The imminent departure of one of Flin Flon’s doctors has the Northern Health Region (NHR) looking for ways to continue to meet patient needs.
NHR CEO Helga Bryant says the cyclical nature of physician tenure in the area is nothing new, and the organization is prepared.
Dr. Farshid Eghbali will leave the Flin Flon clinic in March 2018. His absence will leave a gap in the full-time physician staff that the NHR receives funding for. While the Manitoba government funds three positions through the NHR in Flin Flon, there is often a lag of several months between the departure of one physician and the arrival of another.
“When we recruit physicians, there is a cyclical pattern to it,” said Bryant.
“We still recruit a number of international medical graduates who come up to work for us for a period of time, until they pass their Canadian Family Practitioner Exam, and typically at that point they move to larger centres.”
The Canadian Family Practitioner Exam, once passed, allows doctors to practise anywhere in the country.
“We know that’s our normal pattern, we don’t expect that to change, and we must value them for the time they’re here, know that they will provide good care for the population while they are in the community … but we do know that inevitably they will go to larger centres.”
Bryant said that new graduates hired by the NHR typically finish their assessment program at the University of Manitoba in June. By the time the graduates complete the move north and find housing, it is often late summer or early fall before they begin practising in the clinic.
“Often when a physician leaves, they leave in the spring. We’ll have one leave in the spring, but yet that replacement won’t be here until September. We have that gap, and that’s regular, recurring. It doesn’t happen every year – sometimes they stay a little longer, sometimes they leave a little earlier, sometimes we can predict that and sometimes we can’t.”
Bryant said the NHR has identified an international medical graduate to replace Dr. Eghbali, but that it will be up to eight months before that graduate arrives. In the meantime, the NHR is booking two locums – a physician and a physician assistant – out of Winnipeg.
“We’ve been using a locum model in northern Manitoba for quite some time now. As we become more and more one system for the whole province, I expect we will see more locums because there will be increased collaboration with Winnipeg and with shared health services in Manitoba,” said Bryant, who believes there will be pools of physicians who will be eager to work in the north without living in the area.
“They would be happy to come up and work a week … or two weeks a month, and work the rest of their practise in Winnipeg. That suits us quite well, because they stay in touch with best practices that are happening in the Winnipeg hospitals, they have a good connection with their peer group, other physicians that practise in the same area … and that results in us getting really high quality care in the north.”
The NHR currently uses the locum model in its emergency rooms, where locums are trained specifically in emergency medicine. Bryant says the organization is comfortable moving to this model when needed in family practice, as it is a model they are familiar with.
“I would expect just as the public are pleased with the locum service they receive in our ERs, I’m hoping we’ll have that same satisfactory experience when they have a locum in the clinic.”
There have been concerns in the community about the amount of wait time patients have faced when trying to book an appointment with a physician. In November 2017, the average wait time for the clinic was 20.67 days. In December 2017, the average wait time was 15.2 days. The NHR has implemented a system to try to decrease wait times by setting aside a certain number of appointments daily for urgent call backs and same day appointments at the clinic.
“When we talk about access, physicians have a panel size,” said Bryant, referring to the case load a physician can take on. Bryant said that number can reasonably range from about 950 to 1,200 patients, and a physician generally sees between 15 and 20 patients per day.
“Their days are scheduled. They try to leave a couple of slots open for urgent things. Those urgent appointments might get filled early in the day and they might not have more space. The whole concept behind what we call ‘advanced access’ is to allow enough flexibility in the daily schedule of a physician or nurse practitioner to allow them to see their own patients on a more urgent basis, to prevent the need to go to emergency.”
Wait times have been affected, too, by the departure of Dr. Andrea Thwala in fall 2017. While the NHR receives funding for three full-time physicians, Dr. Thwala operated outside of the NHR and was not funded by the organization. Still, his departure has meant an increased case load for NHR physicians.
“As we experience the impact of losing Dr. Thwala, the panel sizes of the new physicians really are at a maximum,” said Bryant.
“They are watching that, and so are we, because we don’t want to compromise the care that’s being provided, and we don’t want to compromise patient safety…The providers know the patients that they have. They know when they are reaching the threshold of what they can safely handle.”
Bryant said the NHR is working with Manitoba Health to increase funding for the number of physicians the organization can hire.
“The Peachey Report is helpful in this regard, as he recommends panel sizes for northern Manitoba,” Bryant said, referring to the Provincial Clinical and Preventative Services Planning for Manitoba report led by Dr. David Peachey and released in February 2017.
“When we know the panel size and we know our population, we can do the math to determine the number of family physicians and nurse practitioners required in a community … We remain hopeful that we will be successful in that regard.”
