Recently I was driving up the highway, heading to my last day of work in Ferryland, a coastal community just south of St. John’s.
I’d begun helping out at the primary care clinic there one day a week a couple of months prior. The morning sun was just breaking through the fog, and every branch on every tree was outlined in silver. It was magical. I turned off the radio, a lump rising in my throat.
The Southern Shore was the first place to welcome me when I moved to Newfoundland in 1998. To have it become part of my medical practice was satisfying in a way that is difficult to explain.
There were people with lots of medical concerns. But they’d also tell you about the badness they got up to as youngsters, or where I’d be sure to find some blueberries on my way home, while rattling off endearments and thanking me ever so much for my time.
They were funny, gracious and tough.
And today I’d have to say goodbye. Because like so many other doctors before me, I was leaving.
Not by choice, mind you. We all know the heated arguments going on right now about primary care. We know we’ve been told we need to cut 25 per cent from the provincial health care budget. And we all know people who are desperate for a family doctor.
Here are some challenges and obstacles
There are many reasons the ones who train here leave. We have an aging population with a high dependency-to-worker ratio, making our tax base vulnerable, and one of Canada’s highest rates of complex medical needs.
It’s not uncommon these days for people to wait weeks for X-rays and months for ultrasound. It’s painful for patients who feel hamstrung. And there are days after getting home late after dealing with any number of emergencies and surprises and a mountain of paperwork, when setting up practice in a place where people aren’t so sick, or where the margin after overhead is a little friendlier, seems not only attractive, but necessary.
Doctors in Newfoundland and Labrador make among the lowest gross earnings in the country. With a ticket to work anywhere, you could find lots of reasons not to stick around.
But the thing is, a lot of our grads would – if they could. I know this because I’m one of them, and I know it because my medical friends have told me.
They want to be here because it’s home. Or because the work is interesting and important. Because they feel they have something to contribute.
Yet friends whose specific stories are not mine to tell have been advised to go away and do a particular fellowship because that subspecialty was needed here, only to find no job when they came back. About 10 years ago, a group of graduating Memorial University residents representing six different medical services, myself included, sat down with the powers that were and asked for all of us to be able to work at the Carbonear hospital.
That went nowhere. Other friends were simply offered jobs elsewhere and weren’t approached by a recruiter here.
I’m a family doctor, and I always joke I could work out of the back of my car. I went to medical school and did my residency here. I’ve been fairly public about how motivated I am to stay.
So while I can tolerate taking longer to pay off my student loans and wait times for my patients and frustrating bureaucracy and even being put down by those who complain about the care family doctors provide, I am also married to a surgeon.
He was born and raised here, trained here, wants to work here—in a field with long wait times. We brought our kids home last summer and I started a faculty position here.
I was over the moon to have things finally be settling into place.
But a job application and many letters later, there was still no work for him.
He has his own full-time practice elsewhere, and our young kids can’t live in two provinces. I shed many tears, and — after a year of being oh-so-close — I submitted my letter of resignation.
Patients in the parking lot
Not long after I had to resign, I was passing by the ambulance bay at the Health Sciences Centre. Something looked funny. I stopped and counted. There were 12 ambulances lined up in neat rows. Was it a convention or something? A paramedic noticed me counting and stuck her head out the window, laughing.
“Do all of you have patients on board?”
“Every one of us. Can’t get into emerg, so we have to wait with them here. There’s not another ambulance in the city right now.”
I thought about the referral I received recently — from emerg — for prenatal care. A woman, early in pregnancy, but without a family doctor, had called around to four clinics to see if someone could look after her, and none could.
She was eventually told to go to emerg, maybe a doctor would see her there. These were not lazy doctors she called. These were doctors who felt they couldn’t adequately look after the patients they already had.
Every week I get a call or text from a friend or a query from a patient. Do I know of anyone accepting new patients in St. John’s? For a brief moment I was proud to say, Yes! Me! I couldn’t help the almost 20 per cent of the province currently thought to be without a family doctor, but I’d do my best to help a few hundred of them. Now, the answer was a heart-breaking No.
It guts me to hear the mudslinging between politicians and advocates while having to tell my patients that I’m heading back to the mainland and offer them bland reassurance they’ll get the care they need.
We need more shoulders to this wheel
I trust that my colleagues will continue working their guts out to look after them. I also believe we should open the taps and provide every primary care resource at our disposal: train more nurse practitioners, allow pharmacists to work to their full scope, call the midwives.
Lord knows we could use as many shoulders to this wheel as possible.
In medical school, we’re taught to believe we’re a resource to a population, and it makes me grind my teeth that I won’t be here to help.
I quit a job I loved in mid-career because, as the story goes, I was tired of complaining about the doctor shortage when I thought I might be able to do something concrete about it.
That was 17 years ago, and I’m no closer to doing it. I look back now on that decision and blush at my naiveté. I wonder if I ever asked myself the question, Is there a doctor shortage? Do we all even agree on that?
Because to look at the current state of things, I’m not sure we do. We’re too preoccupied with the divisive politics of scarcity.
As I came around a bend in the road past Mobile, a thin line of sun opened up on the horizon.
A little further on, there was Fox Island, sitting patiently in Tors Cove, freshly misted.
It was time for me to fold and move along. But austerity planning has to begin with what we’re not willing to give up, and I can’t imagine what it would take for me to give up on this place.
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