Lack of vaccines for community-based doctors 'appalling,' says NLMA

As Newfoundland and Labrador's COVID-19 vaccination plan expands to include first responders, the association that represents physicians in the province says some doctors are being left out in what it is calling "vaccine inequity."

While Eastern Health has vaccinated physicians working within its facilities, the Newfoundland and Labrador Medical Association says a number of community-based doctors have been left out of the priority groups for vaccinations.

These doctors don't work in hospitals, the NLMA said, but they do work on the front lines of health care, seeing patients in exam rooms, during home visits and while providing palliative care to people at the end of their life.

Neglecting this group of doctors puts the physicians, their patients, and the communities at risk, says NLMA president Dr. Lynette Powell.

They're going to be vaccinating people and they're not vaccinated themselves. It doesn't make any sense.- Dr. Lynette Powell

"As a family doctor myself, I can tell you that we're doing a mix of in-person and virtual care. The people that are in front of me most days are the patients who are most medically vulnerable — those are the patients that will fall through the cracks if we don't see them," Powell said.

"Many of my colleagues in St. John's are doing the exact same thing, and so they're exposed, but they're also exposing this very vulnerable group of patients. I would say the same thing for the other specialists. The rheumatologists, most of their patients are immune-suppressed, they're on immune-suppressing drugs, they're seeing them in person, and they're not vaccinated. It's appalling."

Powell herself has been vaccinated, as a physicians working with long-term care patients in Central Health, and said most doctors working in similar conditions in the other regional health authorities have also been vaccinated. The exclusion is mainly for physicians in the metro St. John's region, she said — a region that was the site of the B117 variant outbreak last month.

It's "naive" to think hospital facilities are the only places of risk, Powell said, adding that it's not about getting doctors vaccinated before other front-line workers.

"It's not me against them; we all want to get as many people vaccinated as possible. We certainly want people who are in positions where they could potentially spread it to other people, particularly medically vulnerable people," Powell said.

"I do house calls. A lot of my colleagues do that — we're seeing palliative patients. Those are situations that, these physicians should be vaccinated — and these physicians are now going to become vaccinators, so they're going to be vaccinating people and they're not vaccinated themselves. It doesn't make any sense."

'No way of signing up for a vaccine'

Dr. Stephen Lee, a fee-for-service family physician in Conception Bay South, sees patients both in his office and in community care homes, and makes house calls.

Lee said he's been trying to find a way to sign up for a vaccine, but as of Monday, there still isn't an option for doctors who work outside Eastern Health.

It makes me feel like there really isn't an understanding of what community family physicians do.- Dr. Stephen Lee

"When I started to see the rollout of other people in Phase 2 getting vaccinated — which I completely agree with, obviously the police and the fire services absolutely need to be vaccinated and I want to make that clear, I don't think we should be ahead of anybody," Lee said, "but at that point I thought, 'Now there will be some type of mechanism for primary care physicians to get vaccinated,' and to date I still have no way of signing up for a vaccine."

Throughout the pandemic, Lee said, he has continued seeing about 60 per cent of his patients in his office, with the exception of during Level 5 lockdowns, when that number was lower.

But even with a mix of virtual-care options, there are some services that need to be conducted in person, whether in his office or in the community-care homes, where vulnerable residents between the ages of 19 and 90 and the employees have already been vaccinated.

"There are things you can't do over the phone — there are injections that need to be given, people with abscesses, people with blood clots in their legs, people with chronic respiratory illnesses, people with cancer that I have to do home visits on," Lee said.

"The demand is always there and we're always going in the office, so that's why I was confused about why we weren't able to get vaccinated."

Lee said he has sent emails to the Health Department, which directed him to the province's vaccination rollout plan, where he said there isn't an option for physicians like him to sign up for the vaccine.

"To me, what's happened in the last week or so, it makes me feel like there really isn't an understanding of what community family physicians do in their offices on a day-to-day basis," Lee said.

'It's frankly offensive'

Health Minister John Haggie said during Friday's COVID-19 briefing that under the province's phased vaccine rollout plan, physicians, as well as other front-line workers, have been vaccinated "in order of their likelihood of exposure" to COVID-19.

"We are aware that because of historical issues at Eastern Health there are a small group of community physicians who really have very little connection directly with Eastern Health facilities and emergency services or emergency departments," Haggie said.

These physicians will be contacted as the province works through its Phase 2 of the vaccine rollout plan, Haggie said.

"I think that's an issue that is small in number — obviously one that Eastern Health are now aware of, thanks to the NLMA."

That was reiterated in a statement from Eastern Health on Monday, which stated that more than 600 physicians have already been vaccinated, including 75 family doctors who are in high-risk areas such as personal-care homes or labour and delivery. 

The health authority's current priority areas for the COVID-19 vaccination are individuals 70 years of age and older, home-care workers, Indigenous populations and first responders.

"Eastern Health expects to be in a position to vaccinate Priority 2 two health-care workers and physicians by mid-April," reads part of the statement to CBC News.

To Powell, the response to the NLMA's concerns shows a lack of understanding about the nature of the roles the community-based physicians play.

"If he feels that family physicians and community-based physicians are not at a particular level of risk, then he doesn't understand our job, he doesn't understand that we're sitting in front of medically vulnerable patients. If he thinks we're sitting in front of the phone all day, he's wrong," Powell said.

"It's frankly offensive.… It's absolutely offensive to this group of physicians that this is the reaction that they're getting from the minister and from Eastern Health."

In the meantime, Lee said he still has no idea when he'll be eligible for the vaccine, and guesses there are likely at least 200 family physicians in a similar situation.

"Prior to the most recent Level 5, I was back to my sort of normal routine of seeing patients in those community-care homes as needed, knowing that I was the only one that wasn't vaccinated, and my concern is that I could have something potentially that I could pass on to somebody else, or I could catch something and pass it on to patients in the office," Lee said.

"To me it's common sense that we would be vaccinated."

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