Newfoundland and Labrador 'decades behind' in primary care

Dr. Alison Drover willingly describes her response to the Newfoundland and Labrador Medical Association's (NLMA) plea to take on more patients as a "rant.''

"We've all taken on extra patients to try to address this shortfall, but we've all got increased wait times now for visits because of this,'' she told The Telegram in a recent interview.

"(Doctors) have done everything they possibly can to help with this shortage, and it isn't enough, and it will never be enough. This government needs to step in now and do something to help.''

For weeks, The Telegram's letters section and email inboxes contained stories of people who can't get a replacement after their family doctor retired or shut down their practice.

Even doctors themselves have been left stranded, and it's believed the dearth of primary caregivers has played a role inunprecedented emergency room chaos this summer.

"It's an unsustainable pattern that we have now with doctors leaving at greater rates than they're joining us,'' said Dr. Drover, who takes dozens of calls daily from orphan patients at her practice in Torbay.

"I've taken on as many as I could, frankly, because I've heard a lot of sad stories, and I took on too many. And now it's exhausting for everyone concerned.''

She said doctors have done everything they can to help alleviate the shortage.

While doctors in this province are paid less than most counterparts in the country, Dr. Drover said that's not even the main issue.

"It's not about money. It's about the fact we want to provide good care for our patients, but the system we work in rewards more visits,'' she said. "More superficial visits, you get paid more, and longer, complex visits, you get paid less. So our system is designed to reward superficial medicine to begin with.''

NLMA president Dr. Susan MacDonald wouldn't talk specifics about ongoing contract negotiations with the government, but says the association has been lobbying for years to shift the fee structure to what is called blended capitation. It would involve providing a lump sum to care for a roster of patients along with a portion that remains fee-for-service.

"We're decades behind in how our physicians should be working,'' Dr. MacDonald said. "We train our residents to work as part of a multidisciplinary team and to have the time to look after complex medical issues.''

Dr. Drover said one-off solutions—such as a collaborative care clinic in St. John's announced by Health Minister Dr. John Haggie last year—are not doing the trick.

"When Dr. Haggie comes out and says there's no problem with primary care because we have a collaborative care clinic ? those clinics get filled up immediately,'' Dr. Drover said.

In fact, the clinic is no longer taking names for a waiting list.

Even semi-private, nurse-practitioner operations either have long waits for appointments or have stopped offering them.

One avenue for relieving pressure on the system is allowing other health-care professionals such as pharmacists to do more within the scope of practice they train for.

But this province, again, is way behind what is being done in other parts of the country.

For example, Newfoundland and Labrador and B.C. are the only two provinces that won't allow pharmacists to diagnose and treat something as routine as a urinary tract infection (UTI).

"It's pretty typical for people to have to wait several days which, with a urinary tract infection, is almost impossible, as people almost always end up in an emergency room to get some form of treatment for it,'' Janice Audeau, president of the Pharmacists' Association of Newfoundland and Labrador, told The Telegram last week.

Audeau said the association has presented data to the Health Accord task force showing that involving pharmacists more integrally in the doctor-patient equation not only saves money, but improves outcomes for such conditions as heart disease and diabetes.

In Alberta, for example, a pharmacist can start a regimen or change a dose of a blood pressure medication and follow up after a week or two.

"Of course, you would loop in the prescriber or the primary-care provider, because it's a team-based approach,'' she said. "This has never been about pharmacists replacing physicians or nurse practitioners. This has always been about working together.''

The Health Accord task force, formed by Premier Andrew Furey last year, has repeatedly emphasized how the Newfoundland population has a higher incidence of cardiovascular problems than do people in other provinces.

"There are so many people who don't have doctors, and these gaps where we could be filling in to improve efficiency might free up some money to be able to reinvest in some of these care teams, reinvest in recruitment and retention of physicians. We need to be looking at a bigger picture. We can't just be looking at it in four-year stints,'' Audeau said.

"I'm hopeful that the government sees that this is a do or die with our health-care system right now, and we need to get creative. What we're doing isn't working,'' she added.

"Our standpoint is it would almost be irresponsible at this point for the government to ignore the data that we have presented.''