In the face of the ongoing family doctor shortage in Newfoundland and Labrador, one newly minted physician says she'd like to start her own practice but systemic barriers within the province's health-care system are a huge deterrent to that dream.
"As new graduates, it's difficult to go into a system that you would be swimming upstream your entire career. You know, it's not an attractive place to be," Dr. Kayla Furlong, who graduated from Memorial University's family medicine program in June, told CBC's St. John's Morning Show on Wednesday.
Furlong said she's far from the only one in her graduating class who feels that way, estimating that out of a typical class of 30 family physicians, fewer than five went into full-time family practice.
Even those grads are mainly taking over from retiring physicians or filling locum spots, she said, meaning there are few — if any — new doctors being added to the stream. She herself is undergoing extra emergency room training, "just trying to help fill those voids there."
There are about 98,000 people in the province without a family doctor, according to the Newfoundland and Labrador Medical Association. The NLMA filed an access-to-information request with the provincial government for its plan to address the shortage, but its president said this week the documents it received show no such planning in the works.
Furlong said that news was both unsurprising and frustrating.
"The family medicine crisis, you know, is not just something that happened overnight," she said.
"It has been known amongst [the] family medicine community for a number of years. And you know, the NLMA and other groups have advocated for change at the government level. But we certainly haven't seen that."
'You're always overwhelmed'
The challenges in the current system are many, said Furlong.
Billing is one issue, with family doctors paid per patient, no matter how time-consuming that patient's needs can be. The associated paperwork for that is unpaid, and is often done after hours, she said, along with managing bills like essential utilities to keep clinics running.
"It's like a small business, and that model is not currently sustainable with a patient population that we really need to see," she said.
"So you're always behind, you're always overwhelmed, and you can't kind of keep up with the patient needs that you do have."
Those patient needs are increasingly complex. Newfoundland and Labrador's aging population and high rates of chronic illnesses mean there's a dearth of expertise in geriatric medicine, she said.
"We're really not in a current state of affairs to to treat the population that's in front of us," she said.
Those challenges, along with a bursary system to encourage new graduate retention that Furlong said isn't as competitive as other provinces, mean there's not enough incentive for her to stick around in the status quo.
"I'm someone who wants to stay in this province. I'm from here. I like the family medicine that's here. I train in family medicine for a reason. But the workplace and environment is is just not ideal at this moment in time," she said.
A tipping point
With all that in mind, Furlong has a message for the provincial government.
"Something needs to change," she said.
"We're almost at a tipping point, you know, and we're spending more health-care dollars in the emergency department on people that you know could be cared for in the community. Just let us know what you're doing."
She said communication between the province and doctors should include new graduates. She and others have asked to be included, but so far she hasn't heard back, she said.
"If things don't change, it's going to be pretty abysmal," she said.
CBC requested an interview with Health Minister John Haggie for comment but did not receive a response by publication.