Moncton gynecologist Dr. Karen Desrosiers never expected to be treating patients in a private women's health clinic and charging them.
She believes her decision to give up her practice as an obstetrician-gynecologist in the public health-care system, combined with the growing demand from women who can't access the care they are entitled to, are symptoms of the same problem — a system that isn't working.
"There's so many patients I'm seeing that have no family doctor," she said. "We need family doctors. We need specialists. It's sad but it's the case that we are living now in New Brunswick."
Gregory Marchildon, Ontario research chair in health policy and system design, said doctors in New Brunswick are permitted to opt out of the publicly funded Medicare system and charge patients directly.
It's a rule that was meant, he said, to allow doctors who provide services that aren't medically required, such as cosmetic surgery, to practise. It wasn't meant as a way for residents to get basic care.
"It was never intended that patients be driven to these non-medicare, private physicians out of necessity due to the lack of available primary care providers in the public system."
Contrary to the 'spirit' of the Canada Health Act
As of Dec. 31, more than 44.000 New Brunswickers without a family doctor or nurse practitioner were registered with Patient Connect New Brunswick, which pairs residents with a primary care provider.
Every province has "an absolute obligation" to provide and pay for medically required care for its residents said Marchildon, and there are no valid excuses for failure.
"The government can't get out of it by simply saying, 'There's no family doctors available,'" said the professor, suggesting the New Brunswick government start paying to send patients to other provinces who could provide care, or set up its own clinic or pay doctors and nurse practitioners who don't have billing numbers.
"It's got to provide that service — one way or the other," he said. "Or they're subject to deduction under the Canada Health Act.
"This situation is really contrary to the spirit, if not the letter, of the Canada Health Act."
CBC News contacted the provincial Department of Health to request an interview but no one was made available, and no information was provided.
Demands of public practice lead to burnout, depression
Desrosiers said the shortage of doctors in the province and the increasing demand from patients led her to experience a burnout and depression in 2015, and she was forced to rethink her career as an obstetrician-gynecologist.
"I was getting tired and overwhelmed," she said. "But you know that if you stop, then your colleagues will have to see your patients. They're already overloaded. They're already working like crazy too. So I was like, 'I can't stop.'"
The practice for an obstetrician-gynecologist is unpredictable because there is no way to know how many pregnant women will require care in any given month. That, coupled with increasing referrals for gynecological care, was a challenge.
"There's just not enough time," she said. "It's really hard to be able to answer all those demands."
We need family doctors. We need specialists. It's sad but it's the case that we are living now in New Brunswick. We need doctors. - Dr. Karen Desrosiers
When she gave up her billing number, Desrosiers had three school-age children and it was getting harder to "bounce back" after working 24-hours straight delivering babies and seeing patients.
"In the end it got worse and worse and I had no choice but to stop."
Now she replaces her colleagues when they need time off and works part time at private clinics, where she sees patients one day per week.
"The patients I'm seeing, most of them have quality of life that is impaired by their problems," she said. "So they're really happy to have finally somebody to talk to them and take care of that."
Waiting lists for women who need non-urgent gynecological care in New Brunswick can be over a year, and Desrosiers said her colleagues in the public system are happy she is able to provide that care at least to some.
Two-tier health care a concern
Dr. Jeff Steeves, president of the New Brunswick Medical Society, believes it's important to look at what is motivating doctors to exit the public health system and to find out why patients are willing to pay.
He said Britain struggled about 20 years ago with a growing number of private health-care providers because of "inefficiencies in their public system.
"When they had some major changes to improve the efficiencies within their system, the private system basically disappeared. The need for it evaporated."
Whatever the reason for doctors choosing to practise privately, Steeves said it is cause for concern.
"If we lose a physician from within the system, then I lose a colleague that I might need their help and to refer to," he said.
"So the concern would be if the private system were to grow, then that would be more challenging for the physicians left within the system."
Dr. Danyaal Raza, board chair of Canadian Doctors for Medicare, agreed and argued that when doctors exit the public health system, the wait lists get longer for everyone, not shorter.
He said patients who can afford to pay at a private clinic are usually "wealthier and healthier," and doctors are "cherry picking" the least risky cases, while the more complicated cases are sent back to the public system.
"Some call it privatizing the profit and socializing the risk," Raza said. "It's a system that I think degrades care for people who depend on the public system."
Desrosiers said if patients didn't face such long wait lists for family doctors and specialists, there would be very few willing to pay for her services.
"There's so many patients I'm seeing that have no family doctor … so they end up in emerge. And then the ERs say that there's too much patients going for no reason, but they have no family doctor to be able to refer them to gynecologists.
"It's like a big circle of things not going well."