Nfld. & Labrador·Opinion

We're medical specialists, and see a side of the family doctor shortage you should know

Specialist physicians Dr. Shaina Goudie and Dr. Boluwaji Ogunyemi say their family medicine colleagues do not have sufficient support, and they want to shed light on the effects of the doctor shortage in Newfoundland and Labrador.

Lack of family doctors creates bottlenecks and worse health outcomes, specialists say

Dr. Shaina Goudie is a rheumatologist in St. John's. Dr. Boluwaji Ogunyemi is a dermatologist, also in St. John's. (Submitted by Shaina Goudie and Boluwaji Ogunyemi)

This column is an opinion by Dr. Shaina Goudie, a St. John's rheumatologist, and Dr. Boluwaji Ogunyemi, a St. John's dermatologist. For more information about CBC's Opinion section, please see the FAQ.


Newfoundland and Labrador's health-care crisis has been in the spotlight over the past several months, from an exodus of family physicians leaving the province to the medical association's suspension of contract negotiations with the provincial government.

It is an unfortunate reality that almost 100,000 patients in our province do not have a family physician.

We would guess that even more do not have access to a stable and consistent family physician because of the high turnover of physicians in some rural areas.

The lack of continuity in those instances is almost as difficult as having no one at all.

Family doctors here are beyond capacity, stretched in every direction, and the consequence is that their patients may not have as ready access to them as in years past.

Nearly 100,000 people are without a family doctor in Newfoundland and Labrador, according to the province's medical association. (iStock)

As many practices already see more patients than they can manage, this results in some patients having to wait several weeks just to get an appointment with their family doctor.

As specialist physicians, we cannot be silent on this issue.

Knowing our family medicine colleagues do not have sufficient support — and the people of our province do not have access to the care they deserve — is something for which we must offer our voice. We see ourselves as allies for family doctors and want to help shed light on this dire shortage and the inequity it creates, especially in rural parts of the province.

It's called a bottleneck for a reason

We also must speak out about the trickle-down effect that the lack of family physicians has on the care patients are able to receive from specialists.

A family physician shortage can cause a bottleneck on specialty services. In an ideal situation, a specialist would complete a consultation and then return the patient when appropriate to the family doctor for ongoing management, with a clear plan in place.

When there is no family doctor to return the patient to, how do you discharge a patient with their care plan?

The short answer is we often don't.

Many of us continue to follow patients that we typically wouldn't otherwise, because following up with a family doctor is impossible for one in five residents of this province. This limits our capacity to bring other patients into specialty practices — and thus reduce their wait times.

Goudie and Ogunyemi say Newfoundland and Labrador's shortage of family doctors results in added pressure on emergency rooms. (Paul Daly/CBC)

Second, when a patient has no family doctor, it is difficult to access a specialist in the first place. The fallout from this is twofold. One outcome is that patients have no option but to go to their local emergency department to deal with conditions that are not truly urgent. This clogs the already strained emergency services.

Other patients will wait and wait and wait, not wanting to go to the emergency room or a walk-in, until they get so unwell that they have no choice. By the time the referrals do get made, patients are too often beyond a stage in their disease for early intervention.

What happens next?

The result is that the patients that specialists see are often in a more advanced stage of disease. They require more aggressive intervention, and there are fewer effective management options.

In a late-presenting rheumatoid arthritis, that could mean permanent joint destruction and loss of function. With a late-presenting melanoma, that can mean significant surgery and possibly chemotherapy.

This also, over time, creates a two-tier system of sorts, in which patients who have access to a family doctor are more able to access not just primary care but also specialist care, than patients without a family doctor.

Some patients have a misconception that if a doctor is a specialist, they must also know everything about primary care.

Specialists are not trained as family physicians and do not have their knowledge and expertise — let alone their long-standing relationships with their patients. We regularly get asked about everything outside of our own areas of expertise.

Some dismissively say that specialists should just accept this, try to beef up on primary care knowledge and accept that if we want to work in Newfoundland and Labrador it comes with the territory.

There is no substitute for family physicians. Not other specialist physicians and not nurse practitioners.

This cannot be the case. Not to be obstructive, not to withhold care for patients in front of us, and not just because we should focus on what we were trained to specialize in.

Physicians doing double the work is not the way to bail out a system that is broken. We will always do our best for our patients. But we also need resources, respect and support to be put into primary care urgently.

Without family medicine, we cannot move forward.

Bluntly, there is no substitute for family physicians. Not other specialist physicians and not nurse practitioners.

Health-care delivery in Newfoundland and Labrador is in crisis. Our province needs deliberate, urgent and effective action by policy-makers because we cannot afford to have this house of cards collapse.

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