There may be rough roads ahead for the community of Fort St. James, the health care providers and especially for Dr. Paul Stent.
Dr. Stent has returned from a one month leave vacationing in South Africa to receive notice his staff of physicians is leaving - all of them.
Dr. Lotze has given notice she will be leaving because her partner now has a job based in Prince George, and the couple will be moving to the larger centre as a result.
Dr. Lotze will be finishing up and leaving the medical clinic the week this story is printed.
With the prospect of only three physicians left to take over on-call services as well as the day to day duties of patient visits in the clinic, the two more recent recruits, Dr. Augustus Van Der Spuy and Dr. Shani Van Der Spuy have given their notice and will be leaving at the end of February.
The couple came to Canada to join the practice in August of this year.
The couple signed on with the understanding they would be two of four doctors providing services in the community, which makes the on-call demand on the couple more reasonable.
With only three doctors sharing the on-call duties of the hospital, one member of their household would be on call two out of every three nights, receiving phone calls possibly through the night, and increasing the potential burn out for the couple both individually and collectively.
“The potential implications for being burnt out are quite serious, not just from my personal point of view but burnt out doctors make mistakes,” said Stent.
Once the other doctors leave, Dr. Stent will be trying to keep the clinic open by himself, and while he won’t be able to do on-call as well, emergency patients will have to go to the clinic to be assessed and will be sent to Vanderhoof if they need emergency room care.
“It will be pretty stressful,” he said.
Dr. Stent himself is also still also planning on cutting back his hours by next summer.
“I’m still going to, regardless,” said Stent. “I can’t carry on like this.”
It is not easy to find locum doctors (doctors who travel to communities to fill in for local doctors who are away) to fill in, and so there will be significant impacts on local services.
The Fort St. James medical clinic will already be operating on reduced hours from Dec. 16 to Dec. 23 and closed Dec. 24 to Dec. 27 so the physicians can take their holidays. The Stuart Lake Hospital emergency room is expected to be closed Dec. 15, 17, 18, 20, 22, 24 and 26. Those days patients may need to go to Vanderhoof’s St. John Hospital if they require emergency care from a doctor.
However, Northern Health is “actively working on this” according to Dr. Susan MacDonald, northern interior medical director for Northern Health. She said Northern Health takes this situations very seriously and is making it a priority.
According to MacDonald, some emergency room coverage will be taken over by Dr. Botha from the UNBC Hospital, an experienced emergency room physician, and discussions are taking place to secure other coverage by locums or Prince George or Vanderhoof physicians in order to fill in some of the gaps in coverage.
There is “life and limb” emergency coverage planned at the hospital on Dec. 16, 21, 25 and 30, which means a nurse will assess emergency room patients and Dr. Stent will see patients with injuries or illness which would threaten life or limb. Anyone else would once again be directed to the St. John Hospital in Vanderhoof.
Patients in the area should be prepared for reduced service for the time being and people who need prescriptions refilled but are otherwise well can have their prescriptions refilled at the pharmacy for the interim until the clinic reopens.
The status of the hospital is still being decided, but there is no plan at this point to shut down the hospital itself, only the temporary closure of emergency room services as long as interim measures can provide some coverage and hopefully new physicians can be recruited.
In March, Dr. Stent expects to not be able to take any hospital duties, as he will be the sole doctor left to run the clinic by himself if no other physicians are recruited by then.
“I don’t know how Northern Health is going to deal with it,” said Stent. “They’re going to have to make some sort of decision.”
“Northern Health is committed to looking at both short and long-term solutions,” said MacDonald, which includes looking at alternative payment structures for local physicians.
Doctor coverage in this community, like in most of the rest of the province, currently relies on physicians doing private practice at private clinics like the Fort St. James Medical Clinic, and then contracting out to the area health authority to cover the needs of the hospital and emergency room. The doctors are paid in a “fee for service” model.
Under this model there has been little success locally in retaining physicians in the community, with few doctors staying more than one year at a time, according to Stent, who has been in the community for 22 years.
While both Northern Health and the administration of the local medical clinic try and recruit physicians for communities in need it is still up to the individual doctors where they would want to work. Because the need for doctors is fairly high across the north of British Columbia and across Canada in small rural communities, it falls on the community as well as the clinic to persuade physicians to work in any specific community.
With only one lone doctor remaining, there will be even more difficulty in recruiting doctors to the community as individuals, because the demands on doctors in a community with so few would be so much greater.
“If you’ve got three doctors and you want five, it’s easy to find the fourth doctor,” said Stent. “The fourth doctor is going to be more interested in coming because he or she will know that he’s gong to share the call with three other doctors so they’ll be on call once ever fourth night.”
But with only one doctor to share on-call duties with, the prospective lifestyle for one doctor coming into the community are far less attractive.
“As soon as you get down to three and two of them go, it’s a real tough hassle to find someone,” said Stent.
Ideally, Dr. Stent would like to see a group of doctors come who see the appeal of the lifestyle offered by a community such as Fort St. James with both summer and winter recreation opportunities and a beautiful lakeside setting.
In order to facilitate the recruitment process, Northern Health is working hard to negotiate with the Ministry of Health to change to an “alternative payment plan” (APP) for physician compensation, according to MacDonalad. This essentially changes doctors over to more of a salary model where they will work a certain number of hours and will have a set amount of time off each year as well. The model is also an “interdisciplinary model” which would include other health care providers such as nurse practitioners within a community to share responsibilities.
This alternative model for paying doctors has seen a lot of success in increasing recruitment and retention in rural communities, according to MacDonald.
“Northern Health has found that model of medical care has brought stability of medical services to the communities that have this type of service delivery,” she said.
Northern Health is applying to the Ministry of Health to try and create five physician positions in Fort St. James under the APP model.
“We’re working intensively with the Ministry of Health and with Dr. Stent to develop this type of primary care model,” said MacDonald.
So far, the APP model has seen a lot of success where it has been implemented and is being used in Fraser Lake, Mackenzie and Valemount, for example.
“I’m optimistic that what will come out of this will ultimately be a better system for both retaining doctors in the community and providing a better work environment in terms of hours and structure for the physicians,” said John Rustad, MLA for Nechako Lakes.
Newly-elected Mayor Rob MacDougall has also been looking into the situation and contacted Rustad when he found out about the situation and plans on speaking to the area First Nation chiefs as well.
“I think we need to sit down and look at a short-term resolution and mid and long-term resolutions,” said MacDougall.
Burns Lake’s critical doctor shortage may have indirectly helped Fort St. James. Northern Health has been working on strategies to address the physician situation in the region more intensely since the crisis in Burns Lake and now these strategies may simply be put in place sooner locally with the potential implementation of the alternative payment plan.
Now that Fraser Lake is on the APP model for physicians, Rustad said the community “has got one of the better facilities around in terms of how the service is delivered.”
Stent also said there is some British Columbia Medical Association funding available as well to provide some “favourable (financial) recruitment incentive” to newly qualified Canadian doctors interested in coming to the community to help pay off their student loans.
The hope is this might help attract some Canadian-trained doctors to work here within the next two months. The program is aimed at retaining rural hospital emergency rooms. The physicians would be required to take on-call duties as part of receiving the incentive.