The lack of a maternity teaching clinic at St. Paul's in downtown Vancouver has resulted in some family practice residents being sent to other hospitals to meet training requirements.
Family practice residents at St. Paul's are being scheduled for four weeks of obstetrics training at the hospital, down from a previous eight, to ensure their training meets a new curriculum set by the College of Family Physicians Canada, according to internal documents. Introduced in 2012, the "triple C" curriculum (comprehensive, continuity of education and centred in family medicine) focuses on competencies and is designed to ensure that residents learn the skills they need by practising those skills under experienced mentors.
Without a maternity teaching clinic, St. Paul's will find it more difficult to provide the training called for in the new curriculum than if the proposed facility had gone ahead, a site director said.
"The service implications for [obstetrics] are big, in that as of July there will be a 50-per-cent reduction of [first-year residents] available for [obstetrics] on call and service on the ward," Betty Calam, site director for St. Paul's hospital, said in an April 10 e-mail to doctors and administrators at Providence Health, which oversees St. Paul's.
"We are concerned about the capacity in the [St. Paul's] community to accommodate 14 [first-year residents] for our "integrated maternity," so any consideration of a primary care ambulatory maternity clinic at St. Paul's would prompt me to return the residents to a longer experience at St. Paul's," Dr. Calam added in the e-mail.
The Globe and Mail obtained the correspondence, as well as a 2012 proposal for a maternity teaching clinic at St. Paul's, through a request under B.C.'s Freedom of Information and Protection of Privacy Act.
Family doctors at St. Paul's have been lobbying for a maternity teaching clinic – in which a group of doctors team up to provide maternity and newborn care – for several years, saying such a facility would improve maternity care for Yaletown and downtown residents and improve teaching capacity.
So far, however, the clinic has not gone ahead, in part because of space constraints at the hospital.
The recent changes to family practice residents' training at St. Paul's will not affect patient care, said Willa Henry, program director for the family practice medicine program at the University of British Columbia's faculty of medicine.
"Women's health has never been at risk – they can still access family doctors in their offices, they can still access obstetrical clinics," Dr. Henry said in a recent interview. "It's just that there is not an on-site [maternity] clinic – which would have been great for not only patient care, but as a teaching facility."
St. Paul's is a training site for UBC's family practice program. About 30 family practice residents – split between first- and second-year residents – train at the site each year.
Not all residents will choose to provide maternity care once they start their own practices, but "consistently we have more residents interested in learning these [maternity] skills than we have available family medicine preceptors who provide and model the care," Dr. Calam said in a May, 2013 memo about the program.
The declining number of family physicians who provide maternal care is a concern across Canada, particularly in remote and rural communities. The Society of Obstetricians and Gynaecologists of Canada in 2008 cited a "looming shortage of health-care professionals providing obstetrical care" in calling for a national birthing strategy.
A maternity clinic at St. Paul's would have made it easier to attract and retain a new generation of family doctors, says Lana Lipkowitz, who heads the Family Practice Obstetrics division at St. Pauls.
"We have a shortage of physicians doing family practice and maternity [care] in this community," Dr. Lipkowitz said in an e-mail. "If we mentor them, they are more likely to stay. Right now, they are going to B.C. Women's and other maternity centres."
A maternity clinic is on the drawing board for a revamped St. Paul's. Liberal Premier Christy Clark announced plans to redevelop St. Paul's in June, 2012, but the project has yet to break ground.
In a mandate letter to Health Minister Terry Lake last month, Ms. Clark included "finalize the St. Paul's and Royal Columbian Hospital revitalization plans" as one of twelve targets for the minister this year.
The clinic remains under discussion, Linda Lemke, director of maternity services and surgical programs for Providence Health, said in an interview.
"We are continuing to work this group to find a solution," Ms. Lemke said.