In the last twenty years, the stories from good New Brunswickers have been heartbreaking. In the old days, a family doctor, facing slow-down leading to retirement, took responsibility for the transition of persons in his practice roster either to someone taking over the practice (a son, daughter, or new business partner) or to a new physician or physician group that would buy the practice and take over the care of the persons on the care roster.
That started to change 25 years ago for many reasons and it has become very difficult for doctors with “a practice” and case roster to “sell the practice” when a new practitioner can simply open up an office and be flooded with people desperate to “have a family doctor”, the euphemism for access to primary health care services. Volumes can be written on what all the changes have been that have created this situation but in the last 20 years we have heard horror stories almost daily of persons, often families or elderly couples, whose physician has decided to either move away, retire, or otherwise “give up the practice”.
Family medicine, done completely, is exhausting when the practice carries the caseload that was normal until 20 years ago. Having a care roster of 2-3000 persons meant the doctor was in the office every day, making rounds at the hospital, taking after-hours call either for his own practice or participating in a group. In addition to all that, the family doctor has been expected to participate in hospital committees and activities. It is no small wonder that when they reach the stage of needing to “slow down”, it is difficult to find someone to take over that practice, particularly if the new recruit wants work-life balance, normal family life, and time for rest and relaxation.
The opportunity to carry a lighter caseload, some say as few as 700, while doing shifts in the Emergency Department and after-hours clinics have lots of appeal to some practitioners. Home for supper with the kids? Of course! Play a little pick-up hockey? Why not. But probably not if your caseload is 2-3000 patients.
Meanwhile, sixty-five thousand tax-paying citizens of New Brunswick suffer. Some say that the real number is much higher because many have just given up trying. Extreme characterization, you say? Not if you are my friend trying to manage the care of his dear wife of 50 years who is well on her way with dementia. The letter comes in the mail: “I am sorry to announce that I am leaving my practice and the phone number to get your name on the provincial priority list is…….” Or my other new friends who have chronic conditions, both of which require periodic adjustment of medication and diagnostic tests who have had the after-hours clinic, when they can get in, as their source of primary care now for over three years.
The older conventional model of primary care served the population very well. But the evolution that has taken place in the last two decades has led to higher numbers of graduates of training programs but an entirely different set of expectations as to practice goals and directions. Young physicians are well trained and very bright; they have to be just to get into medical school.
But those 65,000 people pay the price for the fact that public policy and the evolution of family medicine have not been in sync. It is the public policy issue that must be dealt with if there is any hope for realizing health care reform as promised by government. With respect, junior public servants cannot fix this.
Then explain to Susan and Ford Elms why, in the excitement of leaving the Ontario hustle and bustle to live in our beautiful province, that they have to fly back to Ontario for medical care! Their story of adjustment to New Brunswick was carried in the Daily Gleaner on July 22, 2022.
And explain to patients of Dr. Carmichael’s clinic in Hanwell why some will suddenly need to go back on the provincial waiting list. The public announcement used the term “lottery” to describe how tax-paying human beings would be placed back on a long, often multi-year wait for primary care access.
But the story of Nackawic and their new physician is a real breath of fresh air! Dr. Bamstrup has been the hard-working family doctor serving in that community for decades and has seen many a family through difficult times. In recent years, a health clinic staffed by Dr. Melanie Jones and nurse practitioner Michelle Daniels have been added to the repertoire of services. Dr. Bamstrup has announced a slow down which, presumably, will lead eventually to retirement.
The town of Nackawic has discovered new life, new dreams, new vision in recent years. Their town council has been very assertive in improving the town as a great place to live, a great place to relax and enjoy the river, and a place to develop businesses that will attract people. Deputy Mayor Greg MacFarlane explained how they set up an Economic Development Corporation which has been very active in charting a course for driving the vision of the town.
Advertisements seen on social media describe the community as one that has recoiled from past economic slumps to one of vision, direction, a destination community. Attempts have been made to open up discussions of providing improved seniors services. But in working with the local family doctors, the clinic, and the community leadership knew that having great access to primary care in the future was central to getting people to live in the community and environs. They sought to work collaboratively with the Horizon Health Network and with the DECRH Foundation and now have been able to announce the securing of the services of a young physician who will work out of the community health center.
Looking to the future, this has so much promise as the community becomes increasingly popular as a preferred place to live. The synergy of the health authority, the foundation, the economic development corporation, the town council have made it attractive for the new physician, Dr. Tristan Pickens, to want to practice there.
The great lesson for all rural communities who are concerned about physician retention: don’t wait for government, don’t wait even for the health authority. Do some brain-storming, seek and cultivate partnership relationships. Neither government, the health authority, nor the municipalities can do the job alone.
This is the model that has worked in Northwestern Ontario for decades very successfully, albeit with many challenges. In my experience in that environment, government was the enabler and provided the assistance that only government could provide. Local communities, if they seriously cared about local health services, were expected to invest in the process in several ways. And it is amazing what resources can be found and what an environment can be created when local businesses, municipal leaders, health authorities, government can lay forget the silos and seriously collaborate.
Hopefully, in the health reforms that are anticipated, a new spirit of collaboration can be created and maintained; the old ways with their silos have failed us; but teamwork always takes you to new levels.
Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at firstname.lastname@example.org or www.kenmcgeorge.com
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Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.