Frustrated doctor turns down job in Trepassey, says Eastern Health too inflexible

The town of Trepassey has joined the list of Newfoundland and Labrador communities losing their only doctor, prompting residents to rally outside a community clinic Thursday to protest the loss of a physician who wanted to stay.

Dr. Heather Cuddy had been filling in at the clinic for the last three years, including 2½ years without a contract. When the physician's job opened up she applied and was offered the job. But Cuddy, who said she fell in love with the community and owns property there, turned it down, saying Eastern Health's offer was inadequate.

"To say that I felt devalued would be an understatement," Cuddy told CBC News on Thursday. "It was very disappointing for me, as a physician, and I'm sure for patients who suddenly feel a left a little high and dry with a new provider."

Trepassey is a spoke in a network in which Holyrood is the central hub. Cuddy said the job description included two days in Trepassey, one day in Ferryland (another spoke), and two days in Holyrood at the hub providing virtual care.

Cuddy said she wanted access to a corporate vehicle and to have travel time included in her working day, something she said is offered to the clinic's nurse practitioner. She said long days and time spent travelling are difficult for her as she's a mother of three teens and makes, for example, a requirement that she be in Trepassey by 8:30 a.m. unworkable, since she lives 150 kilometres away.

"They were completely denied, no negotiation whatsoever. Even when I discussed a carpooling option there wasn't a great uptake on that point at all," she said. 

She said that didn't make sense to her, because she can drive 30 minutes from her home in Conception Bay South to Holyrood and still be more than two hours from her patients on the Southern Shore. She suggested spending the two days in Holyrood in Trepassey instead, an idea she said was also denied. 

A final point, and one Cuddy said upset her the most, was there was no negotiation for the rural retention bonus for physicians working in communities far from urban centres — in her case, she said, the bonus should have been $7,500 for the first year.

"I saw no problem with this. If I am serving the town and the people of a Category 1 town, then why would I not deserve that rural bonus? They absolutely refused to consider this and said that my address must be considered Holyrood," Cuddy said. 

"The problem with that is that in the new agreement between the government and the [Newfoundland and Labrador Medical Association], Holyrood is actually no longer eligible for the rural bonus."

Trepassey Mayor Rita Pennell said Thursday that Cuddy's situation is difficult to understand. 

She said her residents, most of whom are seniors, are really upset.

"Without a doctor, we only have one ambulance, and we're two hours away from a hospital," Pennell said. "It's really, really sad."

Residents rallied Thursday morning, angry with Eastern Health for not reaching an agreement with Cuddy. Pennell said the community wants Eastern Health to reconsider its offer.

"The distance to medical care as well as working so far away from support needs to be considered," Pennell said. 

Continuing to recruit

Melissa Coish, Eastern Health's regional director of primary health care and chronic disease management and prevention, said she can't comment on individual negotiations but did say Cuddy's and Pennell's understanding of the situation is "unfortunate to hear."

Coish said the position was posted as a hub in Holyrood with spokes in St. Mary's, Ferryland and Trepassey. She said having the hub in Holyrood would mean a full team for the physician. 

She said there are about 400 residents each in Trepassey and Ferryland. 

"The expectation would be, we as a health authority have to meet the care of the individuals in the region and increase access in the region. If your hub is in Holyrood and you've got your team wrapped around in, then we absolutely expect that patients would be seen there as well as providing [care] in Trepassey and Ferryland," Coish said. 

"When we worked with the department around the hub and spoke, we did involve all members of the team in terms of understanding what we would be posting."

Coish said the salary is negotiated through the NLMA and the Department of Health, with compensation and retention bonuses dictated by the association's agreement with the provincial government. 

As for the benefits provided to nurse practitioners, Coish said that's a separate agreement with the Registered Nurses' Union. 

"The clauses are different, so that would dictate some of these differences," she said. 

Recruitment to fill the position will continue, said Coish.

"We had hoped and will continue to recruit for a physician to provide services certain days of the week in Trepassey and Ferryland and we're hopeful that we'll get there."

She said the health authority is also looking to bring in locums for the short term until a full-time doctor is hired.

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