'We're drowning': A Q&A with an N.L. physician about N.L.'s critical family doctor shortage

Some 99,000 people in this province — about one in every five people — are without a family doctor, according to research by the Newfoundland and Labrador Medical Association.

The shortage has all kinds of repercussions, from overbooked clinics to long wait times, and it's affecting both patients and physicians alike. 

Nicole Stockley, a family physician at Summerhill Clinic in Conception Bay South., says attempts to recruit another doctor for her clinic have been fruitless. 

Stockley shared her experience dealing with the doctor shortage with the CBC's Adam Walsh.

Q: Can you give us a little bit more of an overview of the current situation at your clinic? 

A: Our clinic services about 10,000 patients. The clinic has been around for quite a long time, about 35 years, and at the end of June, the physician who established the practice retired. Since he retired, we haven't been able to recruit a new family physician.

Q: How many patients were impacted by the doctor's departure?

A: He had about 2,000 patients or so. And we discussed as a clinic what to do about that. Of course, our hope had been to get a new family physician to join and help take over some of his patients. But we weren't able to do so. We agreed that, instead of them having to go into that kind of unattached pool that's growing in number, we would absorb them into our practices.

We've been doing our best to try to add those patients into our already-full practices in order to continue to provide them care. 

Q: Remind me how many doctors you have there with yourself? 

A: There's five of us. So that's on average 2,000 [patients] per person. 

Q: How do you even start to stay on top of that? 

A: You don't, to be honest.

This has been an issue for a very long time. I think for years now, family physicians have just been taking on patients because we see them and we know that they need care. And so we've grown our practices far beyond what is sustainable.

At some point you start losing hope that it's going to get any better.

Then you add a retirement on to that, and our wait times have gone from one to two weeks for an appointment to five to six over the last several months. And that is so frustrating for the patients, and it's so frustrating for us because you can't provide good care when you can't see your family physician for five or six weeks.

We try to offset that by having same-day appointments so patients can call first thing in the morning and try to get an appointment the same day. But with our clinic receiving about 5,000 calls a day, we're on those phone lines. Again, a very frustrating process. 

Q: What are the long-term issues that can come up over time with these types of delays? 

A: When we can't get our patients in and our patients feel like they have to go elsewhere or their care is delayed, we really feel like we've failed as family physicians.

There's difficulty booking people for followup. You see a patient. You start a new medication or you make a new diagnosis. You want to see them for a couple of weeks. You fit them into your clinic. There's not really an appointment, but you make one for them. So that just increases the number of patients that you see per day. Now we run late, and patients are very frustrated because their 10 o'clock appointment doesn't happen until 11 o'clock or so.

Then things start to get missed: patients who need routine followup for, say, their diabetes every three months, that's not going to happen every three months. Maybe it's going to happen every four or five or six. And that's not the care that we want to be providing. 

Q: What can you tell me a bit about [your clinic's] efforts to find a new doctor? 

A: We've advertised the position through social media, through the online Labor Medical Association website, and newsletters, the practice, our website, et cetera. I do a little bit of teaching, so whenever I'm in front of a group of family medicine residents, I try to plug our clinic. But it's really been to no avail. 

Q: Why is it taking so long to find? 

A: There isn't anybody, and I think that's really the sad and frustrating situation. You know, the new family medicine graduates aren't going into community family medicine, and I can't really blame them, although I hope they're not listening right now.

It's an unsupported system where we have long-established problems. At some point you start losing hope that it's going to get any better. And and as a new grad, why would you work in a system where you don't feel supported and where there's a constant overwhelming amount of work and a sense of never being able to make any headway? 

Q: Are you seeing any hope for change at all? 

A: I hope so. It's fine to talk about it. And, yes, the health accord is coming, and I think there's going to be great recommendations that come out of it.

But we know what those recommendations are going to be. We've been talking about it for years. It's implementing interprofessional teams. It's providing more support to community practices. It's making sure all of the patients of the province have access to a primary-care provider and it's changing the remuneration process for physicians.

It's great that we're talking about it, but nothing seems to be happening. 

Q: What's your message to Premier [Andrew] Furey and [Health Minister John] Haggie?

A: I think it's the recognition of our struggle. We're drowning, and we don't know if and how to get out of this. We talked about physician burnout and it's not the ability to have a social life or take a day off. It's that we can never escape the ever-present and constant pressure to do more and try to service all of these patients. 

This interview has been edited for length and clarity.

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