New Brunswick

Why one family doctor says she had to leave New Brunswick

Thousands of patients were left without a family doctor when Dr. Julie Hildebrand left Saint John after 10 years in practice. Now, she wants to talk about why.

Dr. Julie Hildebrand says she felt bullied and humiliated

Dr Julie Hildebrand, left, and her husband, Dexter Samuel, moved to Saint John with their family in 2012 so that she could practise medicine. Ten years later, she says, she had no choice but to leave. (Submitted by Dr. Julie Hildebrand)

A former Saint John family doctor says she sold her practice of more than 5,000 patients and left New Brunswick after Horizon Health refused to accommodate her medical condition.

Dr. Julie Hildebrand, who has diabetes, said she was "disappointed and sad" to leave thousands of patients, some of whom she had cared for for 10 years, and wants to speak out about what is required of some doctors who choose to work in New Brunswick. 

"There was no system to help or to support doctors like me," she said. "You're on your own and that's it."

This month, Hildebrand filed a complaint with the New Brunswick Human Rights Commission about her treatment working in the province. 

"If I don't speak out, if I don't say anything about what happened, if I don't try to promote changes, what have I done? Why did I have to endure and suffer this condition?"

Hildebrand, a diabetic for more than 30 years, says Horizon refused to accomodate her medical condition. (Submitted by Julie Hildebrand)

Over 5,000 patients, 70-hour weeks 

Hildebrand came to the province from Montreal in 2012 after being recruited straight out of her medical residency.

"They attract you," she said. "They have a nice package. They're welcoming you. The hospital looked amazing."

She was also attracted by the "great need" she saw in Saint John. 

"I met very, very sick people that were without doctors," she said.

Her practice soon grew to 2,000 patients, and she was working 70 hours a week — and only continued to grow. 

"Eventually, we went close to 6,000 with the medical cannabis patients that I was seeing," she said. "I had a huge, huge practice."

N.B. doctor sells practice after Horizon fails to accommodate medical condition

7 months ago
Duration 2:25
Thousands of patients were left without a family doctor when Dr. Julie Hildebrand left Saint John after 10 years in practice. Now, she wants to talk about why.

According to Dr. Ed Schollenberg, registrar of the College of Physicians and Surgeons of New Brunswick, a more typical practice size in New Brunswick would be 1,500 to 2,000 patients. 

Ulcers, fractures, and infections

But the massive size of Hildebrand's practice was not the problem, she said. 

In addition to her own patients, her contract with Horizon stipulated that she perform hospital rounds, also called "hospital inpatient services."

Every six to eight weeks, she had to visit the Saint John Regional Hospital and provide care for between a dozen and 20 patients, which meant walking 15,000 to 20,000 steps a day.

The size of the Saint John Regional Hospital was initially a selling point, says Hildebrand. But the amount of walking required to complete hospital rounds excerbated her diabetic foot ulcers. (Julia Wright / CBC)

All that walking, combined with her diabetes, caused foot ulcers, fractures and infections.

These types of infections can also "lead to severe complications like amputation," Hildebrand said, who had to use a wheelchair for about nine months in 2016.

She did rounds in the chair for a while, but Horizon later relieved her of the rounds responsibility until 2018. 

Felt bullied, humiliated

But in mid-2018, despite a letter from her doctors outlining her high risk of complications, Horizon began pressuring her to return to the hospital, Hildebrand said. She received a letter stating she was expected to honour her on-call responsibilities, or arrange for a replacement. 

A colleague stepped in to help, but "she has a life of her own," Hildebrand said. "Some days she wouldn't be able to do it."

In 2019, Horizon offered various accommodations to make it possible for Hildebrand to work. Few, if any of them, materialized, she said.

No wheelchair was reserved for her, and the working area for doctors at the hospital was not wheelchair accessible. She had to pay her secretary to push her around in the hospital. 

Ultimately, she said, Horizon threatened to remove her hospital privileges if she did not perform rounds, which would have resulted in the closure of her practice.

"I would have no revenue — basically, bankruptcy," she said. "I felt bullied. I felt humiliated. I felt discriminated [against]."

Few answers available 

In response to a request for comment, Horizon's chief human resource officer Gail Lebel provided CBC News with an accommodation policy that states the government of New Brunswick will "ensure it meets its obligations under the New Brunswick Human Rights Act with respect to accommodation in the workplace."

Although Horizon had insisted Hildebrand follow its rules for rounds, the statement from Lebel said, "for this particular case, she was not a Horizon employee" and referred questions elsewhere.

Dr. Ed Schollenberg, registrar of New Brunswick's College of Physicians and Surgeons, said situations like Hildebrand's involving hospital rounds have come up before, and some physicians have decided to retire or leave the province as a result. (CBC)

Dr. Mark MacMillan, president of the New Brunswick Medical Society, also declined to comment on Hildebrand's case, stating in part "we obviously never want to see a physician leave the province for any reason, and it is unfortunate for the state of health care in the province when this occurs."

The office of Health Minister Dorothy Shephard also declined to comment.

'We're human beings'

Hildebrand said New Brunswick's health-care system does not recognize doctors as people — with their own medical, family, and life situations that could require flexibility. 

"We're human beings, we're made of flesh like everybody else, right? We're not made of steel. We're also exposed to disease and things like that. So that shocked me. It really shocked me."

Further, she says, since she is not a Horizon employee, "why is it that they can impose me to do rounds against medical advice? Why don't we leave the choice to the doctors?"

According to Schollenberg, "in New Brunswick, you have to have privileges at the hospital in order to bill Medicare. A licence on its own doesn't allow you to practise medicine. New Brunswick is the only province where this is the case."

"There is a notion that everyone should have to do their share."

Other physicians have challenged this unsuccessfully, and some have retired or left the province, he said. 

Eventually, Hildebrand said, she chose to leave. When she sold her practice in September 2021, the doctor who took over was able to accommodate only a small fraction of her former patients. 

Hildebrand has planned to stay in New Brunswick for life, but had to leave to protect her own health. (Submitted by Julie Hildebrand)

She's now making "almost double" her former salary in Edmonton for similar work — and is not required to perform rounds. 

"When you try to hire a doctor, you want to keep them in New Brunswick," she said. In her case, the decision to leave was "linked to a culture, maybe a mentality, of how you think a health system should be run.

"But obviously it doesn't work like that, right?"

ABOUT THE AUTHOR

Julia Wright

Host, Information Morning Saint John

Julia Wright is the host of Information Morning Saint John on CBC Radio 1. She previously worked as a digital reporter focused on stories from southwestern New Brunswick. She has a masters degree in English from McGill University, and has been with the CBC since 2016. You can reach her at julia.wright@cbc.ca.

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