Canso considers health-care future amid ongoing staffing issues

Dr. Luke Dobek is exactly what the town of Canso on the eastern tip of Nova Scotia needs. The problem is, there isn't enough of him.

For eight years, Dobek, 44, has worked as part of the medical team that provides primary and emergency care for the residents of the historic fishing community.

"I've worked all over the province and I was just looking for the perfect little place," Dobek said in an interview.

"It's beautiful and the people are wonderful … And now that I'm here, I feel a personal commitment to help the place out, even if conditions are becoming less favourable."

In some ways, those less favourable conditions were inevitable. Like most rural communities, Canso has struggled to attract and retain health-care professionals.

A recent doctor departure has left just Dobek and Dr. Chris Milburn to provide complete care for the community when each is working. Without a third doctor, it means 10 days of each month have no emergency or primary care coverage.

It's not only doctor availability that's created problems. The community is awaiting the arrival of a family practice nurse and Dobek and other nurses in the community say they've watched over time as the availability of paramedics has also decreased.

"It's difficult to get [an ambulance] and usually the patients have to be more critically ill, otherwise you're waiting sometimes six hours, sometimes eight hours," said Dobek.

It's with all of this in mind that officials with Nova Scotia Health held a community meeting in Canso Tuesday to discuss potential options to provide more sustainable service as recruitment efforts continue.

The three-part plan would include the establishment of a collaborative care clinic, an urgent/emergency clinic and enhanced paramedic coverage for times when the emergency department and urgent/emergency clinic are closed. The latter scenario could also include video access for nurses to an emergency department doctor associated with EHS, something nurses at the meeting and Dobek said is necessary.

Those options require help, however. The family practice nurse will need to be in place, a full-time nurse practitioner is required and recruitment efforts would need to continue for another doctor, even if it's one that focuses only on primary care and doesn't provide emergency department coverage.

Brett MacDougall, vice-president of operations for the health authority's eastern zone, said the proposal is about finding alternative models that provide more sustainable access to care, while continuing recruitment efforts.

MacDougall said he and his colleagues would review the feedback they received Tuesday from the community and staff at Eastern Memorial Hospital and determine what is possible.

"We're going to try and have to make the best use of the limited resources that we have and ensure that we're maximizing the care that we can deliver in these communities," he said in an interview.

There are concerns among people in the community about the plan, most notably the increased reliance on Emergency Health Services at times when a doctor is not available.

Along with Dobek, several nurses and community members expressed worry about what they see as an increasingly unreliable service, especially when the next closest hospital is 45 minutes away in Guysborough and the nearest regional hospital is in Antigonish, about a 90-minute drive from Canso.

MacDougall said those concerns are legitimate, but he and officials from EHS who attended the meeting believe they are getting close to turning the corner as a patient transfer system that does not require paramedics expands across the province. Those efforts would allow EHS to prioritize paramedics for the Canso area in the instances presented as part of the plan.

But as with most rural communities, people in Canso have grown accustomed to watching services come and go, and so there is trepidation about what any changes could mean.

"We're kind of leery of what our health-care system is going to look like in this area of the province," said Carla Armsworthy, a Canso resident who attended the meeting at the local fire hall.

With such a distance to the next closest hospital, Armsworthy said it's important for Canso to maintain 24/7 emergency services. She worries about the potential loss of any services.

Health Minister Michelle Thompson, who attended the meeting along with local MLA Greg Morrow, said gathering feedback from communities will be crucial for helping to determine what is required and realistic to maintain services in each area.

Thompson said plans must be developed with local input and communities have a key role to play in retaining anyone attracted to work in a given area. Immigration will also be a key aspect of those efforts.

"It's not always a perfect fit, but we need to understand what the community needs are," Thompson said in an interview. "It has to be something that's fluid. No one size is going to fit all and we can't expect that."

'I don't see young doctors'

Dobek knows that better than most.

As recruitment efforts continue to find a new colleague to work with him and Milburn, Dobek is hopeful yet realistic. While he sees potential help in the proposed model the health authority is advancing, Dobek knows most young doctors are not attracted to a workflow such as his or a community as remote as Canso — no matter how beautiful it might be.

"I'm still the youngest doctor I've worked with in a rural community. I don't see younger doctors. They should be graduating at 30, I should be seeing them out there, and I'm not. They're sticking to the larger urban centres."