Council concerned with loss of two doctors

With the recent loss of two practicing physicians from Ponoka, a town council committee plans to step up recruitment in the coming year.

Coun. Rick Bonnet, a member of town council’s physician retention and attraction committee (PRAC) is disappointed to see doctors leaving.

“It’s not just a Ponoka problem, there are 47 placements needed in the central Alberta region alone,” he stated.

It can be hard to remember that health care professionals also have a life and a family they care for, said Bonnet who would like to see special recognition for doctors in the community.

“I think we should do something for medical staff, maybe have a barbecue,” he explained.

PRAC has looked at what it takes to bring in doctors and the biggest attraction is for their spouse and children to feel like they could make a home in Ponoka, which in turn makes an easier decision for the doctor.

“Not just doctors. Professionals period. You’ve got to have amenities,” he explained.

Dr. Carin Swartz is one of the doctors leaving Ponoka. Based at the Medical Centre, she recently wrote a letter to patients stating effective Feb 29, her practice will move to Wetaskiwin.

The decision to move was not an easy one, but Swartz said her on-call hospital obligations made her feel overtaxed.

“You’re in the office all day and most of the night you’re busy. I would have a 30-hour day. You wonder how safe it is really for the patient who you see at noon the next day,” she said of her on-call shifts.

Swartz requested she be taken off the on-call list in October 2010, but her request was denied.

The College of Physicians and Surgeons of Alberta (CPSA) governs physicians in the province, and is responsible to ensure compliance of the rules and regulations. All doctors need a license to practice, which comes from the college.

Every town also has a separate set of bylaws for doctors on how to care for people in their community. These bylaws are decided on by the medical staff, and not by government administrators. Swartz said the Ponoka medical staff bylaw states doctors are not allowed admitting privileges if they are not a part of the on-call roster.

CPSA requires all physicians must be available to provide afterhours care for their patients or be part of an on-call group, but according to Swartz, in larger cities such as Edmonton and Calgary, doctors usually don’t answer their phones after hours because patients generally go to emergency rooms for immediate care. In some instances, locums — doctors who substitute for other doctors — will also handle emergency care.

Because her request was denied, Swartz made the decision to give three months’ notice to Ponoka medical staff of her intent to give up hospital privileges May 1, 2011. This also put Swartz in a difficult position.

“If I don’t cover it (her patients) in a rural area then on paper they (local doctors) have to sign they are willing to take care of my patients,

Council concerned with loss of two doctors and they haven’t been willing to sign that or come to a written agreement,” Swartz explained.

Not having admitting privileges meant she was unable to read her patients’ files, admit them or administer care at the hospital, so the doctor on-call would handle her patients’ needs.

Two of Swartz’s colleagues at the Medical Centre, Dr. Izak Van der Westuizen and Dr. Brendan Bunting were invited to join with the Ponoka Family Health Clinic — Swartz was left out of the invitation — and will move their practice. Dr. Colum Surgenor announced his practice is moving to Montreal, Que., which left Swartz to manage a large clinic by herself.

For these reasons Swartz announced to her patients in a letter dated Dec. 10, 2011 that she would move her practice to Wetaskiwin where she will not be required to be on-call.

She believes most of her patients will make the 30-minute trip to see her, but some elderly patients are not as mobile and will have to find a new doctor.

Swartz said the best way to fix this problem is to get rid of the local bylaws and have one for everyone to follow; this would make things equal for doctors throughout Alberta.

Dr. Robert Halse of the Ponoka Family Health Clinic, said CPSA requires doctors have a shared on-call arrangement to ensure patient coverage throughout the year and in 2009 Ponoka doctors agreed unanimously on their current bylaws.

“Doctor Bunting, due to the fact that he’s been doing that for 35 years, was granted immunity from doing it,” explained Halse.

A clause in the bylaw does allow doctors over the age of 55 or because of illness, to request to be removed from the on-call obligation. Dr. Peter Davis, Ponoka’s only surgeon, also applied to be removed from the on-call list because he was over 55, but his request was denied. Davis wanted to keep up his surgery at the hospital, but not be on-call.

“The issue about the hospital is it provides services for doctors who provide clinic and full medical services to people in town; he was not prepared to maintain a clinic in town,” Halse stated.

If Davis were approved, there was the possibility it would open the door for all the doctors to work in the hospital and none would be required to work the clinics where patients needed care.

Davis has since left Ponoka to practice elsewhere.

Ponoka now has six doctors to care for its 6,600 population. This number is in line with a report released by the Canadian Institute for Health Information Dec. 15. In 2010 there were 203 active physicians per 100,000 Canadians, or approximately two per 1,000.

But what is considered an ideal doctor-to-patient ratio?

Michael Hunt, director of Pharmaceuticals and Health Workforce Information Services, said in the release it is difficult to give a proper number as several factors define demand: the health care needs of an area, how many hours doctors are working, how care is organized and the scope of practice from health care professionals.

There seems to be no easy solution to the problem, but Bonnet said PRAC is working to attract more doctors in 2012 and give them a slice of the Ponoka community.