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County Docs addressing physician shortage in Prince Edward County

Adam Hambly

The formation of the County Docs Physician Retention and Recruitment program is expected to be pivotal to addressing the shortages of physicians in Prince Edward County.

County Docs, led by newly hired recruiter Adam Hambly, has started to actively recruit physicians to practice in the County.

Shortages of physicians, a decline in enrolment in family medicine and the stress of the COVID-19 pandemic have all led to a critical shortage of family physicians not only in Prince Edward County, but across the country.

There are currently five physician vacancies in Prince Edward County with three more expected in 2023. Demand for physicians is great due to a shortage of doctors resulting from retirements as well as rising patient needs. The County is also experiencing an increase in residents relocating permanently. This in turn, leaves those new residents without a family doctor. Not having adequate primary care providers puts a significant demand on the emergency services at the local hospital creating another health care issue.

Competition for recruiting family physicians is extreme between communities and has brought local organizations together to strategize what can be offered to keep Prince Edward County a premier place for new physicians to want to live and practice medicine.

Lack of competitive financial incentives, the expensive cost of housing for locums and medical learners and lack of office space are arising as prominent areas requiring investment if Prince Edward County is going to be competitive.

Dr. Anne Nancekievill

“In the past, there were few challenges in finding new physicians to take over practices from those leaving or retiring. However, given a perfect storm of fewer medical graduates in family medicine, an aging physician workforce and a growing and aging population, this is no longer the case,” said Dr. Anne Nancekievill, a local family physician recruitment champion. “Our family doctors are integral to our community. Not only do they take care of patients in their offices; they support our local hospital by taking care of admitted patients, as well as covering shifts in our emergency department, acting as medical directors and covering physicians for our four long-term care facilities and providing palliative care both at home and in our local hospice. Our family physicians also provide guidance and support for both our Family Health Team and local hospital programs. We currently have 18 family doctors serving a population of over 25,000 people. It is not enough.”

Hambly was hired to address the recruitment crisis in mid-July. He has achieved early successes including the creation of a new recruitment and retention strategy that is based on reducing barriers for prospective physicians. Hambly is actively recruiting and creating the program elements that other jurisdictions have had for a longer time, boasting maturity and longer prominence in the public domain.

Showcasing Prince Edward County is a key component. A dedicated website for County Docs is in development and is expected to launch in February. Other highlights achieved to date include:
– Securing one locum for a one-year contract, with possibility of permanency – Locums temporarily assist with vacation coverage. In this case, securing this locum has helped stabilize a practice where the existing physician has retired and with the locum’s commitment, orphaning patients was avoided
– Launch of a Doctor Accommodation Network (DAN) to support housing for locums and new physicians. This is critical as locums can provide much needed breaks from practice and viewed as an important factor to prevent family physician burnout
– Speaking to more than 25 potential recruits, conducting 11 introductory calls, with four full-site visits completed. A recruitment pipeline takes a long time to build but this activity is a strong beginning

“With the support of incentive funding by the County, one barrier has been removed, for now. However, we are seeing competition in financial incentives continue to escalate. We have to think about a whole package of offerings for new physicians,” said Hambly. “Our goal is to not only make Prince Edward County a top choice for new physician recruits, but also a place where physicians want to stay. Retention of our current and future physicians is as equally important as recruiting them here.”

Many community members have asked how they can help support the physician recruitment and retention efforts.

The Prince Edward County Memorial Hospital Foundation has partnered with County Docs to invest in the future of healthcare delivery in PEC by launching a new Physician Recruitment and Retention Fund. The Physician Recruitment and Retention Fund will give people in the community an opportunity to contribute to the initiatives underway that will attract and retain new physicians to the area.

Barbara McConnell

“The Foundation welcomes the opportunity to partner with the County, the Family Health Team, the family physicians, Quinte Health, and Adam Hambly to help advance physician recruitment to new prospective doctors, and retention opportunities for those already practicing,” said Barbara McConnell, chairperson of the Foundation. “Through collaboration and giving interested donors a way to contribute, the support we will generate will not only connect patients to doctors, but also result in our hospital continuing to offer procedures and treatment options that are unique to a smaller community.”

To make a donation to support The Foundation’s Physician Recruitment and Retention Fund, contact Shannon Coull at 613-476-1008 ext 4503, email info@pecmhf.ca, or visit pecmhf.ca and select ‘donate’. Also, cheques may be mailed to PECMH Foundation at 403 Main Street, Picton, ON K0K 2T0. It is noted donors who give to this fund will not receive preferential treatment in securing a family physician, but will help strengthen the future delivery of healthcare across the region.

More on County Docs’ strategy will be shared with the community in February, when an official program launch is expected. In the meantime, County Docs is also working on its website and Facebook page.

“Even at these early stages of formal program development, we want to acknowledge the community for their support. We know having a family physician is at the top of everyone’s mind and we are working hard to stabilize our healthcare delivery,” said Hambly.

Medical students or family physicians interested in learning more information can contact Adam Hambly at info@countydocs.ca

Those seeking a family physician should contact Health Care Connect at 1-800-869-8828 or go to health.gov.on.ca/en/ms/healthcareconnect/pro/

County Docs answers frequently asked questions:

Q: What is the PEFHT?
A: Established in 2006, the Prince Edward Family Health Team (PEFHT or the Family Health Team) is a corporation that has a mandate to provide primary healthcare services to the residents of Prince Edward County. The Family Health Team has close to 40 staff and is comprised of allied healthcare providers like Nurse Practitioners, Nurses, Social Workers, Registered Dieticians, a pharmacist and administrative personnel. These team members work in concert with family physicians to support comprehensive, team-based Primary Care. The Family Health Team offers a number of different programs and services and have sites in both Picton and Wellington.

Q: What is the PEFHO?
A: The Prince Edward Family Health Organization (PEFHO/FHO or County physicians or physician group) is an association of all the family physicians practicing in Prince Edward County and was formed in 2006 along with the PEFHT. The collective has an agreement to provide Primary Care services in Prince Edward County and that includes staffing the Emergency Department in Picton on a 24×7 basis. The Family Health Team model that is operating in Prince Edward County is hallmarked by family physicians working with the different professions in the Family Health Team to share care for residents. The Ministry of Health allocates the number of family physicians in the physician group and that number is 23 family doctors. In this model of Primary Care, only family physicians can roster patients. Currently there are five vacancies for family physicians.

Q: Why Isn’t there Nurse Practitioners operating independent healthcare clinics like we see in Belleville?
A: The Primary Care model operating in Prince Edward County, established by the Ministry of Health, only provides for family physicians to have the ability to carry a dedicated case load of patients. Sometimes that is referred to as rostering patients. Our model is called a “Family Health Team/Family Health Organization (FHT/FHO) Primary Care” model. Nurse Practitioners cannot roster patients in this model.

The Belleville Nurse Practitioner-Led Clinic is a different kind of Primary Care model. They were established to have patients register to their organization and consult with physicians as needed. The Family Health Team and the County physicians are reviewing what is possible to shift the parameters of the current FHT/FHO model in efforts to provide more Primary Care services to more residents. Collectively we recognize the incredible strengths and capabilities Nurse Practitioners bring to our community and healthcare delivery and want to foster everyone working to their full scope of practice. We believe we are in a crisis and recognize an all-hands-on-deck approach is needed.

Q: I have heard there is a shortage of all healthcare professions. Is that true for Prince Edward County?
A: The hard truth is simply stated: yes. Not only are we short five physicians, we are short Nurse Practitioners and Nurses. This is true province-wide. When services are delivered being short-staffed, burnout takes place and everyone is strained.

Q: Why is having a family physician so important?
A: Your family doctor is typically your first point of contact with the health care system in Prince Edward County. They are trained to diagnose the whole person and play an important role in you and your family’s health.

Q: How many patients do physicians carry in their practice
A: Every physician carries a different number of patients, but usually has a practice size around 1000, sometimes slightly higher or lower. This is really dependent on the other commitments and responsibilities the physician has. For example, particularly in rural areas like the County, our family physicians work in a variety of settings. These include caring for hospitalized patients, covering the Emergency Department, care at hospice or long-term care homes, as well as in support of clinical programs at the Family Health Team. These other responsibilities will also impact the number of days they are in their office and the number of patients they can carry.

Q: Are doctors business owners?
A: Yes. Most people don’t realize that the physicians in Prince Edward County run independent business practices. They hire their own employees, such as admin and nursing support, carry leases, and pay for clinic supplies. They do not get paid vacation or sick time, nor do they have paid medical benefits.

Q: Why do we need to recruit Drs?
A: Prince Edward County currently has five physician vacancies with more to come in 2023. Patients are falling through the cracks and being ‘orphaned.’ Orphaned means a person does not have a family physician.

Q: Why is physician retention so important?
A: While it is important to bring new physicians to Prince Edward County, it is equally important to keep the ones we have. This means we need to think about such things as workload, mentorship, and professional development. We also have to think about a physician’s personal values and fit with the community, including opportunities for spouses and children. Support from community partners is central to this goal.

Q: What is involved in recruiting a doctor?
A: There is no science to recruiting a physician. Our approach is to expand our reach to new physicians through job postings, advertising and presence at job fairs and conferences. We are also increasing our engagement activities with prospective physicians, in an effort to showcase the benefits of living and working in Prince Edward County. It’s important that both parties feel that it’s a good fit.

Q: Can the physician recruiter find me a doctor?
A: No, the physician recruiter’s role is to help recruit physicians to work in Prince Edward County. If you are in need of a family doctor you should register with Health Care Connect (https://www.ontario.ca/page/find-family-doctor-or-nurse-practitioner)

Q. What is Health Care Connect and why should I add my name to the Health Care Connect Wait list?
A. Health Care Connect (can be seen as “HCC”) is a provincial service that tries to match people seeking a family physician with physicians who are accepting new patients into their family medicine practice. The HCC list for Prince Edward County, as of December 2022, is approximately 1,675 people waiting for a family physician. We believe that number is much higher and would recommend and request our community members without a family doctor register themselves for one. It helps in discussion with the Ministry of Health to potentially allocate more spaces for family physicians.

The one requirement for signing on the HCC wait list is that a person does not have a family physician. We have heard people do not want to give up their family physician who practices outside of the County in order to add their name to HCC. What we want people to know is that the person can still continue to see their family physician for care even if they are ‘giving up’ their family doctor to go on the HCC wait list. That family physician will only be paid differently to provide the same care while you are waiting for a new physician. It is important to discuss this with your existing family physician to be sure all are aware of the intent to obtain a local physician in Prince Edward County.

For more information about Health Care Connect and how to sign up, please refer to: https://www.ontario.ca/page/find-family-doctor-or-nurse-practitioner or call
1-800-869-8829.

Q: Does the Health Care Connect Waitlist Really Work to find me a family doctor?
A: Yes it does. The family physicians working in Prince Edward County do take people off the HCC waitlist and roster them into their practice. What has changed over the years is the increasing complexity of people’s healthcare status. This results in lower numbers of people being accepted into practices at one time, off the HCC waitlist, as it takes more time to stabilize a person’s health.

Q: What is the buzz with physicians and housing?
A: Accommodations in Prince Edward County have increased in cost significantly over the years and this has also impacted our ability to provide reasonably priced accommodations to locums and other medical learners. The County Docs Retention and Recruitment initiative has launched the Doctor Accommodation Network (DAN) to support Housing for locums and new physicians.

Q: Why are so many incentives offered to new doctors?
A: Financial incentives can be appealing to new medical graduates and support them in setting up a practice where they may not have otherwise considered doing so. This is especially true when it comes to rural medicine. While these incentives and the competitiveness of them is an important strategy in recruitment, the overall fit of a community also plays an important role in decision-making and requires a collaborative community approach. County Docs is working on creating a competitive and comprehensive package for new physicians.

Q: How does the planning for the new hospital fit into Physician Recruitment and Retention?
A: Physicians and all other allied healthcare and administrative team members are needed to operate our current and future hospital in Prince Edward County. We feel a new hospital is a wonderful attractor for a new physician to join other physicians in Prince Edward County to practice family medicine.

Q: What else can I do to help?
A: There are many things that our community members can do to assist us in our success. These include, joining our Doctor Accommodation Network, support from our business community (financial and in-kind) – including restaurant, hotels, unique County experiences, lobbying your locally elected government officials to support the County Docs recruitment and retention program, donate to County Docs (portal is live on the Prince Edward County Memorial Hospital Foundation Website). It is also equally important to look after you. Get vaccinated, live a healthy lifestyle and put your safety and those you love first.

Q. Has it always been a challenge to recruit new physicians to the County?
A. The simple answer to that is no. Since 2016, there have been 11 new family physicians recruited to practice in Prince Edward County. The challenges to find new physicians started in the pandemic. Comparable communities with mature physician recruitment programs appear to be making some progress at this time.

Q. I am without a family physician. Who do I go to for my health care issues now, such as prescription renewals?
A. It all depends upon what issues you may be having. Prescription renewals can sometimes be completed with the help of a pharmacist. There are also walk-in clinics in neighboring communities and sometimes virtual physician offerings can be an option for non-urgent care. The Prince Edward Family Health Team has a listing of both walk-in clinics and virtual care options at https://www.pefht.ca/walk-in-care-clinics.php
If in an emergency, there is our local Emergency Room in Prince Edward Memorial Hospital.

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  1. SS says:

    OK, let’s assume that all Ameliasburgh residents a) have family doctors, and b) access physicians in Belleville and Quinte West.

    The most recent data that Stats Canada has on the population of the Ameliasburgh Township sems to be 2001, likely before dissolution. That number is 5,796.

    That leaves give or take, 19,000 people south of Ameliasburgh.

    That said, as far as I’ve been told, the Ministry of Health’s allotment of family doctor positions in Prince Edward County is 23. That would suggest that if they use the 1,000 patients per doctor number for their allotment calculations, they are not assuming that people in the north half of the County are meant to use facilities in Belleville, Trenton, Brighton, etc.

    Full disclosure: I have been on the Health Care Connect list for the County since 2021, and I’m told that it’s not possible for me to find out where I am on the list, or how many are on the list. They did tell me that I should call each doctor and ask. I did so, and was rejected all times.

    I used to use VirtualMD for prescription renewals, but their funding was cut off from the Province recently. The prescription renewal that I need is not on the list of the ones that pharmacists can do now. So next time, I’ll try the TeleMed references on the PEFHT site. Trying to avoid the need to go to the hospital ER, because I don’t want to dilute their resources with something like a prescription renewal.

    Perhaps I am in the minority, and most County residents have an acceptable family doctor access, and no issues getting what they need from the health care system.

    That’s not what I hear from people I talk to day to day, but that’s admittedly a small sample. I guess if no one comments here, then perhaps there’s bigger issues to deal with.

  2. Emily says:

    I suspect a lot of Ameliasburgh residents access Physicians in Belleville and Quinte West.

  3. SS says:

    Question:

    What is the current count of living patients on the roster of each of the 18 family docs practising in the County?

    This information is crucial to understanding just how bad the shortage is.

    A frequently mentioned benchmark for a roster is 1,000 patients.

    Per the 2016 census, the population of the County is 24,735.

    I have asked my opening question to our elected representatives and the Minister of Health. I was told to file a Freedom of information act request. I did so and the 30 day period expired.

    I was then told that an extension of additional 40 days was required “due to the volume of records that must be searched.”

    Let’s see the data and have an evidenced based discussion of how bad the situation really is, and then have everyone up to and including our Premier work together to address this.

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