Halifax's refugee health clinic 'stretching at the seams' due to doctor shortage

Wait times are getting longer at Nova Scotia's only refugee health clinic as it tries to find family doctors for a growing number of patients.

The Newcomer Health Clinic in Halifax is supposed to transition patients to a permanent family doctor or nurse practitioner within two years, but that largely isn't happening. A big reason is that there simply aren't enough doctors.

"The amount of people coming into a clinic versus those transitioning to a permanent family doctor, that's not balanced out yet and we're definitely growing and growing, and very much stretching at the seams," Dr. Tim Holland, clinical lead, told CBC's Information Morning.

Of the clinic's roughly 1,800 patients, 46 were transitioned to a doctor or nurse practitioner in 2018, according to the Nova Scotia Health Authority. The majority self-transitioned, meaning they found a new doctor on their own. 

Holland estimates the clinic has only been able to find a doctor for between 10 and 20 per cent of patients since opening in 2015.

​The Newcomer Health Clinic has one full-time doctor, eight part-time doctors plus two registered nurses. 

Holland said it's thanks to this small but hardworking team that they haven't had to turn any patients away, and he doesn't believe the bottleneck is negatively impacting patients' health.

"But I mean every time you have to push back wait times, another week, another week, to see your regular appointment there's always that risk that exists," he said. 

Some doctors reluctant 

The clinic accepts privately sponsored refugees, government sponsored refugees and refugee claimants. Many refugees who arrive in Canada come with chronic conditions or health needs that haven't been treated in years.

But while the lack of family doctors is squeezing the clinic's resources, it's not the only challenge.

An article last month authored by a number of medical staff with the health authority and refugee clinic outlines why it's not easy to find family doctors willing to accept refugee patients.

"It can seem like a fairly daunting endeavour for a lot of people who've not worked in this population," Holland said. "They might be worried that 'Oh, I don't know what infectious disease issues happen in that country or what the burden of certain chronic diseases are from another region in the world.'"

Holland said the language barrier and time it takes to work with an interpreter can also dissuade doctors.

It can seem like a fairly daunting endeavour for a lot of people who've not worked in this population.- Dr. Tim Holland, Newcomer Health Clinic

That's why the Nova Scotia Health Authority, and doctors like Holland, are trying to convince physicians that it's not as daunting as it seems.  

"We're really looking to reach out to connect people to ensure that their comfort level and understanding [exists]. The refugee community, there's nothing significantly different about what their day-to-day care will require," said Graeme ​Kohler, the director of primary health care, family practice and chronic disease management for the health authority's central zone.

Kohler said any special health problems that refugees may come to Canada with are usually treated within the first two years at the Newcomer Health Clinic.

Transition process studied

In addition to treating patients, the clinic works closely with family doctors, including familiarizing them with interpretation services. It has also set up a refugee health network where doctors, nurses and dentists regularly meet to share information and talk about challenges.

"The physicians and nurse practitioners who have taken on refugee patients universally say it becomes one of the most rewarding parts of their day," said Holland. 

The health authority is now working on a study to see how it can better transition refugees, a model it hopes to share with clinics across Canada. 

Holland hopes it means they'll be able to expand their capacity so Nova Scotia can welcome even more newcomers.

"The more the Newcomer Health Clinic can bring in more patients … that means the more people we can take, more families, more children that we can take out of displaced areas, out of refugee camps and bring to Canada."