Towards better health care

Wellington Community Association holds public meeting

Dr. Anne Nancekievill replies to a question about new physicians’ caseload as physician recruiter Adam Hambly looks on.

By some estimates, there could be as many as 4,000 County residents who do not have a primary health care provider, and this situation may worsen without the addition of new family physicians or nurse practitioners to the Prince Edward Family Health Team (PEFHT). A packed house filled the Legion in Wellington last Wednesday evening as the Wellington Community Association held an information meeting about this crisis in local health care. The group, led by cochairs Diane Riley and Joanna Green, invited County physician recruiter Adam Hambly and members of the recruiting team as well as Wellington Rotary Club member David MacKinnon to speak about the steps being taken to address the state of health care in the County. Hambly was appointed to the role of physician recruiter in July 2022, and with the support of the County, Quinte Health, Prince Edward County Memorial Hospital Foundation, PEFHT and the Prince Edward Family Health Organization, has been given the task of recruiting new family physicians to the County as well as retaining those who are currently in practice here. “Ensuring all residents have a primary care provider is important within a high quality health system, including our hospitals,” he said. “We currently have five physician vacancies. We are allowed to have up to 23 positions that the Ministry mandates for us. It is important to note that before 2020 we didn’t have issues recruiting physicians. Our engagement opportunities were quite fruitful, we had lots of opportunities with residents— positions that are in training with our group—and lots of other physicians that we had encountered. But things are changing. We are fighting against big challenges and a lot of these factors came together in a perfect storm.” The COVID-19 pandemic has put an enormous strain on health care providers all across Canada and there is a nation-wide physician shortage. Two other factors are an aging population in the County with more complex medical needs and a tendency for new graduate physicians to delay committing to a practice, preferring instead to “locum” temporarily in a community to see if it is a good fit for them. Hambly noted that there is a declining enrolment in family medicine. “Medical students are choosing to specialize elsewhere. Even the ones who do specialize in family medicine, there are fewer who want to practise in a rural setting,” he said. This year, there are 1,451 students graduating in medicine. With 2,572 vacancy listings, this creates a lot of competition between communities hoping to attract physicians. Many communities are offering free housing or a stipend, cash incentives and office space incentives. In this region, Belleville is offering $150,000, Quinte West $115,000, while the County lags behind at $100,000. Mayor Steve Ferguson likens it to playing a game of poker where the stakes are ever increasing. There is, however, some glimmer of hope. A one-year locum has been secured for PEFHT, and a new physician has been hired to take the place of one retiring this year, preventing an already bad situation from becoming worse. There are encouraging talks taking place with a number of interested physicians. Hambly advised residents without a primary health care provider to register with Health Care Connect, a service that connects patients with physicians. Currently there are about 1,600 County residents on the waitlist, but he said there a many people who have not yet registered and the number of people without a doctor is very much higher.

David MacKinnon then spoke about the Rotary Club’s initiative to recruit a number of nurse practitioners (NP) to the County, as a satellite to the NP clinic in Belleville. The term “orphan patient” is used to describe those residents without a primary health care provider, and MacKinnon says the NPs could be a viable way to reduce the orphan patient population in the County. He said there are 30 NP practices in Ontario, and nurse practitioners can cover approximately two-thirds of the responsibilities of a family physician. “Nurse practitioners play an important role in Ontario health care, and they have a major possibility to help us here. We have to address the orphan population, and the best way we can do that is to establish a satellite nurse practitioner clinic in Wellington associated with the nurse practitioner clinic in Belleville,” he said.

“This seemed to us to be the most creative and innovative way to proceed, especially when we learned that additional nurse practitioners would likely be available if they could be guaranteed stable positions in appropriate workplace environments.” The Rotary Club has been in contact with the Sandbanks Medical Clinic in Wellington, where there are three vacant offices. He noted that nurse practitioners are a cost-effective way to deliver health care services, and that this project is a complement to the physician recruitment program. He added that there is already a model for satellite clinics in the Sudbury area, and that could be adapted here. “The stars seem to be aligned, and everyone agrees that nurse practitioners could be a very important part of a solution to the orphan patient problem.” The Club has been in contact with the Ontario Minister of Health and with MPP Todd Smith, and MacKinnon is hoping to secure three nurse practitioner positions for the County. “We have to develop this process further and sell it to governments, but we think our proposal not only addresses the immediate crisis, but also positions us for the healthcare system of the future.”

There was a question and answer session following the presentations by Adam Hambly and David MacKinnon. The first question was about the average number of patients per physician. Hambly replied that it was close to 1,000 for each doctor, but that number could vary by a couple of hundred. The second question was related, asking whether it was fair to ask a new physician to take on such an immense workload. Dr. Anne Nancekievill replied that the PEFHT is prepared to support new physicians in adopting a caseload that is manageable. Shannon Coull, executive director of PECMHF wanted to know if the number of physicians could exceed the Ministry limit of 23. Debbie Korzeniowski, executive director of PEFHT, replied that the Health Team is committed to ensuring equity of access to health care and that the needs of the community are increasing. Later in the evening Mayor Ferguson said that he had informed the Ontario Minister of Health the County population is increasing and the allocation of 23 physician positions would be insufficient going forward. A nurse practitioner in the audience commended MacKinnon for the project to bring a NP clinic to Wellington, saying that it would take people off the Health Care Connect waitlist. One comment noted the absence of walk-in clinics in the County, with the consequence that residents seeking health care will visit the Emergency Department, with the potential of overloading an already fragile system. To register with Health Care Connect, dial 811 or visit ontario.ca/healthcareconnect.To learn more about the Wellington Community Association, please visit wellingtoncommunityassoc.com.