Patients will be left behind as overextended doctors move to collaborative clinics, MDs warn

Collaborative-care clinics are being touted as one of the solutions to the severe shortage of family doctors in Newfoundland and Labrador, but two groups that represent the province's physicians say the government is creating a new problem.

In a joint media release Tuesday, the Newfoundland and Labrador Medical Association and the Newfoundland and Labrador College of Family Physicians warned doctors are being recruited away from family practices for the clinics but those who take the jobs full-time are not allowed to bring their patients with them — creating a whole new population of orphaned patients.

"I certainly can't fault my colleagues for wanting to transition into that type of practice. The problem is that when we just shift physicians around in the system we don't solve any of the problems," Dr. Nicole Stockley, the college's director of external engagement, told CBC News on Wednesday.

"If you're not paying attention to the fact that it's primary care that is really crumbling, the solution seems to be, 'Well, we'll just put more people to work in emergency [rooms] and more people to work in the hospital' and that just further deteriorates and degrades family medicine and primary care."

Collaborative-care clinics are operated by teams of health professionals, including doctors, nurse practitioners, social workers, pharmacists and dieticians. Their focus is to connect with residents registered through Patient Connect N.L., a provincial list of people who don't have a primary care provider.

While collaborative clinics are the "gold standard" for health care, said Stockley, they don't solve the problem of the provincial doctor shortage.

She said collaborative clinics have been something the college has been pushing for over a decade but the hope was that with the creation of the clinics the province would see an increase in doctor recruitment. 

Dr. Chris Patey, president of the physicians' college, said family doctors are stretched thin, which may be why some are leaving to work in the collaborative clinics.

"We need more support for family doctors who at this moment are stretched thin on the front lines," he said. "This is a good model that's been created and that's what family physicians have been looking for."

Dr. Mari-Lynne Sinnott, a St. John's family physician, said the biggest reasons some physicians move into collaborative clinics are a need for a better work-life balance and a desire to do work they feel truly makes a difference.

She said family physicians are already stretched thin and those who remain in community care will see a bigger increase.

"These patients are looking for care and most of us are already overwhelmed with our own patient populations but we're trying to do our best to help support the people who are now left without a family doctor," she said. 

Capacity left in collaborative clinics: Haggie

Health Minister John Haggie said Eastern Health has been focusing on recruiting retired physicians or those not doing full-service family medicine for its collaborative clinics.

He said seven doctors joining the clinics are new to full-service family medicine while another managed to find an unrelated physician to take on their patients for them from their practice.

And contrary to the concerns of the doctors' groups, Haggie said two more doctors are taking their patients with them to the collaborative clinic, including one who he said had been planning to close their practice.

"They've asked them to register with Patient Connect N.L. to make sure we don't miss anybody and to allow those people who need more urgent appointments to be seen sooner."

Haggie said the province is still focusing on recruiting new doctors, and with time and the growing popularity of the clinics he believes physicians from established practices will transition to collaborative clinics and bring their patients with them. He said there is capacity in the clinics that are opening in St. John's.

"There would be no difficulty in accommodating, for example, the individual who hasn't been able to get anyone to take over his practice," Haggie said.

"We simply ask them to register with Patient Connect so that no one gets skipped."

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