Town's chart doesn't look good

Unnati Gandhi
http://www.theglobeandmail.com

CLEARWATER, B.C. — Every morning at 8 a.m., Bob Mackenzie and John Soles are already making their rounds at Dr. Helmcken Memorial Hospital. They slip in a few minor procedures – stitching a wound for an elderly neighbour, setting a bone for the boy across the street – before heading to the clinic.

Patients, often the same people they ski or play hockey with, have already begun to stream in, and while the last appointment is scheduled for 5 p.m., the pair typically don’t make it out the door until much later.

Depending on which of them is on-call that night, one returns to the hospital. Dr. Soles, 46, usually tries to sneak away for dinner, but “it’s a roll of the dice every night,” he said. The problem for Dr. Mackenzie, 62, is he can’t fall asleep after those 2 a.m. emergency calls, wondering whether he’s made the right decision.

On-call ends at 8 a.m., but, by then, they’ve both already begun their routine again.

The physicians, who have been on this two-day cycle since mid-December when two other doctors left, will be handing in their three months notice to the B.C. Interior Health Authority on March 30, unless the authority can find at least two full-time doctors to help lighten the load.

The decision, they said, was difficult, especially because both of them have become a part of the community – nestled among mountains, freshwater lakes and hectares of forest along the North Thompson River. And it’s left the region’s nearly 5,000 residents, who rely solely on them for any kind of medical care, scrambling to find help.

Clearwater isn’t alone. Symptoms of overworked doctors and underserviced communities are evident across the country. Nearly five million Canadians don’t have access to a family physician, according to Statistics Canada.

But it’s rural Canada that’s been hit hardest by the universal shortage of family doctors.

Brian Day, president of the Canadian Medical Association, said there are many of reasons for the physician shortage. Among them, he said, is a report published in the early 1990s by Robert Evans and University of British Columbia colleague Morris Barer that persuaded federal and provincial governments there were too many doctors per capita. The report resulted in a cutback of the number of spaces at medical schools.

Others factors, Dr. Day said, are the increased complexity of medicine and the more chronic medical conditions that go hand-in-hand with an aging population, both of which increase the demand for doctors. The average age of a doctor in Canada is 50, with 4,000 set to retire over the next four years. The country, he said, is already short about 26,000 doctors.

“This is a crisis.”

In rural Canada, the problem is further exacerbated by the fact that few doctors are inclined to practise in small communities and isolated areas right out of medical school, with their debts often spiralling into the hundreds of thousands of dollars, he said.

Dozens of reports have shown that the long-term solution involves expanding medical school enrolment, repatriating the 4,000 Canadian physicians who have left over the past decade, and helping foreign-trained medical professionals to fulfill the requirements necessary to practice in Canada.

The short-term solution – so that a busload of Clearwater residents don’t have to make the 90-minute trip “into town” to Kamloops every Thursday in hopes of getting a doctors appointment – is more complex.

Murray Ramsden, CEO of the B.C. Interior Health Authority, which provides publicly funded health services to about 720,000 people in the province’s Interior, said that IH has advertised nationally and internationally to recruit physicians. In the meantime, it’s backfilling these communities with locums – travelling doctors who relieve rural physicians for periods rarely longer than two weeks.

Acknowledging that this is not sustainable in the long run, medically or financially, Mr. Ramsden said that if no physicians are found for Clearwater by June 30, emergency services will no longer be offered there.

“What we’ll be going to is an enhanced ambulance service to be able to take the critically ill to one of our urban settings,” he said. “We also need to look at air support.”

Nonetheless, Mr. Ramsden said he’s optimistic that the right doctors will come along and want to settle in Clearwater, just as three doctors recently decided to do in Castlegar.

Clearwater Mayor John Harwood even met with Health Minister George Abbott this month and the two agreed more needs to be done to entice young doctors to practise in rural B.C., although no firm commitments were made. Mr. Abbott was not available for comment.

But Dr. Evans, the lead author of that 1990s report and a professor at the Centre for Health Services and Policy Research at UBC, still doesn’t think the answer – long- or short-term – is increasing the number of doctors.

The problem in Clearwater has nothing to do with too few doctors, he said, but with the fact that the town’s economy is declining as the forestry sector as a whole takes a hit. Economically speaking, declining populations, he said, will inevitably mean fewer doctors.

But in characteristic Clearwater fashion, the community is rallying to remedy their situation.

The small town is selling its image – rural, outdoorsy and close-knit. The local inn with the area’s only 24-hour diner greets those travelling on Yellowhead Highway 5 with a sign: “Congratulations Rachel and Jim. It’s a girl!”

Ken Kjenstad, acting mayor of Clearwater while Mr. Harwood is out of town, said Clearwater is in direct competition with other doctor-starved communities offering lucrative incentives.

“We’re up against some communities that are offering doctors a car, golf memberships, $350,000 a year, a five-day workweek, and only one month on-call,” he said at the Caboose, a popular restaurant from where you can see into the medical clinic next door. “Of course, not having the resources to do that, we’re taking the vein that we really don’t want to go out there and try and take somebody else’s doctors away.”

The community’s efforts have worked wonders in the past, said Mr. Kjenstad, who’s lived in Clearwater for more than 30 years.

It took nearly 25 years, but the new hospital, which now employs 111 people, was opened in 2002. “It was built by people like Annie and Charles who did bake sales every weekend for I don’t know how many years,” Mr. Kjenstad said. The muffins, penny drives and fundraisers raised nearly $250,000.

In much the same way, a recently formed physician recruitment committee made up of volunteers is trying to woo visiting locums to stay past their two-week commitment and practice here full-time.

Shelley Sim, the local travel agent, has been given the task of arranging personalized baskets of goods to give to the locums upon their arrival. Some tea and an Oprah magazine were part of a basket for a doctor who had fallen ill, while a “beer buff” locum was given a sample of international brews. “It’s just a way for us to say thank-you to them,” Ms. Sims said, “and I think it evokes that small-town sense of friendly community that is Clearwater.”

THE PHARMACIST FILLS IN

Talk of the looming doctor crisis is brewing at the town’s coffee shop, the Flour Meadow Bakery & Café. A group of new mothers, who meet every Wednesday, are worried.

Elizabeth Shook was told by a receptionist to take her seven-month-old son Michael to the pharmacist to have a rash checked out because the doctors weren’t available. And when Madelaine Hegenbarth went into labour in December, she had to be taken to Kamloops because Dr. Soles, the only remaining prenatal physician, didn’t have the time or resources to attend her baby’s birth.

Then there’s Charlotte West, 44, and her son, Colt, 8, who moved to Clearwater nearly two years ago because the town had a hospital, a rarity in small-town B.C. Because she’s on disability, Ms. West can’t afford to move again, even though the town will likely be deserted if the doctors leave. “Things are already looking a little bleak,” she said.

Meanwhile, Jeannette Stockton, 68, finds herself, along with many of her friends at Evergreen Acres Senior Centre, thinking twice before she makes an appointment to see Dr. Mackenzie or Dr. Soles. “You can see that they’re tired and you can hear that they’re frustrated sometimes, but they’re only human,” she said.

Michelle Wight, the town’s only pharmacist, has had more and more people coming in asking for her advice “because they don’t want to be a burden to the doctors.”

This is the last thing Drs. Mackenzie and Soles wanted. They both moved to Clearwater, in 1976 and 1989 respectively, because of the appreciative community and collegial set of doctors that wanted to provide quality care. But things have changed, and continuing to work full-time while splitting on-calls every other day is doing just the opposite.

They say they’re torn.

Dr. Soles, who has two children in high school and one in university, doesn’t want to leave Clearwater, but he may have no choice. He’s an avid backcountry skier who grew up in a small town outside Golden, but he hasn’t had time to spend with his family or enjoy the outdoors because he’s always working.

Dr. Mackenzie was even offered one of those “seductive” recruitment packages from Fort McMurray, Alta., with a free house, car, office and a 40-hour workweek. That demonstrates just how desperate the situation is, he said, “when they’re trying to recruit an old guy like me.”

But he doesn’t want to leave Clearwater. “When you’ve become part of a community,” he said, “it’s hard to relinquish that bond. I’ve delivered babies of babies here.”

A seller’s market

Recruiting family physicians to practise in small towns has become a nationwide bidding war. Some recent examples of what communities have offered:

Digby, N.S. The town agreed to pay $187,000 to cover the medical school tuition of a husband and wife pair of physicians on the condition they practise in the community for 10 years.

Kirkland Lake, Ont. Any doctor who worked there for a week received $8,000, plus airfare, lakeside accommodations, a car rental and free child care. Anyone who decided to make the move permanent received an established, fully paid-for practice.

Moose Factory, Ont. Family doctors received an annual salary of $300,000, free housing, moving expenses, no overhead costs, eight weeks of paid vacation and four return trips home every year.

Beaverlodge, Alta. An incentive program offered five years of property and tax exemption, plus $5,000 in moving expenses.

Princeton, B.C. Physicians were offered a free car and golf membership.

Unnati Gandhi

LOCUMS:A BAND-AID SOLUTION

The B.C. government’s Rural Specialist Locum Program was originally intended to help rural physicians secure periods of leave from their practices so they could go on vacation or attend a continuing-education course. But the program has increasingly been used to temporarily parachute physicians into rural communities that have too few or no family doctors at all.The locums often earn up to three times as much as full-time physicians in the community, with a income of $1,000 a day, plus an on-call fee of about $600 a night, according to Clearwater physician Bob Mackenzie. Their accommodations and travel expenses are covered, and many locums have made a business of travelling from small community to small community, never intending to stay.

“The locums, while they help us keep the hospital open, is not a long-term solution,” said Clearwater’s acting mayor, Ken Kjenstad. “It’s just a way for them to make really good money and keep practising without having to be committed. You’re at the hospital for a weekend, you pick up your paycheque and you’re off.”

Dr. Mackenzie said there are doctors who do long locums in hopes of finding a community they’d like to settle down in – but they are rare. And when compensation is reduced for those who choose to move in, there isn’t much incentive to settle, said Clearwater’s other physician, John Soles.

“It’s very difficult,” he said, “to argue with somebody, ‘Oh, you should come live here and make less money than those people parachuting in.’ ”

Unnati Gandhi

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