Eastern Health’s evening clinic at Carbonear General Hospital was introduced last March to help address a doctor shortage in the area that was largely unprecedented.
According to Dr. Peggy Tuttle, clinical chief of staff for rural Avalon, the Trinity-Conception area has lost eight family physicians to retirement over the last several years. Each of those doctors had worked in the area for a long time and accumulated anywhere from 6,000 to 10,000 patients each.
“Those numbers are numbers we’ve heard thrown out there, so to fill those voids, we would actually need a higher number of doctors today, because this again was not someone coming out and starting a brand-new practice where you have 1,000 patients. This is somebody that’s had a 30 or 35-year practice,” Tuttle said.
Because of this, the health authority was noticing an increase in visits to the emergency department at the hospital. Word of the need to fill gaps was also making its way around the family physicians who continued to work in the area, Tuttle said.
While doctor recruitment is always on the tip of the tongue for people involved at an executive level in health care, it had become apparent there was a need for a short-term solution. And with that came the idea for the evening clinic on weekdays from 5-9 p.m. (a weekend clinic had been offered in the past to help out the emergency department, but the weekday option was a first for the hospital). The first clinic was offered March 26, 2018, and it’s been kept plenty busy ever since.
“The clinic itself has been used at capacity every night,” Tuttle said. “There’s no question there’s a need for family docs in the area. This is not meant to replace the family docs in the area — this is a bridge to get to the point where we need to be.”
According to data obtained through an access to information request filed with Eastern Health, the evening clinic handled 7,098 appointments in 2018. That averages out to approximately 35 appointments per day for each of the 201 weekdays it was operational.
The cost of the clinic is built into overall operations for the outpatient area, though the health authority has identified a minimum cost of $60,000 per year to cover employee compensation according to information released to The Compass. Tuttle said the clinic typically has two doctors working, though room is available for a third. Those doctors already work in the area and make themselves available for an evening shift.
“It’s not somebody that we’ve hired for the clinic,” Tuttle explained. “Anybody can apply for it. We just understand that a lot of our docs in the area are already working at full capacity, so they don’t have their evenings that they can come and offer as much.”
As an additional service, the clinic has helped keep patients out of the emergency department, where people could wait hours for a simple prescription refill or treatment for a common cold, ear infections or sore throats. Asked if she could envision a point down the road where the clinic can wind down, Tuttle stated it is “still required right now.”
Meanwhile, the physician recruitment file remains an active one for Tuttle and her colleagues, like Joanne Howell, the senior site manager for Carbonear General Hospital and the Dr. A.A. Wilkinson Memorial Health Centre in Old Perlican. She’s worked with a community advisory council to get a sense of what towns need from Eastern Health.
“We did focus groups throughout rural Avalon to see what their needs are,” Howell said. “Obviously, physician recruitment was one of the needs that came out loud and clear. But now, we’ve asked members of the community — and it’s still open to members of the community — to join our advisory council. That way, they become the voice and they help represent the needs of their particular community.”
Eastern Health officials have met with local family doctors to learn more about their concerns and challenges. Tuttle hopes working together with physicians will help when it comes to recruiting others.
One change Ron Johnson has noticed among newer family physicians is a desire to stay engaged in different areas of medicine. Johnson, Eastern Health’s vice-president and chief information officer, said they’re more interested in working in collaborative clinics with other doctors and staying connected with allied health professionals and the local hospitals.
“The traditional model of fee for service, it’s still very viable,” he said. “I guess we’ve just got to figure out how we can sort of help the fee for service physicians recruit and sort of adapt to these new models.”
Tuttle noted many new grads are interested in handling family medicine for a couple of days a week, while also having a foot in the door to the emergency room or long-term care work.
“As a group, as a community, we have to try to help work collaboratively to see how we can help them meet those wants so that we can help recruit to the area,” she said.
The Trinity-Conception area is well-positioned in many ways when it comes to this desire to stay active in different medical nooks. The hospital in Carbonear can offer doctors the opportunity to spend some time away from a family practice and engage their minds in other ways.
The hospital has also served as a bit of a recruitment tool for helping get future doctors into the area through an arrangement with Memorial University. Carbonear General Hospital is a newly-recognized teaching site for the Faculty of Medicine. Officials with the school visited Carbonear last year and met with hospital staff to discuss how more students can be brought to the area.
“We’ve built a really good relationship with the teaching element from the university, and we have some physicians here that are really engaged in teaching, and the students love it here,” Tuttle said.
The hospital is presently experiencing an increased student presence (including departments that haven’t traditionally had them before like radiology and psychiatry), and Eastern Health has managed to directly recruit doctors in Old Perlican and Whitbourne thanks to their experience coming to the Trinity-Conception area as part of their training.
“We’d like to see it more widespread, and I think we will get there,” said Tuttle, who believes this will also aid recruitment for areas outside of family medicine. “But it’s going to take a bit of time.”
There are also high hopes for what the Carbonear Institute for Rural Research & Innovation by the Sea (CIRRIS) can do for the region. A research initiative dedicated to rural medicine, the project has office space in the hospital and was founded by an emergency room doctor and registered nurse who both work there. That group is part of a multimillion research proposal now before a funding body.
“They’re really linking rural practice with education and research, so it seems very positive,” Johnson said, adding there’s “no question” CIRRIS will help Carbonear attract attention.
As a region, Tuttle noted rural Avalon is a growing one and has a younger population base than most others in Newfoundland and Labrador. In Carbonear and surrounding communities, she highlighted the great schools and recreation facilities as assets that can help attract physicians.
“That’s big,” Tuttle said. “If you’re a family doctor or any kind of doctor coming to an area, you want to know that you have those assets around you. It’s a security net. Plus, you can have family and stay settled. You’re not just going to go somewhere for a couple of years, but when start a family you have to move. You have everything you need for your family around here.”
Eastern Health has worked directly with local town councils too on recruitment. Johnson said it’s important they understand the infrastructure and amenities they provide can help play a role in getting doctors to practice medicine in the region.