Doctors closing, moving practice because of infrastructure needs, says Yukon Medical Association

The president of the Yukon Medical Association says he's noticed a "concerning trend" lately, with some physicians closing up or moving their practices out of the territory.

"In many cases patients of the closed practices were not able to find a new physician," said Dr. Derek Bryant.

"What we're seeing is there's some very significant pressures and challenges to primary care and practice in the Yukon right now that are potentially leading to these closures and may continue to [cause] difficulty accessing a physician."

Bryant says that in the past 18 months, four medical practices have closed in the territory.

He says part of the issue is an "absence of infrastructure" in the territory.

Bryant said a lack of available office space was behind the decision by two family physicians at the Whitehorse Medical Services clinic to close up practice this spring. The clinic is closing its doors and Dr. Zale Apramian and Dr. Lia Johnson announced they wouldn't be relocating their practice like their colleagues at Whitehorse Medical Services but will instead continue to work in the health care field in a different capacity through the Whitehorse Hospital.

In a letter to their colleagues last week, Johnson and Apramian said the decision to close their practice did not come lightly, and "reflects a combination of professional and personal considerations."

"It is challenging to work within a system with insufficient support for family medicine," they wrote, citing the need to expand health-care infrastructure to better support doctors.

"In the absence of strong action by our health care administration, we fear that the territory will continue a pattern of sluggish recruitment and retention."

Bryant also pointed to the recent decision by an orthopedic surgeon at the Yukon Surgical Clinic at the Whitehorse Hospital to move his practice to B.C., which Bryant says came from "challenges with the surgical capacity at the [Whitehorse] hospital."

In a letter to his colleagues on Jan. 18, Dr. Adam McIntyre wrote that, "systemic under-funding of the orthopedic service has forced me to make the difficult decision to move my practice to British Columbia."

McIntyre also wrote that orthopedic service stopped accepting any new consult referrals in April of last year, citing concerns about maintaining standards of care in the absence of adequate resources.

He also urged his colleagues to continue to advocate for more surgical services for Yukoners as the territory's population continues to grow.

"The territory needs more robust support for patients and health-care workers," he wrote. "Prioritizing more operating rooms [ORs], more surgical time, and eventually, a new hospital, if they are ever to meet the demand and standards of care for Yukon patients — something that Yukoners dearly deserve," he wrote.

'Correctable' problems, Bryant says

Bryant said these doctors are closing or moving their practices because of "correctable" problems.

"We've already seen some improvement. There's an increase in beds in the hospital which would have resulted in fewer cancellations for surgeries," he said.

"What we would really need to see is an ongoing expansion in the number of beds so that we can keep up with our population and also an increase in the operating rooms." 

Yukon Health Minister Tracy Ann McPhee was not available for an interview. In a written statement to CBC News, she said her government is taking proactive steps to enhance orthopedic services in the territory. 

"The Yukon Government remains committed to improving surgical services and addressing long-standing challenges in health-care delivery," the statement reads.

"Planning is already underway for a new surgical facility at Whitehorse General Hospital, and we are increasing funding for total joint procedures to improve access to orthopedic surgeries."

Community health cooperatives

According to Dr. Raymond Rupert, a Toronto-based family physician, community involvement is an essential part of stabilizing health care in any area.

"The community has to get activated," said Rupert 

He cited examples in Saskatchewan and Quebec of "health care cooperatives, or collectives where communities have come together."

"They might supply a building, a clinic, equipment, admin staff or something. Sometimes the community has to step in to help with the operation or administration of the clinic." 

Rupert said families using such a service might pay a small monthly fee which would be put back into the clinic to support staff salaries, or purchase equipment, or cover additional expenses.

He said it's not just about bringing physicians into a community, but also keeping them there.

"Because after they've done some ice-fishing for a couple seasons, they're kind of done," Rupert said. "So you've got to think a bit smarter and figure out how to really change their work environment."