GANDER, NL – More than a few people in the central region do not have access to a General Practitioner (GP).
Dr. Chris Dicks said he has turned down close to 2,000 patients since opening his practice four and a half years ago.
Dicks said his work started at 35 hours per week and increased rapidly to meet the needs of extra patients. He now works an average of 60 to 65 hours per week. Although Dicks recognizes the desperate need of patients without a GP, he had reached his limit.
“A lot of people struggle to see (the long hours) – they see your office hours as the work you do, but you end up doing patient work at home, there are on-call hours and your hospital work commitments,” he said.
“Taking on extra patients would either be a disservice to the current patient population I have, or would be to neglect my family. I had a choice and I had to stop accepting.”
As a result, these patients are left without a family doctor. Many have medical conditions like congestive heart failure and kidney failure, according to Dicks.
“Some of them are healthy and fine, and some of them are horribly sick, but you can’t say, ‘I’ll accept you, and not accept you’ based on health.”
By the numbers
Gander is a town of approximately 12,000 people, but its health care facilities service a population of 80,000.
The shortage of GPs in central is serious. According to Dicks, the ratio of GPs to patient is concerning. There are 10 full-time physicians in Gander, he said.
“For the population in Gander that it services, it is woefully inadequate.”
Dicks believes the addition of four full-time physicians will make a significant impact in addressing the issue.
The Newfoundland and Labrador Medical Association counts 593 family physicians in the province, 17 of them in Gander. Four are salaried, working either on the base or in the hospital, and 13 are working on a fee-for-service basis, meaning they see patients and then bill MCP for their care. Of those 13, three are based in the hospital and 10 work out of community-based practices.
According to data from the Canadian Institute for Health Information (CIHI), there was one family physician for every 793 people in the province in 2015, which is lower than the Canadian average of one GP per 868 people.
Up the chain
The shortage of GPs leaves patients with few alternatives for medical care. Dicks said some patients travel to other towns to see a GP. Others who are less mobile go to emergency at the hospital.
“The emergency room has been overwhelmed, and it trickles down from here. People are getting far sicker than otherwise because they aren’t able to see a doctor in time and end up in the emergency room,” said Dicks.
“In the emergency room now, on any given day, there is a six- to eight-hour wait time and the hospital is completely filled up with people who are waiting either to get a bed in the old age home, or just because they weren’t managed as an outpatient because there isn’t a physician that could do it.”
Central Health communications director Gaïtane Villeneuve could not confirm the wait times suggested by Dicks.
“Wait times in emergency departments are influenced by a number of factors – for example, emergency ambulance arrivals or complexity of patients’ health concerns,” said Villeneuve.
“Patients are advised during triage that if their condition changes in any way while they are waiting, to notify the triage nurse immediately,” she added.
Central Health recently took steps to address the GP shortage by filling two out of four full-time salaried hospitalist positions at James Paton Memorial Regional Health Centre, said Villeneuve.
“Patients who are admitted to hospital and don’t have a family physician are cared for by hospitalists,” she noted.
“That has lightened the load a little on us, but more can be done,” said Dicks.
The struggle to attract GPs continues in Gander. According to Dicks physicians are attracted to western Newfoundland for the outdoor life.
“And in the eastern region, everyone goes to medical school there and puts down the roots there,” he said.
Further, the Central Newfoundland Regional Health Centre in Grand Falls-Windsor is the teaching hospital.
“This means that everyone who goes through training, the experience is generally in Grand Falls-Windsor. And they don’t get much exposure in Gander,” he said.
“Unless you grew up here, there is no reason to be here. It does not make any sense. And that’s why I take on medical students – that is the exact reason.”
Medical school graduates come out of school with heavy student loan debt. One thing Dicks said the health authority could do to attract new doctors is make concessions for these students to start their practice and pay back their loans interest free.
“Really what it comes down to is to set up incentives to recruit people to Gander. There needs to be some extra financial incentives for people to come here,” he said.
Bringing in more doctors also has a trickle-down effect in the community. Surrounding businesses benefit from and rely on spin-offs like shopping, restaurants and the use of services in the town.
“When you lack physicians, this patient will travel further elsewhere and local business gets hurt by it in a very big way,” said Dicks.
As far as Dicks is aware, there is no locum use for GPs in Gander. A locum is a person who stands in temporarily for someone else of the same profession. He recalls the use of one a couple of years ago, but none since.
“We don’t get any and I don’t know why. Having locums is a great way of recruiting doctors to a certain area. As it stands right now, if anyone is interested in doing locum, they have more than their share of patients waiting to see them.”
Villeneuve said the hiring of GPs is handled by private clinics, but added the health region’s medical services department is exploring ways to attract additional GPs.
“The health region works with stakeholders like community-based private clinics to collaborate on ideas to better serve the health needs of the people living in Central Health communities,” Villeneuve said.
Dicks is aware that the shortage of GPs frustrates many current patients, and for those who do not have one, not much can be done from their end.
“Patients get frustrated when we can’t see them on a given day necessarily, but in our defence, we are not part of the problem,” he said. “We are part of the solution, doing what we can to service all the need that is out there.”