Doctor on the brink of reinventing family practice for 10,000 rural N.B. residents
'They’re just on the edge of getting support from us,' health minister says
The Cure is a CBC News series examining strategies provinces and territories are using to tackle the primary care crisis.
In the heart of New Brunswick's potato belt, a doctor ready and willing to reform the delivery of family medicine has been assured the province is "just on the edge" of providing the money and other supports to get collaborative care off the ground.
That's a service model that promotes health-care professionals and non-clinical staff working together as a team in one place. All salaries and some of the business costs are paid by the province.
Dr. Stuart Lockhart says new doctors don't want the burdens that come with running a small business. That was top of mind when he helped design the Carleton North Medical Clinic in Florenceville-Bristol and agreed to come home to New Brunswick after working in Saskatchewan.
The 4,000-square-foot space has eight exam rooms and an artificial intelligence scribe system to capture oral examination notes, which are then stored electronically and can be accessed by any health professional who is seeing the patient on a given visit.
Ideally, Lockhart said the clinic team would consist of doctors, nurses, a diabetes educator, a medical office assistant and visiting specialists.
"We would have 4 physicians or nurse practitioners here at all times. We would have nurses, we would have allied health rotating in and out for patients to access as their first point of contact. We would have evening classes and we would have a weekend service."
He said the clinic is designed to increase access to timely appointments by sharing patient loads, while also improving working conditions for staff, which in turn, would hopefully boost recruitment and retention.
"This is a very new thing for New Brunswick still," said Lockhart, who is receiving support from people and businesses nearby.
For example, the clinic was built with financial support from local service groups and the McCain Foundation, the philanthropic arm of French-fry giant McCain Foods. The municipal government, the District of Carleton North, pays the annual $85,000 rent.
New doctor expected in mid-March
Lockhart is one of only two family physicians in a catchment area of some 10,000 people, following the retirement of his father, Dr. Bruce Lockhart, and his uncle Dr. Colin Lockhart. The family has produced four generations of local doctors dating back to 1908.
Lockhart said a new doctor is coming soon, and the clinic will be working to take on patients from the provincial waiting list.
It's an important development, but the overall picture is still disconcerting. In the sprawling Upper River Valley health zone, Horizon recently reported 35 physician vacancies plus 14 doctor vacancies in the local hospital.
Family practices up and down the River Valley are due to close within a few years.
"Gone are the days of family physicians alone being able to meet the high demand for primary care services," said the youngest Lockhart physician at a recent public meeting. "There simply aren't enough of us and probably never will be."
Minister visits clinic, says help is coming
"Dr. Stuart [Lockhart] is very progressive about collaborative care," Health Minister Dr. John Dornan said in an interview with CBC after visiting the clinic. "What they need there is the staff. We will help them out."
The Holt government pledged to open 10 community clinics within the first 18 months of its mandate.
"We're on a very aggressive time schedule," Dornan said. "Some areas are very close to that. They're just on the edge of getting support from us to open them up as collaborative care clinics. We're quite optimistic we're going to deliver on this."
In addition to the clinic in Carleton North, the Fredericton North clinic at Brookside Mall is also high on the list of collaborative clinics in the works, as are sites in Moncton, Saint John, Edmundston, Campbellton, the Acadian Peninsula, St. Stephen, Sussex and Sackville.
Best package, middle pay
To staff these clinics, New Brunswick is up against a doctor shortage all across the country.
Canada is in the grips of what some call a primary care crisis, with an estimated 6½ million people lacking a primary health-care provider. A report from Health Canada estimates the country needs 23,000 family doctors immediately to fill the gap.Sweetened offers are popping up everywhere, from private medical scholarships to signing bonuses and other incentives.
- N.S. offers retirement fund top-ups for doctors, hoping they'll stick around
- B.C. aims to poach U.S. doctors and nurses by highlighting 'uncertainty and chaos' south of the border
In 2023, for example, British Columbia created a new payment model that raises family doctors' pay by 54 per cent. Last fall, Nova Scotia announced a new doctor retirement benefit.
When Dornan was asked if New Brunswick could compete, he answered emphatically.
"We will lead," he said. "In New Brunswick we will lead, and we will have a better package here than anywhere in the country."
When asked to be specific about compensation, Dornan said he could not go into details because the province is negotiating a new contract with the New Brunswick Medical Society. The current Physician Services Master Agreement expires on March 31, 2025.
"There are parts of this country that are the best paid, and some that are the worst, and then there are some that are in between but have a very attractive quality of life, practice, support," he said. "And we think we will fall there.
"We feel confident that we are going to be attractive to the early career physicians."
Full-court press
Carleton North Coun. Ryan Dickinson sits on the local recruitment, welcome and retention committee. He is also a paramedic.
"In my line of work, I show up to patients' houses who have no other choice," Dickinson said. "They call the ambulance and go to the ER because their family physician has either recently retired or moved. We're seeing an upswing of that in the last two years."
Dickinson said the committee's job is to sell the area and the clinic.
"You have to love the place and in order to have that, new young doctors also want the added advantage of having a health-care facility that's fully stocked, staffed and ready to provide the care for the patients in their area."
The mayor of Carleton North said the previous local government — the council in place before municipal reform — was ahead of its time.
He says the Town of Florenceville-Bristol worked with the developer to get the clinic built and the town agreed to pay the first five years of rent. Harvey says he's proud of how clean and modern the clinic is, including its electronic medical records system.
"We're all here trying to find a new model that is appealing for young health-care professionals. You have to reinvent what you're doing," he said.
Harvey said he has high hopes the answers will come in the March 18 provincial budget.
"You can identify and you can recruit, but eventually you have to pay them," he said.
"I think you'll see in the new budget, the first new budget of the government, that they'll have a bucket of money for these types of clinics."
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