Fredericton doctor with 'too many patients' forced to leave city

Fredericton doctor says she's moving her practice to Sussex because of a lack of "on-call" support from other doctors in her family physician group.

Dr. Sunita MacMullin is leaving behind more than 1,900 patients, although she's willing to see them in Sussex if they can get there.

MacMullin said she has to move because other members of her physician group would not provide backup for her.

Instead, she said, they told her she has too many patients — especially patients in hospital.

In a letter to her patients a few weeks ago, MacMullin said that without on-call support from other doctors, she would have to provide 24-hour care, seven days a week, which would not work.

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"This in itself is risky for me to be on 24 [hours], seven days a week and never having any vacation," she said. 

MacMullin said that at any given time, eight to 10 of her patients are in hospital. 

Dr. Edouard Hendriks, the vice-president of medical, academic and research affairs with Horizon Health Network, said there is no limit on the number of hospital patients, or inpatients, a doctor can have.

But MacMullin said her family physician group told her last March that she had too many hospital patients and the size of her workload was unacceptable.

Team approach

Like much of New Brunswick, Fredericton has a shortage of family doctors. 

Family physician groups are part of the province's effort to give people access to family doctors, including outside office hours. 

Under this team approach, patients sign up with a particular doctor, but they're able to see a different one within the group if their own is not available.

Being part of a group is voluntary for doctors. 

Took over another practice

MacMullin said the number of patients in her practice is related to the size of the relatively old practice she took over  from  Dr. Russ King a few years ago.

The New Brunswick Medical Society wouldn't comment on this case, but the organization said there's no specific policy, standard or guideline for the size of a family physician practice in New Brunswick.

A typical family practice would have around 1,300 to 1,500 patients, but some doctors have as many as 2,500 patients, the society said. 

The number could be lower for a physician involved in other work, such as palliative care, nursing home care or as an emergency department physician.

Exhausted possibilities

​MacMullin will move to her new practice by April 2018, since neither she nor Horizon Health's department of family medicine  was able to establish on-call support.

Every proposal I had was met with a simple 'No, we're not going to give you any backup.'-Dr. Sunita MacMullin 

MacMullin said Sussex, where she has been working in emergency for 15 years, was the only viable option short of leaving the province.

She will continue to do after-hours clinics and emergency clinics to provide care to her patients in Fredericton.

She signed a deal with Shoppers Drug Mart, which is building her a new office in the Sussex area.

"Luckily, my colleagues in Sussex … have welcomed my practice of medicine to the area and have created a healthy system of "on-call" support for one another.

In the letter to patients, MacMullin said she was also willing to care for them in Sussex, if they wished to commute, although this wouldn't help senior patients who can't drive.

MacMullin also noted she will no longer have admitting privileges at the Dr. Everett Chalmers Regional Hospital in Fredericton, and the Sussex Health Centre is too small to accommodate patients from the city.

Always a 'No'

MacMullin said she tried to stay in Friedericton. She was willing to give up vacations for a year but still there was no resolution with her family physician group. 

She also volunteered to take care of her own hospital patients if she could get coverage on weekends. She was ready to work every other weekend as well.

"Most physicians in a group work every sixth or seventh weekend or even eighth weekend," she said. "I said to compensate for the extra work, I'm willing to do this and their response was 'No.'" 

She said her group even took issue with her affiliation with Shannex, where her office is located, but MacMullin said she has only 28 patients at the retirement home, and only three who were ever admitted to hospital.

Before she was kicked out of the physician group, MacMullin tried to join another group.

"The other groups were not interested," she said. "Nobody stepped up."  

No one responsible

MacMullin said she also sought advice from the College of Physicians and Surgeons, but the college said there's no requirement that a physician have backup. 

"Every proposal I had was met with a simple 'No, we're not going to give you any backup,'" said MacMullin.

Stéphane Robichaud, CEO of the New Brunswick Health Council, said no one has responsibility for managing physician groups in the province, so it's up to an individual doctor like MacMullin to solve problems that arise.

"At the end of the day, we have a situation in New Brunswick for this very important part of our health system where we have never clarified responsibility for the management of this part of the system," he said.

Robichaud said if someone was designated to oversee physician groups, the allocation or patient loads would be done in a planned and co-ordinated way. 

"Everyone pretty much works [and] every unit works essentially in silo," he said.

CBC News tried to talk to Dr. Ed Schollenberg, registrar with the College of Physicians and Surgeons of New Brunswick, but he would not comment.

CBC News has also tried to speak with some of the doctors in MacMullin​'s Fredericton physician group. Some initially said they wanted to choose a spokesperson, but in the end no one would talk.

Filling MacMullin's practice

Hendriks said MacMullin informed Horizon of her decision to move her practice to Sussex. 

"It is common in any profession for employees to come and go for various reasons," he said in a statement to CBC News.

He said Horizon is trying to recruit someone to take over her practice but suggested her patients contact Patient Connects in the meantime.

He said physician recruitment is a priority for Horizon Health Network.

"We have seen some improvement in New Brunswick over the past year and remain optimistic we will fill Dr. MacMullin's vacancy," he said.