GANDER, NL - Like a broken record, the ongoing shortage of family doctors is frustrating many residents and business and community leaders.
The issues with retaining and attracting GPs to the area were first uncovered by the Beacon as early as 2011.
"We (the council) are certainly aware, and it is a long-standing issue," said Mayor Percy Farwell, who is determined to get to the root of the issue. "There are many elements to the problem. There is a Central Health issue here. No doubt."
Gander, it seems to Farwell, is at the losing end of attracting GPs compared to other communities in the region.
While he did not offer any solutions, he said the town's Physician Recruitment and Retention Committee is in the process of identifying issues in consultation with doctors, and plans for the town to take a lead in resolving those concerns.
Town council, in partnership with Gander and Area Chamber of Commerce, recently held a meet-and-greet session to build bridges and hear concerns from doctors.
"We need people that will come and stay, and get to them as early as possible and promote the community to them. Make sure there is good support network for the families," Farwell said.
In addition, he said the town has met with Central Health senior management and Health Minister John Haggie to address identified gaps and set priority issues, including the shortage of GPs and mental health services in Gander.
In addressing the root of the issue, Farwell expressed interest in hearing from past and present doctors. This feedback will be forwarded to the health minister and Dr. Peter Vaughn, who is set to conduct an external review of Central Health, announced last month.
Farwell said feedback from doctors so far is very concerning.
"It seems that you speak out at your employer at your peril and the penalty is you get a target on your back and your professional credibility will be undermined. Doctors can't risk that - its rather oppressive," said Farwell.
In hindsight, the mayor said the health services situation deteriorated significantly when the structure changed from having two separate administrations at James Paton Memorial Hospital in Gander and Central Newfoundland Regional Health Centre in Grand Falls-Windsor respectively.
"Since that ceased to be, that's when things got off the rails," he said.
View from the Chamber
Sonja Maloney, owner of Jumping Bean and spokesperson for the Gander and Area Chamber of Commerce, said complaints about Central Health were brought to the group's attention about a year ago.
"It has taken this long because we needed to set up meetings with certain people and hospital management," she told the Beacon.
"We wrote letters and we were waiting to hear back. There is a process to follow in these situations and to get to the underlying issues," she said.
The Chamber was concerned about possible loss of services and subsequent impact on local businesses. Patients come to Gander for medical appointments and procedures, but they also spend money in local businesses.
"They are coming in to buy groceries, get their gas and they are going to local restaurants and dining out," she said.
"We thrive on that here in Gander and supporting areas. So the loss of those services would be very difficult here around Gander. And once you lose those services, it's really hard to get them back."
Maloney referred to what seems to be a disparity between services and the recruiting process in Gander and Grand Falls-Windsor.
"With these services possibly lost, such as (obstetrics), the physicians and us feel they are not getting a fair recruitment process in Gander, as there are two recruitment officers in Grand Falls-Windsor," she said. "We feel that we need to be recruiting, but (also) retaining these physicians."
The Chamber is pleased, however, with the recent announcement of the external review of Central Health.
"We feel we played a huge part in it because it was not long after that the announcement from minister Haggie came out that they were going to do an external review."
GP shortages happen in most communities to some extent, according to Haggie when interviewed by the Beacon. The distribution of physicians is "patchy," he said, although he added the province currently has the highest number of physicians since 2004.
Haggie did not elaborate on the actual doctor-to-patient ratio but said he was optimistic the new model of primary care, based on health care teams, would push that ratio in the right direction.
When a patient visits a clinic under the team approach model, a physician may not be the one to attend to them.
"Rather, you see a nurse practitioner, registered nurse, diabetic educator or foot-care nurse or even a social worker - depending on your needs," Haggie said.
"Gander is cast in the model of the 60s and 70s, which is physician centred and physician delivered."
Haggie did not provide a launch date for the new system, so until then, many patients will be left without a GP and will use emergency services in the hospital for their medical needs.
"It would not be surprising if you saw an increase in demand in emergency department," the minister said. "Traditionally, across the department in the province, you will find somewhere between 50 to 60 per cent of patients that could actually be managed in a primary care setting. The two are probably linked that way."
Haggie said hiring new GPs is a business decision, because most primary care in urban areas is delivered by business partnerships.
"Central Health is aware of that and recruitment of primary care physicians is left to the private practices. They are stand-alone practices. This is part of the challenge to try and integrate them (to the new system)," Haggie said.
In the meantime, Haggie is optimistic several inroads have been made in helping to alleviate GP workloads.
The minister said discussions are taking place to see if nurse practitioners could work in areas of primary care to help reduced demands on those services - that is, take on some duties of GPs.
He believes the collaborative effort from the town council, the Gander and Area Chamber of Commerce, the medical community and the regional health authority plays a significant effort in recruiting GPs and physicians.