72-year-old Canso doctor calls for better succession planning

After practising medicine for 47 years in Nova Scotia, Dr. Cathy Felderhof is looking to reduce her workload and take some time off.

But finding someone to take her place has been a challenge.

She's been searching for two years for a doctor to take over her role in Canso, at the eastern tip of the province's mainland. She's had no luck.

She does not want to leave unless a replacement family physician is hired in the rural community she has grown to love over the past 17 years.

"It would be like leaving your children behind, you've taken care of them," said Felderhof. "You have taken care of all generations and you get to know them very well, so you want to be sure they're taken care of."

She has been helping care for the community of about 800 people along with two other doctors at the Canso Medical Centre.

They work in one-week rotations. During the rotation, they are on call 24/7 as the emergency room doctor for the Eastern Memorial Hospital across the street.

"We get calls during the night, not every night," she said. "It's a tough job in the sense that I'm tired when I leave on the seventh day."

Doctor shortages have been a problem for a number of years in Nova Scotia. As of  April 1, there were 88,359 Nova Scotians on the family practice registry wait-list.

'My job is to take care of the patient'

Felderhof is not ready to retire, but she would like to take some time off this summer to consider next steps. It's something she has never done in her long career.

"I can't even remember when I last took a week off to tell you the truth. It's hard to walk away."

She would like to see an improved strategy when it comes to succession planning for doctors.

It's been an issue for years, she said, and as of now there is no doctor scheduled to work the second week of May at the Canso family practice.

While keen to work in partnership with Nova Scotia Health on what the community needs, she believes the recruiting model needs to be examined.

"It's not my job to be doing that," she said. "My job is to take care of the patient, my training is to take care of people and their health concerns."

She said she informed Nova Scotia Health two years ago she planned to leave.

Dr. Chris Milburn said dropping down to two doctors in the rotation creates problems even over a short period. Milburn was recruited to the area by Felderhof around two years ago.

"There is a week's worth of patients that haven't been seen, prescriptions have to be refilled, they could have had an ache or a pain or something significant that they need to be seen," he said.

It's not realistic for Milburn to work any extra weeks. He has commitments to a practice in Sydney.

He said one of his biggest concerns is the impact on emergency care in Canso.  

"If we go down to two docs, inevitably we're going to have some weeks where there is no doctor here," Milburn said.

He said the nearest hospital is in Guysborough and that can be 45 minutes away if the weather is poor.

Some people in the area have been working with the local doctors to try to bring more attention to the issue.

"We're just doing what we can as advocates for our community and this area," said Bill MacMillan, who wants to see Nova Scotia Health make rural health care more of a priority.

"We're concerned about other communities similar to ours in the province of Nova Scotia where they have the same needs. Fifty to 60 per cent of people in Nova Scotia are taken care of through rural clinics or rural hospitals."

Determining where doctors are most needed

Dr. Kevin Orrell of the province's new office of Health Care Professionals Recruitment said he identified succession planning as a key area that needed attention when he took the job.

He said he's grateful for Felderhof's commitment to her community. Work is underway, he said, on a strategy to figure out which communities need new physicians in the province.

He said efforts are happening on a number of fronts to attempt to recruit doctors, including a $125,000 incentive for doctors who set up outside of Halifax.

"We have recognized for a time [that] rural medicine has been challenging and the replacement for these doctors that have worked so hard in these areas is going to be a plan that we need to initiate moving forward," Orrell said. 

That plan could look similar to one he helped introduce when he was president of the Canadian Orthopaedic Association. That plan had senior surgeons mentoring younger doctors over several years.

In addition, Orrell said he is in contact with Dalhousie University, aiming to find medical students who are willing to train in rural areas. Searches are also underway for doctors across Canada as well as in other countries.

He accepts those strategies will take time but, in the short term, doctors who work as locums could also be considered for some locations in need.

The health-care recruitment office has a goal of hiring 100 new doctors every year for the next 10 years.

Nova Scotia Health has posted a job for a family physician in Canso, but Orrell said two doctors might be needed given many senior doctors look after a large number of patients.

Felderhof has suggested mentoring younger doctors on the way to handing over a practice is something she thinks will work but is hoping new policies get put in place quickly.

"I have stated that I think the situation is urgent."