Dr. Paul Williams of the Trent Hills Family Health Team

Dr. Williams Spoke of the Strained State of Health Care in Trent Hills

5,100 patients in the Trent Hills area don’t have a doctor

Article by John Campbell

Trent Hills - Fri., July 15, 2922 - For the second meeting in a row, Trent Hills council has been asked for its assistance in providing primary care to local residents who haven’t a family physician.

The call for help this week came from Dr. Paul Williams on behalf of the Trent Hills Family Health Team.
The pandemic, he told council June 12, “has put a huge strain on the health-care system in general. The backlog for non-nursing services and increased demands for health care are pushing health-care workers to the brink.”

Doctors and nurses are “retiring in high numbers or leaving the field to pursue other work,” he said. In the past four months in Trent Hills two physicians “retired after many years of practice, and one has decided to move on to another field of medicine. Despite our best efforts we have not yet been successful in recruiting any physician replacements for these three doctors.”

That has left approximately 4,400 patients without a family physician, and Trent Hills already had 1,700 people on the waiting list to get one, he said.

However, roughly 1,000 of 6,100 patients no longer live in the catchment area and the hope is they “will now get primary care closer to where they live.”

That still leaves 5,100 patients in the Trent Hills area needing primary care.

When the family health team realized several months ago it wouldn’t be successful in recruiting family doctors, it decided “to re-purpose” the 3.2 full-time equivalent nurse practitioners it had on staff who saw patients “needing episodic urgent care” when physicians weren’t available, he said.

They also dealt with patients whose health issues “fell within their scope of practice. And some of the nurse practitioners had extra expertise in areas of women’s health and prenatal care.”

The work they performed “helped to lighten the load of the doctors in the clinic and allowed them to carry the practice sizes that they had.”

Under the new model of care, the nurse practitioners will roster about 2,600 of the orphan patients and serve as their primary care provider.

That means the doctors now have to see “all their own patients without the support that they previously had from the nurse practitioners,” Williams said. “So with these changes, both physicians and nurse practitioners will be working harder than they did before. We’ve all accepted this as a necessity to try and meet the demands as best we can.”

Even with the changes, approximately 2,500 individuals in Trent Hills will still be without a primary care doctor or provider, he added.

Campbellford’s two walk-in clinics “do help meet the needs of these orphan patients by providing good urgent episodic care, prescription renewals, but it’s no substitute for primary care,” Williams said. “Study after study has shown that patients with primary care providers are healthier, live longer, and utilize (fewer) hospital resources.

The Trent Hills Family Health Team has submitted a business proposal to the Ministry of Health to fund three more nurse practitioner positions, and it has the support of local MPP David Piccini, but “it’s unlikely that we will be successful,” Williams said, based on “what we’ve heard through webinars.”

The family health team continues to actively recruit family doctors but it’s “becoming increasingly difficult not just for Trent hills, but for every community across the province,” he said.

Physicians are self-employed contractors who bill the government for their services and use the money they receive not only to pay themselves but also clinic staff, supplies and other expenses.

The rise in these overhead costs has “far outpaced the negligible increases” that ministry has given physicians in the past decade, Williams said. “This means that most family doctors are taking home less money now than they did 10 years ago.”
“In addition to the reduced remuneration, family doctors are dealing with an aging population with more complex medical needs. And we’re also inundated with an ever increasing amount of medical forms that take up more and more of our time.”
“All of this is pushing family doctors away from primary care,” he said.

In fact, The College of Family Physicians of Canada released a statement in June that said “there is a crisis in family medicine,” Williams said, for many of the reasons in evidence locally. “Something needs to be done now.”

The “reality is there’s a severe shortage of family doctors across all of Ontario, even within large urban areas. This, unfortunately, means that Trent Hills is now in direct competition with every other community in the province for doctors.”

And “family doctors are people with families and their own needs so they will naturally seek out communities that can offer them the best incentives,” he said. It’s “a huge problem that requires a dramatic change in the entire country of how primary care is organized and how family doctors are remunerated.”

But “it may be years before primary care is re-innovated,” Williams, and “in the meantime… we need to do everything we can to recruit physicians to our community, despite being in competition with every other in the province.”

The municipality and Campbellford Memorial Hospital contribute an equal amount each year to physician recruitment and retention efforts ($75,000 apiece in 2021).

Williams said he had no specific request to make of council; he was there to “encourage” members to look at the initiatives being offered by surrounding communities and to ask themselves “if we truly offer a competitive recruitment package at this time that helps to attract and retain physicians.”

A family physician with no ties to the community “will easily move 30 minutes down the road to a community that offers better financial support,” he said. “We need our whole community working together to ensure that we can bring doctors to this town (and) keep them here so so that we can guarantee good primary care for all of our citizens for years to come.”

Williams was pressed by Councillor Rick English on what sort of “enhancements” council should consider making.
“It is difficult because … larger communities have deeper pockets and they can offer larger signing bonuses or other incentives,” Williams replied.
Adding to its difficulty is that the municipality is a small community that’s also committed to helping fund Campbellford Memorial Hospital, which is looking to build a new hospital.

One thing other communities are providing more and more is assistance with overhead costs, he said.
Any reduction with those costs “helps to attract physicians and can keep them here in the long run.”

A signing bonus, on the other hand, can get doctors to move here for three to five years “but then when that’s done, they move on to the next town and get the next signing bonus.”

Councillor Cathy Redden cited a CBC report she heard earlier in the day that said fewer medical students are choosing family medicine as a career because of the long hours and many challenges. The proportion of medical students choosing primary care practices had dropped from 38 per cent in 2015 to 30 per cent in 2022.

She suggested council “become more aware of what’s actually taking place” and then decide what it can do to support the recruiting of doctors “even better than what we’ve been doing.”

Two weeks earlier, council had been asked for its help in setting up a nurse practitioner-led clinic. Beth Van Dusen said a local pharmacy had agreed to provide her with a site and resources but not pay her a salary. Van Dusen said she hopes the province will provide her with one, based on a proposal she has prepared, but she asked the municipality to cover the cost in the interim.

Council, as it did with the presentation by Williams, received her presentation for information.

Editor’s Note: Dr. Paul Williams has been working in Trent Hills as a doctor for 22 years