CBN medics say towns can play role in doctor retention

By Mark Squibb/May 5, 2022

Doctors Christopher Peddle and Megan Hayes, practising in Carbonear and Harbour Grace respectively, spoke with mayors, councillors, and other community members at length about doctor retention and recruitment during a recent Conception Bay North Joint Council meeting.

Both are board members of the RE-Boot Family Practise Network, a group of 83 physicians started in 2015 and incorporated in October of 2019 to address challenges faced both family physicians and members of the community.

Deborah Wearn, RE-Boot FPN Executive Director, opened the discussion by explaining the organization’s goals, purpose, and history.

“We have a lot of different strategies related to recruitment and retention,” said Wearn. “But our goal is to find, and help to facilitate, innovative solutions for improved family physician recruitment and retention. One of those strategies includes facilitating opportunities with our community allies, such as municipalities.”

Wearn introduced Peddle and Hayes, two of the nine board members, and Hayes spoke first to the challenges facing the region.

“We have a lot to say about recruitment and retention, because we see where the gaps are,” said Hayes. “There’s an issue of recruitment and retention here in Newfoundland and Labrador. It exists in primary care. We’ve felt it for a long time, but it’s getting a lot more attention.

Hayes said close on 80 medical students are posted all over the province each year, and that doctors try to pique students’ interest in living in the area.

“But, we have not been successful in doing that,” Hayes admitted. “Because mostly we have been showing them the work of family medicine. But the part that might entice them is the life outside of that, which we are hoping you guys are able to come up with some ideas of how to show them that.”

She said salaried positions remain unfulfilled, and as more physicians set their sights on retirement in the coming months and years, and as less students visit through international programs, there is a need for new doctors in the area.

“They have a huge amount of debt and it’s daunting to start a practice,” said Hayes. “I can tell you what it was like for us to start our practice in 2014.”

Hayes, who graduated from family medicine in 2009, wanted to return to her home of Cupids. She said that her and two other female doctors had to spent two years looking for an investor, as they could not afford a building of their own, before they could set up their practice.

“So, new graduates are seeing the massive amount of work involved in running a clinic, and they’re not doing it,” said Hayes.

She said the Newfoundland and Labrador Medical Association (NLMA) estimates there are as many as 90,000 folks without a family doctor, although the government disputes this number. Those in need of a family doctor can register with Patient Connect NL.

She added regional health authorities focus largely on recruiting positions within hospitals, not community clinics.

“They want to staff the hospitals, but they’re not talking about putting people in the bricks-and-mortar, like we have in Harbour Grace,” said Hayes. “The roles in the hospital are important, but we all know that that’s not who you’re going to, to try and keep yourself out of the hospital.”

She said there is an incentive program for new family medicine grads, but that much is still in the works.

“I think it still remains (to be seen) as to whether or not they know what to do to get family doctors in the area,” said Hayes. She added no one is recruiting fee-for-service doctors like herself.

Dr. Christopher Peddle spoke to his decades of experience in family practice.

“You guys are obviously incredibly important stakeholders,” said Peddle. “And that could have a very relevant role in attracting, we hope, new family doctors to the community.”

Peddle, a self-described ‘transplanted townie,’ has been practicing in Carbonear for decades.

At one point, the TC Medical Clinic where Peddle works had five full time physicians.

“They worked like dogs, that’s all they did, was work, work, work,” said Peddle. “That was a lifestyle that existed, and that’s the way it was done at that time and that style of practice doesn’t really exist anymore. Nobody is prepared to work like that, because frankly it isn’t particularly sustainable. So, the new graduates, and quite rightly, like many new graduates in any field, talk about ‘work-life balance,’ and that’s extremely important because the jobs we do, like many jobs, are very time consuming, high stress jobs. So, finding that balance is very, very important, and that’s where communities can get involved.”

TC Medical has seen thousands of patients over the years — and also a number of doctors that have come and gone.

“The three older partners retired, like they must, in their seventies nearly, and we’ve had three people recruited, and two have left, and the third is leaving,” said Peddle.

He said communities should make an effort to connect medical students when they first come to town.

“It would be nice to have some sort of formalized approach to how these learners could be contacted and get introduced to the community,” said Peddle. “So, what we see as being incredibly important is what kind of ideas can we think of that could sell our region as a nice place to live?”

He said such a committee already exists in Clarenville and that others are being organized in other parts of the province.

“Sell the area ,” said Peddle. “What’s attractive? What are things that make you want to live here? What are the benefits of living here?”

He suggested free gym memberships, day care and babysitting services, and spousal employment are all perks that could be included in an incentive package.

Peddle added he’s optimistic the region can be seen as an attractive place for physicians, if stakeholders work together to present it as such.

Councillor Danielle Doyle spoke to efforts the Town of Carbonear has been making.

“I don’t know if you’re aware, but the Town of Carbonear has been trying very, very, very, very, very hard to help with this process,” said Doyle. “We’ve been held up with COVID, but we started, right at the beginning of COVID, a Welcoming Community Committee that we were hoping to be able to do a lot of these initiatives that you talked about.”

She said one of the biggest issues is finding out exactly who they’re selling the town to. Doyle said Eastern Health will not release information regarding visiting medical students due to privacy concerns.

Hayes than jumped in to tell Doyle that council might have more success contacting MUN directly.

“I think MUN would be your better bet, and they would love to (help,)” said Hayes.

Doyle added the Town of Carbonear is also working towards doing a series of promotional videos.

Hayes said she loved hearing that individual communities are working on initiatives, but suggested a regional approach may be more effective.

Bay Roberts Mayor Walter Yetman asked what wasn’t working, and why the area wasn’t attractive to doctors.

“With the initial overhead and the initial setup, what I found very helpful was getting business tax relief,” said Hayes. “If you’re just starting out, you’re thinking of all that overhead. And all you have to do is put ‘medical’ in front of any type of equipment and the price doubles.”

Peddle said most folks have little idea how much it costs to run a clinic — from plowing the snow in the parking lot to purchasing equipment. Those overhead costs, said Peddle, are daunting to new graduates.

“New graduates say, ‘I don’t want to pay all that much money. I can’t afford that,’ and ‘I don’t want to work that hard just to try and support it,’” said Peddle.

Another factor is an area’s lifestyle options, including dining.

“The food options aren’t great, from their perspective,” said Hayes, saying Carbonear sometimes earns the moniker ‘grease alley’ for its offerings of greasy, deep-fried fast foods.

Clarkes Beach councillor Dave Penney raised another issue.

“I grew up in Mount Pearl and I moved to different parts of the island for work — I’m a school principal — and I can certainly attest to the isolation one feels, and one’s spouse feels, moving to an area where you don’t know anybody,” said Penney.

He asked whether MUN could increase the number of medical graduates, and if that might ease the problem.

Both doctors noted MUN has increased the number of graduates over the years to 80 a year these days, but the problem remains.

Hayes said rather than hope for more graduates, towns ought to work to attract those who do graduate.

“I doubt we’re going to get many more (graduates) soon, so I guess our question to you guys is how do we entice the ones that we can get?” asked Hayes. “Because again, I think if our work-life balance looked a little different and they came and trained with us, they would be more tempted. Because essentially, they’re comparing this to working in a hospital with no overhead, secretaries provided, nursing provided, all of that stuff.”

Once the doctors logged out of the call, municipal leaders continued the discussion.

Cupids councillor Rod Delaney said he firmly believed the issue of doctor attraction and retention fell largely on the lap of the province.

“We all know the difficulties and the challenges of retaining physicians here,” said Delaney. “I’m a supporter, 100 percent I’m a supporter, but you’re not going to get me to go to the community of Cupids, of 800 people, and ask for financial relief. It’s just simply not going to happen, it’s too difficult. Regionally, lets have that conversation, it’s way too important, and I might be saying something controversial to the room, but I feel that there has to be some objectivity here given to the smaller communities that just simply don’t have the resources. We’re struggling now with our water and sewer locally, and now we’re talking about providing tax relief to other people, and those other people are physicians.”