Newfoundland and Labrador doctor shortage: the international factor

This story is one of a series exploring the shortage of doctors in Newfoundland and Labrador.

With only one graduate of Memorial University's medical school promising to hang out a shingle this year, and several existing family physicians either retiring or scaling back their practices, the doctor shortage in Newfoundland and Labrador is hitting crisis levels.

The only other option is to recruit more doctors from outside the province, something politicians say they're working on.

"One of the ways that we can provide reinforcements to the front lines of the health care sector is through immigration,'' federal Immigration Minister Marco Mendicino said during a stop in St. John's last week.

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According to the Canadian Institute for Health Information (CIHI), more than one-quarter of the country's physicians received their MD degree outside of Canada, and Newfoundland's share per capita is higher than the national average.

From 2015 to 2019, the number of internationally trained family physicians in the country crept up by just over one percentage point.

But that doesn't tell the whole story.

Dr. Kweku Dankwa is a rarity among such doctors. He came to St. Anthony 26 years ago to work at the Charles S. Curtis Memorial Hospital. And he never left.

"You can always attract people, but whether you keep them is another thing,'' said Dr. Dankwa, a pathologist, in a recent interview. "And when you have a revolving door, you also create an environment where people believe that it's not a place to be.''

Originally from Ghana, Dr. Dankwa was working at the Walter Reed military hospital in Washington, D.C., when he made the decision to move to Canada. He says he chose St. Anthony because administrators there were the first to respond to a number of applications he sent out.

He had no idea where he was going.

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 lo to you even when you are pretending you haven't seen them, you can't help it but to say hello back and to relate to them. It's a big difference. And I hope, whatever happens here, you don't lose that, because that is what life is all about. We are each other's neighbour.''

But the clinching factor, he says, is how the whole family was treated.

"My wife was pleasantly surprised. We didn't even know people who would knock on our door and take our children for a walk. Coming from the U.S., to let your children go with someone you didn't know, you're asking for trouble.''

Health Minister John Haggie was criticized last week for saying in an interview that a simple welcome basket could go a long way to retaining rural doctors.

But Dangwa says the concept makes sense, as long as the welcome extends beyond that initial gesture.

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"The way I see people being welcomed is not simply just having a group meeting and saying, 'Welcome.' That is fine, that is good to begin with. But don't leave them, don't forget them,'' he said.

And while the doctor is mingling with patients and colleagues all the time, the family is in a different situation.

"Whoever is left in the house, whether it be the spouse—either the wife or the husband—and the kids, they are in a different bubble,'' he said.

"My view of welcoming somebody by the community is also making sure that the community are interacting very well with that part of the family that is left at home when the other party is at work at the hospital. The spouse and the children, they are the ones who are going to ground us in the community.''

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Dr. Dankwa has more advice for those trying to recruit and retain doctors.

• Stop talking about health care cuts. Uncertainty turns people away. "Who would come into the system when they know there is a threat of a hospital shutting or services going? That is a big negative recruiting factor.''
• Streamline the licensure process. Otherwise, you're competing with more attractive markets. "If you are licensing someone to practise, and it's going on and on and on and on, I'll go to a place where I can get a licence, because (in another location) you are not sure if you are going to get a licence or not.''
• Don't ignore or brush off foreign doctors because you assume they're going to move on anyway—an attitude Dr. Dankwa says is common in Newfoundland. "I tell staff when they come that 'I don't care how long you are going to stay here, but what I care (about) is how you work with us. We will welcome you as if you are going to be here for 100 years but we want you to put out your best as well. And when they are leaving, for however long or however short a time they stayed, we treat them as if they've been here a long time.''
• The medical school should ensure its departments are reaching out to affiliate with doctors all over the province, not just those in the metro area.

Dr. Dankwa says he appreciates the support provided by groups such as the Newfoundland and Labrador Medical Association.

"The Society of Rural Physicians has been a great and positive voice for physicians in rural areas,'' he said. "For those of us in rural communities, it is helpful to know that, indeed, that network exists and is supportive.''