of wisdom teeth to the reconstruction of bone and tissue in the jaws, face and neck. By 2007, there were none.

"The availability of OMF surgical services was interrupted with the unexpected death of two of the surgeons and a retirement," the documents said.

Because there is no oral maxillo facial surgeon practising in Newfoundland and Labrador, patients may need to travel to Nova Scotia or the U.S. for complicated dental and jaw surgery.

"The provision of services at other sites (Halifax, the south shore of Nova Scotia and Boston) continues to be pursued," the notes said.

The province also arranged to provide monthly "itinerant" services in oral maxillo facial surgery beginning in November 2009, according to the notes, which said as many as 300 patients were waiting for services.

Some success with recruitment

The briefing notes indicate the province has had some success recruiting physicians. Between March and September of 2009, the total number of physicians practising in Newfoundland and Labrador increased to 1045 from 1037.

The province says it hopes to develop more homegrown doctors by increasing the number of graduates from Memorial University of Newfoundland's medical school to 80 from 60.

Last year, 14 of the 19 family practice residents who graduated from Memorial University chose to work in Newfoundland and Labrador.