A planned maternity-care clinic at St. Paul’s Hospital has been put on hold, disappointing doctors who had been lobbying for the facility and potentially forcing family practice residents to go to other sites to get required training in obstetrics.
The clinic would have provided space for a group of doctors to offer pre– and post-natal care to women and their babies, and allowed doctors to spell each other off when it came to deliveries. It was to have started operations this year, says Catherine Reilkoff, head of the family practice obstetrics division at St. Paul’s.
It would have enhanced training at St. Paul’s and helped serve a burgeoning number of women who live in or near downtown Vancouver and may have a hard time finding someone to deliver their babies if they don’t already have a family doctor, Dr. Reilkoff maintains.
“One of the big elements of this was teaching. But another big element was just providing community service,” she said.
Doctors involved in planning for the proposed clinic at St. Paul’s say the lack of such a facility could compromise maternity-care training and affect future accreditation.
Without such a clinic, they say, it could be difficult for residents to get the full range of experience called for by the College of Family Physicians of Canada. Under a “Triple C” curriculum introduced over the past few years, training is supposed to be “comprehensive, focused on continuity of education and patient care and centred in family medicine.” A family practice maternity clinic, the thinking goes, is more likely to meet those requirements than a model in which residents learn through stints on the obstetric care ward.
Currently, St. Paul’s is accredited by the CFPC as a training site for University of British Columbia residents in family medicine. Doctors who have obtained a medical degree require a two-year residency to be certified as family doctors and can pursue residencies at a number of sites across the country.
Still, CFPC accreditation teams “seemed comfortable” with the situation in B.C. around family practice residency training during a recent review, David Snadden, UBC’s senior executive dean of education with the faculty of medicine, said Friday.
The clinic was put on hold late last year after the doctors involved and Providence Health Care, which runs St. Paul’s, failed to agree on how many hours each week the doctors would have to the space.
Dr. Reilkoff and other doctors say a family practice clinic can improve patient care by ensuring continuity even after a baby is born. That prospect is appealing to patients such as Nina Carnegie, who struggled to find a physician after she moved to the Lower Mainland from Ontario last year, when she was seven months pregnant.
After finding a physician at a walk-in clinic, she was politely shown the door after her baby was born because no physicians at the clinic were taking new patients. Soon after, however, she was able to return because the clinic – operated by one of the doctors who wanted to run their maternity practice out of St. Paul’s – took on a new doctor. “It is a big-time relief – I am with someone who knows our history now,” Ms. Carnegie said. “You don’t have to recap the whole situation – the relationship has already been established.”
Hospital-based family practice maternity clinics are seen as one way to encourage new family doctors to deliver babies when they launch their own careers. In recent years, the number of family doctors delivering babies has declined, in part because young doctors are shunning the 24/7 demands that commitment can entail. By teaming up with other doctors at a family practice maternity care clinic, doctors can share on-call duties as well as administrative and overhead costs.
Haneen Remaileh, a UBC medical graduate working as a locum, or replacement doctor, primarily for maternity doctors at St. Paul’s, says she would have welcomed an opportunity to work at a clinic at St. Paul’s. “I don’t always get as much exposure [to maternity care] as I would otherwise have liked,” said Ms. Remaileh, who did her residency in Alberta. “Because sometimes I am locuming for a family practice doctor who doesn’t do maternity care.”
Maternity-care clinics work well for patients and doctors, says Shelley Ross, who co-chairs the General Practice Services Committee, set up in 2002 to tackle the declining number and low morale of family doctors in the province. “The way that I did obstetrics – that’s not sustainable any more,” said Dr. Ross, who practises at Burnaby General Hospital. “Nobody wants to work 24/7 any more and I don’t blame them.”
Similar concerns are part of a new campaign from the Midwives Association of British Columbia, which in January unveiled a proposal that would increase the number of midwives in the province and boost the percentage of babies they deliver from 16 per cent to 35 per cent by 2020. The province has said it will review the MABC’s position.
A maternity-care clinic is on the drawing board for a new tower planned for the St. Paul’s site. And Providence Health is still open to discussing how a clinic could be launched before that redevelopment gets under way, says a Providence Health Care official.
“We are always happy to work with our department and want to continue to do that,” David Byres, vice-president of acute clinical programs at Providence Health Care, said on Friday. “We’ll continue to examine other options and, if we can’t find one currently, we would consider to work towards the tower.”