Time to 'think outside the box' to fix Yukon hospital staffing challenges, doctor says

A doctor who works in Yukon says it's time to find new ways to address the shortage in health-care workers — for example, by delegating more work to nurse practitioners or physician assistants.

Dr. Kevin McLeod, an internal medicine specialist who divides his time between Whitehorse and Vancouver, said it has become "exceedingly challenging" to keep up with demand in the Yukon.  

Amid a shortage of staff, McLeod said he saw more than 60 new patients and even more follow-ups in a three-day span at Whitehorse General Hospital this month. 

The Yukon Hospital Corporation has warned of service delays, and cut down its room appointments — citing costs, inflation, and a need to ensure its services remain sustainable. 

But McLeod told CBC's Yukon Morning the problem was not necessarily a lack of funding.

"There are solutions that don't have to be expensive," he said.

"You always hear, 'we need more doctors, we need more doctors.' Well, doctors are expensive and they complain a lot. And I'm sometimes one of them. Physician assistants are great to attach to a physician to extend their capacity. I can kind of off-load, very carefully, certain things that don't need to be done by me."

McLeod believes the Yukon — which doesn't currently have practicing physician assistants — is the "perfect" place to experiment and see if that worked.

He also believes that nurse practitioners can play a larger role in the Yukon. 

"Just thinking a bit outside of the box, we need to expand people's scopes of practice," he said. 

"I know some of my colleagues won't like that, but you know, we've got to do what's best for patients. There are things that a nurse practitioner will do a million times better than me, that a physician assistant will do way better than me, right? There's things that I'm going to do way better than them. And it's just different training." 

In Alberta, nurse practitioners will soon be allowed to set up their own publicly-funded independent practices. The announcement has received swift pushback from doctors, who say it is "false equivalency" to think a nurse practitioner is a family physician.

But in a hospital environment, McLeod said it seemed "crazy" not to utilise the physician assistants and nurse practitioners who were living in the country, trained and ready to go. 

"We need a way more team-based approach," he said. 

Job vacancies

The hospital workforce shortages in the Yukon appear to be right across the board.

Yukon Hospital Corporation is now advertising 56 jobs across its hospitals in Dawson City and Whitehorse. Nearly half the jobs advertised are nursing roles, offering up to $55 an hour plus bonuses. 

It's seeking eight medical radiological technologists in Whitehorse alone. 

Last week, there were more than 70 job postings — equivalent to about ten percent of the Yukon Hospital Corporation's total staff.

A report from the C.D. Howe Institute last November estimated the average job vacancy rate for hospitals across Canada was 5.5 percent. 

Yukon Hospital Corporation communications manager Jessica Apolloni said there weren't necessarily 56 gaps within the workforce each day. Some of the jobs advertised are part time or casual. 

Apolloni said the hospital was looking for staff in Canada and beyond. She said it welcomed internationally-trained nurses who were able to work in the territory. 

"We're happy to work with them to bring their designations over," she said. 

"I feel for them, and we do a few different things. We offer nursing mentorships so that staff are able to move up into more specialized positions that may be vacant or need more support. We offer flexible scheduling. We try to use temporary or travel nurses, also known as agency nurses, only when necessary." 

'Really complicated' 

Dr. Alex Kmet, president of the Yukon Medical Association, said there was a health human resource crisis across the country, making the situation "really complicated." 

"You essentially have to start turning jurisdictions against each other, in terms of bidding up incentives in order to attract. But really that just ends up being poaching from one jurisdiction or another," he said. 

Kmet said in Whitehorse, the operating room nursing staff was depending on agency nursing "a lot." 

"One of the interesting things I hear...when they come and do their six, eight or three months of time here, is that often they have a permanent position back home and they've taken some leave to do some agency nursing. So it could be that some of those stats might reflect someone who still has a full-time job back home but has mechanisms to be on leave and who are filling that gap with agency nursing," he said. 

"Especially when you're one of the fastest-growing jurisdictions in the country. You know we've [almost] hit 45,000 people," he said. 

"I get the sense that we're facing more challenges now than we were say five years ago or certainly pre-pandemic." 

In March, local agencies formed a health human resources steering committee to come up with new solutions to health-care staffing shortages. It's being led by the Yukon Government and the Yukon Hospital Corporation.