Doctor closes rural after-hours clinic citing overwhelming demand, complex cases

A family doctor who ran a weekly after-hours clinic in western New Brunswick says she's had to close it less than a year after opening due to overwhelming demand from patients showing up with complex medical conditions.

Dr. Debi O'Leary opened the clinic in the Canterbury Community Centre last spring, with the goal of offering care to people who needed quick access to a physician for minor ailments, routine screening and prescription refills.

But within months of opening, O'Leary said she began seeing more and more patients presenting with issues like congestive heart failure, diabetes and cancer.

Already balancing other patients from her regular family practice, O'Leary said the demands from the after-hours clinic became too much to handle.

"When somebody comes in and you diagnose them, especially say a new diabetic, they're going to need medication, they're going to need follow-up [care] every so many months, you have to look at all the other physical concerns that they have, whether they also have, say, hypertension and chest pains and other things that go hand in hand with diabetes," O'Leary said.

"You have to take responsibility for the care of the people that you initiated on, and it's been very difficult to do that."

The Canterbury Community Centre is located in Lakeland Ridges, a sprawling rural municipality of 2,600 people taking in the former villages of Meductic and Canterbury, between the St. John River and the Canada-U.S. border.

It was created as part of the province-wide local government reform at the beginning of last year.

O'Leary operated the Lakeland Ridges after-hours clinic on Tuesday evenings, and on some days, would open it at 5 p.m., and be there until 10 p.m.

And on days when she saw patients with more complex needs, she found herself doing more follow-up work the next day, which would impact her work and that of her staff at her regular practice.

"I just started to feel overloaded, and I started to realize that there was only one of me and if I keep doing this, it's a detriment to being able to do my own practice and follow up with my own patients."

CBC News asked for an interview with Health Minister Bruce Fitch about the clinic's closure, but did not receive one.

Instead, Department of Health spokesperson Sean Hatchard, in an email, said the province is working to encourage opportunities for team-based care models that include after-hours clinics.

He said such models can also offer access to care by other providers when a patient's regular provider is unavailable.

Hatchard said the department is also working with partners to fill health-care positions as quickly as possible, adding that 109 physicians have recently been hired, resulting in a net increase of 49 new doctors in the province between April 2023 and Jan. 31.

'We've identified a desperate need'

O'Leary said she thinks the challenges she had with the clinic speak to a wider problem in New Brunswick's health-care system.

She said many of the patients who showed up to the after-hours clinic didn't have family doctors, and were turning to her because it was their best option besides showing up to a hospital's emergency room.

"I mean, we've identified a desperate need and I think everybody kind of knows about that," she said, noting that some patients hadn't been seen by a physician for two or three years.

O'Leary said her after-hours clinic was mostly a solo operation, with support at times from medical school graduates who had been placed alongside her for their residency.

She said she thinks the model she tried could work, but to be successful would need funding from either the Horizon Health Network or the Department of Health in order to hire more staff.

A loss for community

Lakeland Ridges Coun. Randy Stairs was "disheartened" to learn that O'Leary closed the after-hours clinic.

He said the clinic was a valuable service to residents, particularly those who don't have family doctors.

Making the loss worse, Stairs said another family doctor in the area plans to leave the province entirely, leaving the health care of many more people, including him and his wife, in question.

"The wife and I have got to go shopping somewhere to try to find a doctor. The medical clinic would have been really handy," he said.

"We're going to wind up going to [the emergency room] until such time — it could be a year, two years, three years. We don't know. We have no idea, and it's a big problem."