Shortage of doctors at Nanaimo hospital forces man with terminal cancer to wait for care, family says

A shortage of doctors at a Vancouver Island hospital forced an elderly man with a terminal cancer diagnosis to wait more than a day for follow-up care, according to his family.

And one physician says the lack of hospitalists is delaying care for many patients at Nanaimo Regional General Hospital (NRGH), though the health authority says critical care access is not being impacted.

An ambulance took Drew Smith's 88-year-old father, Bill, to NRGH on Wednesday

Bill Smith was admitted to the emergency ward and seen by an ER physician, who decided he should stay for ongoing care for a terminal cancer diagnosis, according to Drew.

However, there was no hospital doctor available to take over his case.

The family was told Bill might have to wait two days "in a hallway" to be seen by a hospitalist, a hospital-based general physician who co-ordinates care for patients with complex needs.

Drew says a doctor then handed them a letter, explaining the hospitalist shortage was due to "ongoing resource restrictions" at NRGH.

It also suggested the family could email hospital administrators and supervisors with any further questions, and provided a list of their email addresses.

Vancouver Island Health confirmed eight out of its 24 hospitalist positions are vacant after physicians left, but declined to comment on the family's case, citing privacy concerns.

"When a doctor gives you a piece of paper and basically says, 'You know, there's a problem here and you need to get the word out,' it's kind of like an eye-opener," Drew said.

'Backbone' of in-hospital care

When hospitalists are not available, there's nobody else at the hospital who can adequately pick up the pieces, says Dr. David Forrest, critical care doctor at NRGH whose work is affected by the issue. 

"They manage the vast majority of patients in the hospital," he said. "Hospitalists are the backbone of in-hospital care."

The shortage impacts patient care and the hospital in several ways, Forrest says.

When a hospitalist is not available to take over patients's care, it becomes difficult to move them out of intensive care units, resulting in less capacity for the hospital to admit new patients into the emergency department.

"Emergency physicians are oftentimes spending significant portions of their shift actually troubleshooting and managing, and trying to manage patients that are unattached, that are waiting in the emergency room to actually be admitted to the hospital," he said.

Patients aren't receiving continuous care from a physician as well.

"While everyone's doing his or her best … it's certainly not the best care and it means that patients are not getting continuous care from a physician group."

Critical care not impacted: Island Health

Although some patients are waiting longer to be assigned to a hospitalist after admission, critical care is not being impacted, Island Health said in an emailed statement to CBC on Friday.

"There are no extraordinary or unusual delays in admitting people who require the care of a specialist," read the statement.

Once a patient is triaged and assessed in the emergency department, they are supervised by a care team in an acute care space until they can be assigned to a hospitalist, the statement said.

"No one is being left without care. That is simply not the case."

The delays are, in part, because hospitalists have reduced their patient loads to reflect the lower capacity of their team, according to Island Health.

The health authority also acknowledged the health-care system's staffing crunch and says the hospital is seeing more patients, and more of them needing admission, which staff in the emergency department have been "stepping up" to support.

Doctors leaving for community practice

The shortage of hospitalists has gotten progressively worse in recent months, says Forrest, adding part of the problem is that they aren't paid at NRGH on par with others in B.C.

"Our hospitalist group, which is an excellent group of physicians, are managing a much higher acuity and have a greater workload for lesser pay than many of their colleagues across the province."

Forrest says the improvements to how community-based family doctors are paid in B.C. have made hospital-based practices less attractive, leading some to leave and work in the community, where they can earn more money.

While physician compensation is generally set at a provincial level, Island Health confirmed it is currently negotiating a new contract with hospitalists at NRGH, and trying to "understand what a contract would look like that hospitalists feel would lead to enhanced recruitment and retention of physicians in their group."

The shortage is affecting other hospitals, too. In May, a group of doctors at three Metro Vancouver hospitals spoke out about the crisis to CBC News.

B.C. Health Minister Adrian Dix acknowledged the problem, and said the province was "actively" working to hire more hospitalists. 

'They're tired'

Bill was moved out of the emergency ward into a room, and seen by an intern physician as of Friday morning, according to his family.

Drew said receiving the letter was difficult, but he's glad the doctors are speaking up.

"With the stress of your parent who is basically ... dying, and then you get that on top of it — I'm glad he was honest. Obviously for him to do that, he wants to see change too, because it's terrible."

Drew doesn't blame the staff caring for his dad, whose spirits are down due to his illness.

"Everybody that works in the hospital is doing their job to the best of their abilities," he said.

"But you could tell that they're tired, they're doing double shifts, they're getting called in for extra shifts."