A new report from the Newfoundland and Labrador Medical Association says 60 additional full-time family doctors are needed immediately to address a shortage in the province, with hundreds more needed in the coming decade.
The association's Family Physician Human Resource Forecast, released Wednesday, found that while there are 629 licensed family doctors in Newfoundland and Labrador, there are only 431 who are "full-time equivalents," due to responsibilities beyond patient care.
Some family doctors may work in emergency rooms, long-term care facilities or oncology departments, instead of or in addition to working in their own practices.
The report found that of the 60 additional doctors needed right away, 24 are needed in the Eastern region, 12 in Central, 12 in the Western and at least 11 in the Labrador-Grenfell region.
In total, 243 more family doctors are predicted to be needed over the coming decade, the report found.
This need is based on current shortages of family doctors, an aging population and recruitment, turnover and retirements of physicians.
The report found that while the province's population is projected to remain stagnant over the next decade, the increased requirements on the health care system due to age and gender are equivalent to a population increase of about 72,000 people.
Real and severe deficits
In a statement released Wednesday, the NLMA said it commissioned family physician Dr. David Peachey of Nova Scotia health-care consulting firm Health Intelligence to write the report in the absence of a provincial plan to address the shortage of family doctors.
Peachey has completed similar work for seven other provinces and territories, and said the province faces some very significant challenges.
"Going forward, primary care deficits are very real. They are more real and more severe here than elsewhere that I've seen in Canada," he said.
Data released by the NLMA in September showed that as many as 99,000 people in Newfoundland and Labrador — or one in five — do not have a family doctor.
Peachey said that deficit has real effects on those seeking medical care and puts extra stress and financial pressure on emergency rooms.
"Many patients end up on waiting lists or going to an emergency department when they don't have to, and sometimes don't have issues addressed that end up in their being admitted to hospital with a problem, that, if they had been addressed [earlier], they would not," he said.
"The negative impact on quality of care and overall health is very significant."
Retention and collaborative care
Peachey had two suggestions to help address the province's lack of family doctors: retaining more graduates from Memorial University's School of Medicine and establishing collaborative teams with a variety of medical professionals.
"I think if you get the greater retention from MUN, and you progressively build and increase the number of collaborative teams, those two factors alone will bring you success," he said.
NLMA president Dr. Charlene Fitzgerald said fewer graduates are staying in the province and efforts need to be made to retain them and attract them to family medicine.
"While Memorial University excels at training family doctors, the number of Memorial medical students who enter family practice in the province and eventually come back to work in the province after they've completed their residency is declining," she said.
We don't think that we're competitive. - Robert Thompson
The association's executive director, Robert Thompson, said things like signing bonuses, mentoring programs and assistance in setting up new practices could all help keep MUN grads in Newfoundland and Labrador.
"There are some provinces that have the ability to strike deals around paying down their debt, enhanced incentives to relocate to that province and other ancillary kinds of benefits," Thompson said.
"We don't think that we're competitive and that's why we've asked the government to enhance incentives."
When it comes to collaborative care, Fitzgerald said teams of family doctors, nurses, mental health professionals and others can improve care and allow more people to see a family doctor.
"Collaborative teams are a huge part of diminishing the eventual physician need and serving the needs of our population in an efficient way," she said.
"Nurse practitioners and other allied health professionals play a huge role … Dr. Peachey's numbers estimate that family physicians will be able to attach 50 per cent more patients if they work in teams."
'Government must now decide'
Fitzgerald said the province now needs to take heed of the report and implement its recommendations.
"This forecast is based on the needs of our population. The government must now decide whether it will make policy and budget decisions in light of these needs," said Fitzgerald.
"The provincial government is responsible for attracting the right number of doctors to meet the needs of our population. We are calling on the government of Newfoundland and Labrador to use this forecast and adopt a family physician human resource plan. We also ask them to approve our proposals so that the job of attaching patients to family doctors can begin without delay."
Thompson was hopeful the province will invest money in addressing the shortage of family doctors now that the report has been presented.
"We think that ... this evidence should move the government to create the plan and to start moving forward," he said.
"The government does have financial stress and it's sometimes hard to think about investing now to save money later, but that's where our mind needs to move now. There needs to be investment now, because it will pay off."
Health Minister John Haggie did not speak to media Wednesday, but in a statement said =the department appreciated the work done by Dr. Peachey.
"Health and Community Services officials received a presentation yesterday, and are pleased that he recognized the positive impact of collaborative primary health care teams ... our approach is to tailor solutions based on community needs," the statement read.
"We know there is an issue with access to family doctors in this province. We intend to continue working with the Newfoundland and Labrador Medical Association to ensure increased access and services. Work is already happening with them, the regional health authorities, Memorial University, and the Family Practice Renewal Program, to find solutions that work."