Need a dermatologist? After central N.L. clinic closes, only St. John's options remain
Dr. James Coffey was seeing more than 300 patients a week
In mid-June, Dr. James Coffey announced he would be closing his dermatology clinic in Grand Falls-Windsor to join his twin brother Joe — also a dermatologist — in St. John's.
When that happens at the end of the summer there will be no dermatologists left outside Newfoundland and Labrador's capital area.
James Coffey says after 10 years in practice it's hard to resist the lure of St. John's, with a wider range of services and procedures available in its hospitals.
"You have strength in numbers with on-call services. You have students and different resources available. I think it's hard to match that in the periphery."
Top doctor
When the provincial government in June released billing figures for N.L.'s doctors, Coffey was listed as the 10th highest paid, billing the government nearly $1.2 million in 2018-19. But he says the overhead for his private clinic, with 20 employees, including five nurses, isn't cheap.
"My overhead was $925,000 to provide care here in central, and that's a tab that I provided on my own, not Central Health," said Coffey, who said he pays thousands of dollars a month to ship liquid nitrogen to central Newfoundland for treatment.
But his biggest stress, he said, is the heavy burden of his ever-growing wait list. After Corner Brook dermatologist Dr. Joshua Mercer moved to St. John's in May 2019, Coffey took on many of those patients, who couldn't or didn't want to drive an extra 400-plus kilometres to the capital. It made for a busy office for him and his staff.
"The average dermatologist sees 120 patients a week. I was seeing 320 a week. We had a practice of almost 40,000 patients that we were delivering care to in Central and part of Western," said Coffey.
He soon had to stop taking referrals because of the demand.
"I would legally be liable for the flexibility of signing off on these consults but it might be a year before I see them, and if anything happened I'd be on the hook so it was easier to send them to someone in St. John's with a one- to two-month wait list and [they would] get seen in a timely fashion."
Common problem
Dr. Wayne Gulliver says it's a familiar story with specialists in the province.
For over 30 years, the professor of dermatology and medicine at Memorial University's school of medicine has been working to improve dermatology services in the province.
"When a person is there on their own, they're on call 24/7, and they have very little interaction with their colleagues. It becomes very difficult for one person in a specialty to survive," said Gulliver.
Gulliver said that is isn't unlike other specialties, like cardiology or rheumatology, and provincewide delivery of services needs to be rethought.
It becomes very difficult for one person in a specialty to survive.- Dr. Wayne Gulliver
He suggests the model used in Labrador is a start.
"We have two dermatologists that fly in there every four to six weeks, spend two or three days and provide a very good service there. And so we may have to consider, you know, such a model for Corner Brook and for Grand Falls-Windsor," said Gulliver.
Coffey also has a few suggestions on how to ease the burden for patients and physicians.
He would like to see more use of virtual care, with pictures and videos of patients provided to specialists by their family doctors, and a travelling clinic for regions who need the care.
He thinks his former employees can also help fill the gaps.
"Maybe we can find a way where nurses can work out of the hospitals and work remotely with dermatologists providing satellite clinics," he said.
A spokesperson for Central Health says the authority is not currently recruiting, but will be working with the group of dermatologists in St. John's to look at a combination of virtual care and travelling clinics.
Western Health says it's worked with locum doctors since May 2019, but that is on hold while travel restrictions due to the COVID-19 pandemic are in place. The authority is also looking into providing virtual care.
Coffey said he hopes to work with the provincial government to cut through the red tape he says is preventing it from happening already.
"Hopefully, we can bridge that gap when we meet as a group, come to a consensus on how we would like to provide care uniformly across the province and make sure every patient has equal access."