CALEB NICKERSON
PONTIAC Sept. 2, 2020
Note: In this article, I am attempting to cover some of the region’s health care issues in a way that goes beyond the surface level and provides a nuanced look at what needs to happen if services like obstetrics are to return. The challenges faced by rural doctors (which is what this first instalment will focus on) is a subject that’s as vast as the county we call home. This article is the first in a series that will delve into as many angles of this multi-faceted problem as possible. If you have a story or perspective you want to add to the conversation, send an email to editor@theequity.ca or call 819-647-2204.
Dana Scott, a mother of three from Quyon, has a problem: her kids need a family doctor.
It’s a routine request that almost any parent will encounter but in the Pontiac, like most rural areas across Canada, it’s a bit more complex than that. While they had been seeing a physician in Gatineau for several years, last July she heard about . . .
a new physician at the Lotus Clinic in Shawville and took a chance.
“I took [my children] off… put them on the RAMQ list and phoned Lotus, and they picked them up off the list,” she explained. “That’s how it works. It’s a little risky if they don’t pick them off the list.”
She said the reason why she decided to make the jump was due to the close location and the convenient service.
“If you phone and you have to get your kids in for whatever medical reason, fever, ear infection … If your doctor doesn’t have an opening you can see someone else, whether it’s the medical resident or another doctor on staff that day,” she said. “It’s super convenient with kids because I don’t have to go to the emergency [department at the hospital], which you want to avoid.”
Scott could book same-day or next-day appointments, a major plus since her eldest is only six years-old. However, in January of this year she received notice that her newly acquired doctor was leaving and her children had been transferred to a doctor working out of the CLSC in Quyon. While the location was a great deal closer, Scott said that the change wasn’t ideal. The new doctor was only in town twice a week and the lack of short-notice appointments meant that she had to opt for the emergency room on several occasions.
In August, she tried to set up an appointment for her kids before school started and she was informed that not only were there no more openings, but her second doctor in the span of a year was leaving for the city at the end of the month. When she spoke to The Equity in August, Scott was still working out what her options were, but said that she knows many other families are in the same boat. She was thankful that her children are in good health.
“We’re a pretty healthy family, so far we’ve been lucky that there’s been nothing severe,” she said.
Scott is not alone in her frustration. In addition to nurses and other health care staff, there is a shortage of doctors in the region, both in general family practice and in the numerous specializations required at the hospital. This is a phenomenon that afflicts rural areas across the Canada.
As Dr. Guillaume Charbonneau of Maniwaki wrote in an article for Canadian Family Physician in 2018, rural Canadians make up 20 per cent of the population, yet are served by only eight per cent of the country’s physicians.
His experience is not that different from the Pontiac. Charbonneau makes a very concise argument that outlines the main social issues that prevent doctors from settling in rural areas.
“It is difficult to recruit physicians to rural practices given the advantages of urban settings. Urban areas offer the types of schools many physicians prefer for their children and employment opportunities for their spouses. Moreover, many physicians only work in rural communities temporarily. It is, therefore, equally important to create strategies that promote retention.”
There are also geographic conditions to consider. In terms of area, MRC Pontiac alone is more than twice the size of Prince Edward Island, with a population of less than 15,000 people year-round. Charbonneau goes on to point out that success in both attraction and retention is the result of a full-court press from stakeholders in the general population to officials in all three levels of government.
Dr. Tom O’Neill is the chief of the anesthesia service at the Pontiac Community Hospital (PCH) and has 35 years experience teaching residents in a variety of specializations. In addition to his duties at the hospital, O’Neill also has a family practice with over 900 patients (most physicians have an average of 500 patients).
He has been on the front lines of recruiting and retaining doctors in the region for decades, and said that the difference in skill sets between rural and urban areas is one of the main hurdles. The doctors in the Pontiac need to be generalists, with a much broader set of skills than the doctors in the city. Like O’Neill, local physicians might have a busy family practice and also handle a department at the hospital, in addition to teaching and other duties.
“If you’re looking at recruiting for rural areas, first of all, you have to realize with CISSSO we got fused with an urban area,” he said. “It’s still the hardest thing in the world to get these people to understand that in a rural area, you need different skills and when you have those skills, part of your time is consumed doing that, much more than in the city.”
O’Neill added that this isn’t an issue that’s unique to the Pontiac, but is rather common not only in rural Canada, but in northern England, Scotland and Australia as well.
Dr. Keith MacLellan, a local physician and co-founder of the Society of Rural Physicians of Canada, said that the tendency towards hyper-focused areas of expertise in medical schools, as well as in the population at large is one of the biggest factors.
“The overall view that I have is that work of all kinds is becoming more and more specialized, not just in medicine, but social work, nursing, law … everything is becoming much more specialized,” he said. “There’s nothing wrong with that, it’s sort of a natural tendency of human work. The problem is, in rural areas of the world, there are very few specialists. Specialization almost always entails urbanization and dense populations, so … you find the more rural you go, it’s very common that people don’t have just one little job that’s focused, they have three or four jobs.”
He used the example of a small-town mechanic, who might also serve as the town’s locksmith and also own a backhoe. If a specialized service like a Speedy Muffler sets up outside of town and cuts into his business, the town is in danger of losing not one, but three services. The same goes for rural physicians.
Of the roughly 25 physicians and specialists in the Pontiac region, more than half are at or exceeding retirement age. Despite the numerous efforts underway to keep local medicine alive in the area (which will be detailed in the next article in this series), MacLellan said that drastic action is needed just to maintain services at their current levels.
“It’s not working out. If you look at the Pontiac, I think probably in the next five years we’re going to need at least 20 new doctors, all keen and doing a lot of things, certain of their stuff and with broadly skilled practices … able to work in many different fields,” he said. “I don’t see that happening. I hope it does, but I don’t see it happening.”
O’Neill said that his hat is off to all the workers putting in long hours in service to the community, as well as the physicians in Pembroke that have taken on additional work following the closure of PCH’s obstetrics unit in February. He said that the hospital is a vital anchor in the community, and must be protected.
“If you look at health care in the Pontiac, it employs about 500 people,” he said. “If that hospital didn’t work here, I can guarantee that at least a quarter of them would be gone. I always find that people don’t actually recognize what they have until they lose it.”
The next instalment of this series will examine some of some of the possible solutions to address this crisis, as well as the people and organizations working to implement them.
