Former hospital administrator, Katherine Walters, at her home on Bell Island, N.L.GREG LOCKE/The Globe and Mail
When Bell Island lost its last remaining family physician a few months ago, residents did the only thing they thought they could do – they tried to seduce him into coming back.
It was a move of desperation that temporarily worked. People on this windswept island of 2,500 in eastern Newfoundland and Labrador, once a hub of iron ore mining, created a Facebook page called the Bell Island Grand Seduction. It was full of glowing reviews for Firas Ayar, who had worked there since 2013. Dr. Ayar did return on an 11-week temporary placement, but eventually, unable to secure an acceptable long-term contract, he left again for Ontario.
Stories like this are becoming increasingly common in rural communities across N.L., where a severe physician shortage has left a quarter of the population without a family doctor, up from 11 per cent a decade ago, according to the province’s medical association.
Fogo Island, on the northern coast of Newfoundland, also lost its only full-time physician this spring – the first time in 200 years the island has been without a doctor. In Bonavista, a shortage of doctors forced the temporary closure of emergency services at the Bonavista Peninsula Health Centre, requiring people seeking care to drive 90 minutes away to the next nearest hospital.
Newfoundland and Labrador grappling with severe doctor shortage
The situation is only getting worse as roadblocks to recruitment pile up, including infrastructure problems that make rural areas unattractive for prospective doctors, the end of a provincially run program that once attracted internationally trained physicians to Newfoundland and a general countrywide shortage of doctors.
Without a doctor on the island, patients who need emergency care have to be taken via ambulance on the ferry to Portugal Cove, and then on to a larger hospital in St. John’s. The internet is spotty here, making virtual care difficult, and there are limits to what the island’s sole nurse practitioner can do.
Ken Kavanagh, who organized the campaign to keep Dr. Ayar on the island, said no one can blame any doctor for refusing to take on a workload once shared by three physicians.
“Given the health care crisis in this province and in this community, why would any family physician come to an isolated community and be possibly subjected to the extraordinary and perhaps uninformed expectations of a community?” he said.
A ferry ride to Bell Island on the MV Flanders (above) is a 20 minute trip from Portugal Cove.GREG LOCKE/The Globe and Mail
The N.L. government has promised reforms to its distressed health care system, including new plans for physician recruitment and retention. They’re instating community-based collaborative health teams and increasing access to virtual care to reduce the demands on family doctors.
But rural communities complain these plans are complicated by infrastructural issues, such as weak internet and unreliable ferry connections, which make remote locations unattractive places to work.
Katherine Walters, a former hospital administrator who has lived on the island for 10 years, says she’s hopeful the province can finally begin to address some of the systemic problems in its health care system. But Newfoundlanders have heard grand promises before, and seen little change, she said.
“We’re very wary when new things come around because, by God, new doesn’t always mean good for us,” she said. “This province has a bad track record for planning and following through on those plans. It just doesn’t look good.”
To make matters worse, N.L. is trying to rebuild its primary health care system at a time when the competition for family physicians within Atlantic Canada, and around the country, has never been greater. Hospitals across Canada are struggling with long wait times in their emergency rooms, and many rural communities are temporarily closing local medical clinics because of staffing shortages this summer.
Within Atlantic Canada, the fight for doctors is only getting more fierce. Nova Scotia – where the Tim Houston government swept into power on a promise to fix chronic doctor shortages – recently announced it had recruited more than 160 new physicians in the 12 months ending in March.
The province is aggressively courting doctors with $10-million in incentives that encourage them to set up practices in rural areas, in addition to a new recruitment office to promote the province’s quality of life. The government has sent international recruiters to Scotland, Ireland, London, Singapore and Dubai to lure nurses, doctors and continuing care assistants to Nova Scotia.
Nova Scotia has also introduced a new compensation model, copied after New Brunswick, where family doctors are paid based on how many patients they have and the number of services they provide, instead of a fee-for-service model that physicians complain leaves them overworked and is an impediment to attracting new doctors.
Meanwhile, Prince Edward Island, where more than 17 per cent of the population lacks a family doctor, sent its chief physician recruiter to St. John’s in December to make her pitch to Memorial University medical students. That prompted N.L. politicians to complain their government needs to do more to retain those same homegrown graduates.
The Dr. Walter Templeman Health Centre on Bell Island, N.L.GREG LOCKE/The Globe and Mail
In N.L. there is a proposal to modernize doctor salaries, away from a fee-for-service model and toward a blended model that pays them for a broader range of work beyond just billable services. The old pay model is increasingly unappealing for a lot of doctors who may not want to be the only physician in small, aging communities where there’s more need for help than they can provide.
“Historically, physicians have felt somewhat trapped in these communities. They haven’t had the support they needed, and they can’t get any relief,” said Newfoundland and Labrador Medical Association president Kris Luscombe. “They’re saying, ‘I can only do so much.’”
There is optimism some of the reforms introduced by N.L. Premier Andrew Furey, himself a doctor, can begin to turn the tide. But after years of decline, there’s a lot of work to be done. Until 2021, the province’s doctors went four years without a new contract, allowing its pay rates to slip behind other Atlantic provinces who were trying to lure the same medical school graduates.
“We’re starting to see some attention to this shortage, and some investment. But that’s on the backdrop of a decade of it languishing and going backward,” Dr. Luscombe said.
“Young physicians are highly valuable, and the other Atlantic provinces are becoming increasingly aggressive on recruitment. We were falling very much behind.”
Many of Newfoundland’s rural communities have relied on foreign-trained doctors to fill critical roles in health care. More than 500 international physicians came to the province after 1997 under the old Clinical Skills Assessment and Training Program, which was phased out in 2019. That program allowed physicians who were trained outside of Canada to become licensed in Newfoundland more easily than elsewhere. It was replaced with the national Practice-Ready Assessment program that removed the province’s advantage as a place to start a career in medicine in Canada.
N.L. has further pledged to create new immigration pathways for international medical school graduates, but that plan has yet to be put in place. The province is also increasing the number of students in practical nursing programs by 40 per cent, who will play a greater role in rural community health care.
The Canadian Medical Association say locums, or temporary doctor placements, could help ease some of the physician shortages in rural communities. But licensing restrictions between provinces can make it difficult for physicians in other parts of Canada to get approved to work in Newfoundland, even those with years of experience.
“Locums offer a lot of potential,” Dr. Luscombe said. “If there’s physicians elsewhere who have capacity to come here and work, then reducing those barriers would be helpful.”
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Greg Mercer