County Docs shares recruitment progress and priorities with more than 200 residents

By Sharon Harrison
Packed in like sardines for a standing-room-only public meeting Wednesday night, more than 200 people wanted to hear an update on physician recruitment efforts in Prince Edward County, during a meeting at the Royal Canadian Legion in Wellington.

Top of mind for many County residents is not just the shortage of family doctors, but dire predictions of a worsening situation, especially given the five doctors have left and three more are planning to leave in 2023. But there was also some good news to share.

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 – in Prince Edward County and across the nation.

Hosted by the newly-formed Wellington Community Association, the public met Adam Hambly, the Prince Edward Family Health Team’s (PEFHT) new physician recruiter, who outlined progress made by the new County Docs Physician Retention and Recruitment program.

Hambly spoke of challenges faced, achievements made to date and priorities going forward.

The elephant in the room was ‘orphaned’ patients whose doctor had either retired or left and the expectation that more orphans will be created this year if vacant physician spots are not filled.

Hambly explained how residents should register with Health Care Connect, a provincial organization that manages waitlists for doctors across the province. However, it was noted that even if the County attracts new physicians to replace those retiring or leaving, it does not address those patients without a doctor currently who are on the Health Care Connect list, because they would taking over existing doctor rosters.

Hambly noted that while the waitlist numbers are not posted for public viewing, there are currently (as of December 2022) 1,675 residents in the County on the list.

“We know and we expect that number is grossly underestimated and that’s because, for whatever reason, patients are not registering on Health Care Connect,” he said. “It’s really important. That is the primary way to get a physician, and it really helps to make that number more accurate and is a case for us if we were to go to the ministry and say we need more physician spots available. They may look at that number.”

The County currently has 18 doctors, but is allowed by the province to have 23.

“The journey of recruitment together is quite the journey, and we do have some challenges ahead of us,” said Hambly. “There is a lot of concern in the room, and it is currently justified.”

Hambly reminded that health care provisions are ultimately a provincial responsibility and are not controlled at a local level.

“What we are seeing is this movement for municipalities to step in where they can and support, and the County is also following suit with that movement.”

He said while the responsibility does not fall to the collaborative organization they are working with, “we all recognize that there is a vested interest in making sure everyone in the County has a family physician or working toward that goal.”

Hambly confirmed that while each family physician roster varies depending on the other roles they hold within the healthcare community, each has about 1,000 patients, plus or minus a few hundred.

Diane Reilly, Wellington Community Association co-chair emphasized the point of the evening’s discussion has to be centred around local issues and only what the County can do, and what residents can do.

“We can’t address the Ford government. Please directly address the Ford government on this issue. That’s what’s needed, and the federal government, but we can’t deal with those issues this evening, only our local issues,” said Reilly.

Hambly said one of the biggest factors identified is the County physician group is approaching retirement.

“Last year we had three retirements, and if you look at our current state right now, we have three physicians in our current team who are over the age of 65.”

As it turns out, those three are not the three expecting to retire this year. However, “That really highlights the severity of our situation,” Hambly added.

He also highlighted the aging population in the County, one with more complex medical needs.

“We are seeing a tendency with new grads to delay committing to a practice, so what they are doing is what we call locuming, and that is when a physician covers a practice for a period of time; it could be a month, a year, or a few weeks.”

He explained when they are covering that practice, they are trying it on to see if it is a good fit, if the team is a good fit, whether the community is a good fit, a trend Hambly said they are seeing more and more coupled with a hesitancy to commit to something right away.

Joining the meeting were members of the Prince Edward Family Health Team and physician recruitment committee, including Dr. Anne Nancekievill, Dr. James Burrows and Debbie Korzeniowski, PEFHT executive director.

Also welcomed were members of the Prince Edward County Memorial Hospital Foundation, including executive director, Shannon Coull, as well as Lina Rinaldi, Quinte Health vice-president.

David McKinnon, with the Rotary Club of Wellington, spoke in detail to a proposal of establishing a satellite nurse practitioner (NP) clinic in Prince Edward County using three vacant diagnostic rooms at Sandbanks Medical Centre in Wellington, something many attendees indicated they were in favour of.

The clinic would be associated with the nurse practitioner clinic in Belleville, which is one of about 30 established nurse practitioner clinics in Ontario. McKinnon noted a backlog of 12,000 people at the Belleville NP clinic.

He noted how the Rotary Club established a health and wellness committee about six months ago, particularly because of the number of orphaned patients and other problems with health care delivery in the County.

“Probably two-thirds of the things that need to be done for most people can be done by both parties [NPs and physicians] equally well,” said McKinnon,

He said there is significant overlap between most family physicians and NPs, indicating it isn’t a question of competing one against the other.

“This is a question of recognizing that NPs do have, and are playing, an important role in our health care and there is a major possibility to help us here.”

McKinnon indicated extensive discussions have taken place with the PEFHT, Belleville NP clinic, with the owners of the Sandbanks Medical Clinic, and the club has also presented the idea to the Ministry of Health and to MPP Todd Smith.

“Those discussions have all been positive. NPs could be a very important part of the solution to the orphaned patients problem. Nurse practitioners (NPs) are cost effective.”

He said it is a different approach, but one they think fits with building a healthcare system for the future.

“We think our proposal not only addresses the immediate crisis, but positions us in the healthcare system of the future which is going to be different,” he said. “If we can get two or three NPS down here quite quickly, and I think it’s entirely possible, if we can sell our proposal, I think we can go a long way to helping to solve the orphaned patient problem.”

Questions from the public were many, and focused on residents without a local doctor, the Health Care Connect list (a show of hands revealed two-thirds of the room were not on the list and should be), whether the County could get more than the 23 doctor allocation, as well as concern for the extensive development expected which would worsen the demand for physicians.

The idea of bringing in foreign doctors was also raised, where it was indicated it was beyond the local mandate and was a provincial responsibility.

Several people were concerned at the list of orphaned patients waiting for a doctor who wouldn’t be affected by any new doctors coming to the County if they only be taking over existing practices, not working to reduce the list.

“That physician has the option to build the practice up, but it’s hard for us to speak on how Health Care Connect manages their process. I wish I had a better answer,” Hambly said.

Another audience member asked about recruiting additional doctors to help chip away at the list.

“That would require approval from the ministry. We cannot have more than 23 right now,” he said.

Debbie Korzeniowski, PEFHT executive director said it was a legitimate concern.

“I have heard very many times in my travels day-to-day that doctors are concerned about the equity of access to care,” said Korzeniowski. “The challenge is new incoming doctors have some career choice about how they start out and where they take over beginning from, and some of that isn’t within our control.”

She said all their doctors do take patients off the Health Care Connect list.

“The challenge I have seen over the years is that those numbers were taken off often in greater numbers, and what I’m seeing now is that the numbers have decreased, maybe 20 or 30 at a time, and now I see 10 at a time.”

Hambly again emphasised the importance of registering on the waitlist as it helps show the ministry the need for more physician spots.

An audience member asked the audience through a show of hands how many had found a physician through Health Care Connect. One person raised their hand.

“I think that is pretty useless,” he added.

Lina Rinaldi, chief nurse executive at Quinte Health said she was very much in favour of primary care NPs, but reminded there is also a shortage of NPs generally.

“I see that as being very complementary to this community and do fully support,” said Rinaldi. “Having said that, we do need family physicians here and physicians that will also support our future hospital, as that’s equally important.”

The question of why the County was not partnering with others to do recruiting on a larger scale, as a larger team to help the physician recruiter team, was posed to County mayor Steve Ferguson.

“The regional approach has been discussed as recently as last Friday with mayors Ellis (Belleville) and Harrison (Quinte West), along with talk about the game of poker we are playing,” said Ferguson.

In terms of financial incentives offered to doctors to settle here, he noted how Quinte West offers an $115,000 incentive, Belleville offers $150,000, and Marmora offers $250,000.

“We offer an $100,000 incentive,” said Ferguson, adding concern that “soon it’s going to be, I see your $150,000, I’ll raise you the $175,000.”

“I am fully supportive of looking at the different options that maybe available, including what we can do about NPs and I’d like to hear more about setting up a clinic,” said Ferguson, stressing, “there’s an awful lot of this beyond our control.”

Ferguson said he has met with Minister Jones to talk about the need in the County for the current number of physicians of three, which is the number retiring, and that number is insufficient.

“I have also pointed out that Prince Edward County has a population that is increasing and it’s no secret there is development throughout the County that is bringing new residents, and those residents will likely need physicians, and 23 will not be enough to serve the current evolving population.”

“We continue to roll the boulder up hill; every municipality is doing the same thing.”

Ferguson added council is supportive of the physician recruiter team’s activities.

“It is a very, very difficult problem to deal with, particularly because we are dealing with the province,” he added.

It was suggested by another audience member that a clinic could be put on so people could see a doctor once a year at least.

Hambly spoke to the national shortage of physicians, noting it is not just a County problem. He said part of the reason is declining enrolment in family medicine.

“Medical students are deciding to specialize elsewhere, not in family medicine,” he said. “Even with the ones that do decide to do family medicine, we are getting fewer that want to practice in a rural setting.”

A search found 2,500 active job postings for physicians across the country, noted Hambly. He also looked at the number of graduating physicians across the country, which is just over 1,400.

“It’s easier to see that massive gap we are fighting against, which is creating a lot of competition, something he describes as ‘fierce’.”

Hambly also spoke to the range of incentives being offered by some communities, which not only include financial incentives, but also housing, such as free housing or a stipend for accommodation to entice physicians to come to a certain community.

“We are seeing huge cash incentives, bigger than what we are offering, and we are also seeing office space incentives, whether it’s free office space or a subsidized office space arrangement, so what that’s doing is having these physicians when they are looking around, they are choosing elsewhere.”

Hambly said they recognize the level of investment that is required to build a robust physician recruitment program, and also a competitive incentive package, stating how important it is to set “reasonable expectations” and to be “transparent” however negative it may seem.

“Unfortunately, we have realized that there is no magic or science to recruiting physicians in this climate and it could potentially take years to bring us back to full complement make-up of physicians,” Hambly said.

“We need to be prepared for a long road,” he said. “We hope that it is not. We are confident we have some really cool things that we can advance the program with.”

He was pleased to report six complete site visits with physicians have been completed in the County where doctors and their family came to see the County. As well, 20 interviews have been undertaken in the last six months with doctors from across Ontario, Canada and international, two of which are promising leads.

“That’s a huge step forward for them, it shows that they are serious.”

Announced last month, a one-year locum has been secured for a physician that retired.

“That’s tremendous as it saved that entire population from being ‘orphaned’. Locums usually assist with vacation coverage but in this case helped stabilize a practice and 1,200 patients were not orphaned.

“We’ve also had a physician that was planning to retire decide to stay and that is significant, and that shows our program is instilling hope to our physicians.”

Also, not officially announced publicly, is a full-time family physician who will start in the fall.

County Docs recruitment seeks funding to continue efforts into year two

County Docs addressing physician shortage in Prince Edward County