Want to fix the family doctor shortage? First, you'll need to get a time machine
Many of the complex issues have been problems for decades
Last week, Health Minister John Haggie and Premier Andrew Furey went to Springdale for the official opening of the Green Bay Health Centre.
The new building has room for four doctors, but that quartet was not there to greet them. That's because three of the doctors had already left to work elsewhere.
Earlier this summer, there was a staffing crisis that required local physician Todd Young to step in and cover the emergency room, because the centre's sole doctor needed to take leave.
The Springdale area is just one place in Newfoundland and Labrador that is really hurting for doctors.
The Newfoundland and Labrador Medical Association says about 90,000 people in the province (about 17 per cent of the population) do not have a family doctor.
Emergency rooms, with wait times that are always challenging, have been particularly clogged this summer. Eastern Health has said the two St. John's ERs are overflowing in part because of a bottleneck related to a lack of beds in nursing homes. That's related to a nursing shortage, which itself has been connected to how relief nurses have been recruited to help staff COVID-19 vaccination clinics.
The push to vaccinate is winding down, which should relieve that particular issue.
It will not, though, relieve the bigger issue: many people will still not have a family doctor to call their own.
"This crisis didn't form today, all out of the blue. This has been building and building and building for years," NLMA president Susan MacDonald told the Telegram's Peter Jackson, as part of a thorough series on the current crunch.
"The status quo is just not good enough. We have a crisis in the emergency room, we have a crisis in family medicine … It's time to say enough is enough, and we have to change. Change is painful, change is hard for everybody, but we have to change how we do things."
Many of her colleagues would agree.
Far from a new set of problems
In fact, many of her colleagues have agreed with this for years. Decades, in fact.
I know this, because I heard them. For a good number of years, I covered medical politics in Newfoundland and Labrador, particularly in the '80s and '90s as a freelancer for The Medical Post and other publications.
That meant sitting in on the annual NLMA meetings in June, and reporting on the hot topics.
I won't forget the moment when the tickly issue of how family doctors get paid came to a head on the plenary floor of an annual meeting of the medical association. It was at the meeting room of the Mount Peyton Hotel in Grand-Falls-Windsor in the early '90s, when — in the midst of a heated debate, by medical association standards — a salaried physician warned the fee-for-service doctors that their destiny was to accept a different payment system.
"I am the future," she said.
But wait a minute.
Maybe the truly stark moment happened a few years later at the Glynmill Inn in Corner Brook, or a few years earlier at the Hotel Newfoundland, or maybe it was at the Hotel Gander…
Shortages of family doctors have been chronic, but some periods have been more alarming than others. I recall how pretty much all of one graduating class left the province to find work, in the wake of Premier Clyde Wells's administrative moves in the early '90s to curb spending. One of them was capping the number of opportunities to practise medicine.
Some critical issues then are still issues now. The most fundamental: how to manage limited public dollars to cover the needs of a public-payer medicare system, and the public's expectations. (Incidentally, that salaried physician's predictions for the future have not been proved true yet; according to the NLMA's own data, only about 29 per cent of their members are on salary.)
I also recall jurisdictional squabbles, with doctors touchy about what they saw as encroaching demands from other professions, particularly nurses. (Registered nurses can feel the same about, say, licensed practical nurses.)
This was no local phenomenon, by the way. Nationally, what was called "primary-care reform" even earned its own acronym: PCR. There were pilot projects, and loads of suggestions on how to transform how the public got that critical level of care.
The practice of medicine itself has changed considerably over the years. Doctors who have come into the profession no longer want to do the around-the-clock slogs that older generations did. A phrase from earlier decades that was particularly grating was the "feminization of medicine," often patronizingly used to suggest that the higher numbers of women moving into the profession were somehow to blame for medical shortages.
Would a time machine help?
There are no quick fixes for medical care. There never are.
Consider the thousands of people craving a family doctor, many of whom turn to emergency rooms for basic care. There is no secret holding room where doctors are just waiting for work. It takes years to make a new doctor, from an undergraduate degree through medical school to post-grad work to licensure. Tack on more years for a specialty.
When I was thinking about some of the current problems, I joked to myself that what we really need is a time machine, where we could go back and fix some primary-care issues.
Getting over some jurisdictional fights might have meant more co-operation with other health professionals, like pharmacists, say, who could have been doing more in their scope of practice. Or registered nurses, who could have been handling more duties under doctors' supervision.
There might also have been a greater flowering of interdisciplinary settings that can allow doctors to guide rather than be overwhelmed by steep waiting-room demands that actually do not require the skills of an MD.
I was writing about primary care reform in my 20s. I'm now well into my 50s. I'm not sure what to make of the fact that some problems from so many years ago are still on the table.
It's interesting to see doctors being a bit feisty again (and it's definitely worth noting that a contract negotiation is underway).
I do recall that one of the feistiest NLMA presidents was one John Haggie, the Gander surgeon who led his members into a strike in October 2002. The key issue was remuneration rates that Haggie described as the lowest in Atlantic Canada. Haggie, rather than their ally, now seems to be an adversary of the very group he led.
Let's see what problems get fixed in the months and years ahead. Hopefully we won't have to wait a few decades to judge their success.