LITTLE CURRENT—Patients rostered with the Northeastern Manitoulin Family Health Team (NEMFHT) in Little Current have received letters informing them that their doctors would no longer be serving them. First, it was Dr. Ken Barss who was moving to Ottawa, now Dr. Ben Quackenbush has informed his patients that he is closing his family medicine practice to concentrate his efforts on obstetrics and emergency room work, while Dr. Kathleen MacKeracher is reducing the scale of her practice because of the need to “accommodate the hospital workload.”
“Like many small, Northern rural communities, the physicians here are really struggling,” noted NEMFHT manager Judy Miller. “I’m sure you’ve seen the recent CBC ‘The National’ clip about the North Shore (Blind River, Thessalon, Richard’s Landing). In many respects Manitoulin is not far off from this situation. We are in a real battle to recruit new rural family physicians as they are needed everywhere.”
Ms. Miller noted that Manitoulin and the North Shore recently lost their physician recruiter as “he left his position for another job where he thought he could make a bigger difference.”
Ms. Miller noted the recruiter “didn’t have much luck for permanent recruitment in his role.”
The NEMFHT manager noted that the health team’s lead meets quarterly with the hospital and municipalities to discuss recruitment and to seek assistance. “We have upcoming meetings with the ministry and Ontario Health,” she noted. The NEMFHT’s lead recently chaired an Ontario Medical Association (OMA) committee in order to give recommendations on the Rural and Northern Physician Group Agreement (RNPGA)-style contract the health team on where the agreement needs re-vamping and modern changes to make it more attractive to physicians.
“We have no locums scheduled after October 4,” cautioned Ms. Miller. “That leaves 5.5 physicians who currently staff the Little Current emergency room and the16-bed inpatient unit 24/7, which has become increasingly busy with single medical doctor coverage. If that was all we were doing that would be enough, but we recognize the NEMFHT could collapse without us and ER would become even more unmanageable. We have some hopes for an internationally trained physician possibly joining us in November and at least two family medicine residents with interest in the coming two years but we need to prevent full burnout and the loss of local physicians. Once they leave or close practices, we know it’s virtually impossible to get them back or re-build.”
“All the physicians in Little Current (like many of our neighbouring communities) have been working above capacity for some time,” noted Ms. Miller. “Given the breadth of our responsibilities (24/7 ER coverage, inpatient care, nursing home/OB for some in addition to clinics) all our practices are double the size they should be to be manageable. This has been compounded by Dr. Barss’ recent retirement and the NEMFHT nurse practitioners have stepped up to manage much of his practice—themselves also now at or above capacity—in order to try and keep the hospital open and retain our local physicians.”
“With the exception of Dr. Quackenbush’s practice closure (about 500 patients impacted), all of the patient’s being discharged are from out of our catchment (ie. Sudbury, Espanola, Southern Ontario and beyond) and can continue to receive services until the end of October.”
Things are not all doom and gloom, as some of those patients will be in Manitowaning where they have full complement of physicians for their complement and are accepting patients, noted Ms. Miller. “We have reached out to them and they are aware and will accommodate patients there as they can. Particular attention was paid to try and continue to serve those (even if out of catchment) who are particularly vulnerable, like those with cancer etc. The ministry recognizes our catchment area as NEMI, AOK, Whitefish River First Nation, Sheguiandah First Nation. You can expect further letters to come from Dr. Ann McDonald’s practice, as well as those of Dr. Stephen Cooper and Dr. Simone Meikleham. For Dr. McDonald that amounts to less than 50 patients.”
These amount to small changes for the NEMFHT to try and create some space to do the work, which is truly overwhelming currently, noted Ms. Miller. “The alternative would be to close their practices like Dr. Quackenbush has done, which the other doctors are trying not to do—but certainly remains in the realm of possibility. There will be more work changes in the future to try and manage things if there aren’t improvements.”
Ms. Miller said that they recognize patients living on Manitoulin or in their catchment are likely the most vulnerable because of the lack of access to physicians and other services on the Island. “There are no walk-ins, you can’t get a pap test with public health here like in Sudbury or elsewhere, and ERs are not places to receive primary care—but we know there are many unattached patients here as well who have no choice,” she said. “We feel for our patients, both those we are keeping and those that are being discharged and it is morally injuring us to make these difficult decisions.”
The NEMFHT currently serves the Northeastern part of the Island, including Little Current, Sheguiandah, Aundeck Omni Kaning as well as Wiikwemkoong. Wiikwemkoong makes up one third of the NEMFHT patient load and the health team holds monthly clinics to support that First Nation community.
Laura Shilliday is one of the patients who have received letters from Dr. Quackenbush indicating he is closing his practice—she said she does not believe a good job of communicating was done in the letter she received.
“What are the ramifications beyond,” she asked? “What happens to specialist care? That wasn’t addressed in the letter. If you are on a roster are you still rostered for nurse practitioners—I called to ask but nobody called me back.”
Ms. Miller noted that such patients would need to access the hospital emergency room. “If they have their referral to a specialist and they become unattached after October 31, we will be monitoring the status of that referral with members of our team,” said Ms. Miller.
While some of the planning currently underway is still in flux, the NEMFHT is working on finding solutions.
Ms. Shilliday expressed concern about the Northern Ontario Health Travel Grants. “Nurse practitioners can’t sign travel grants,” she said, asking “how is that handled without a doctor, do emergency doctors handle that?”
“If they are seen by a nurse practitioner, we have a doctor’s name that is used for the grant. If they have no doctor the ER doctor would have to issue it,” said Ms. Miller. She assured concerned patients that the NEMFHT is working diligently to ensure that no patient “falls between the cracks.”
While he is scaling back his family practice, Dr. Quackenbush will continue to provide Aundeck Omni Kaning clinics, obstetrics and emergency room coverage.
News of these latest changes to Island doctors’ practices comes hard on the heels of an announcement that the Thessalon Hospital emergency room on the North Shore has been indefinitely closed.
