Sunday, March 20, 2011

A crisis of healthcare access in Wakaw, Saskatchewan

There is a crisis in Wakaw, Saskatchewan. Not because its hospital is losing inpatient care, but because no one is asking the right questions.

Wakaw is a town of about 1000 people, located 100 km northeast of Saskatoon. Like many small prairie towns, it has been struggling to retain family physicians to provide care to its citizens. Retirement and relocation has overwhelmed recruitment, and now, without any resident physicians, the local hospital will no longer offer inpatient services.

The comments in the Star-Phoenix article centred around the inability of Wakaw and the Saskatoon Health Region (SHR) to recruit physicians, citing physician unwillingness to take on heavy on-call responsibilities.

VP of community services for SHR, Shan Landry, is quoted saying:

Most (doctors) now are looking for a lifestyle that does not include that kind of demand on their time.

Wakaw mayor, Ed Kidd, responds:

In reality, the more they tout it, the more these doctors agree with them. We’ve had doctors in our community forever that have done on-call. I understand emergency services could be an issue, but on-call, I think you can get doctors that are still compassionate and believe in their patients. I think the health region makes a mistake by continually prescribing this to the doctors.”

With respect to Mr. Kidd, times have changed.

This is a particularly poignant issue for me because of some advice my father gave me. He had served as a GP/general surgeon in a small Saskatchewan city for about 30 years. He earned the respect and admiration of his fellow citizens through his total dedication to their medical care. As I began my own practice 20 years ago, he said to me “My only regret is that I didn’t spend enough time with my family. Don’t make that mistake.”

Even when you’re not actually seeing emergency patients while on-call, you always feel a low-level tension at needing to be available at all times. You can’t travel. You can’t be the sole caregiver for your children. You can’t have a drink. Most physicians would find it onerous to be on-call more than 1 in 4 nights.

So, the question they are asking is: Where can Wakaw recruit 3 or 4 physicians?

But, is that the right question to be asking?

Before I suggest some other questions, I should say that all I know about this situation is what I read in the paper. I’m sure some of these questions have already been considered, but I haven’t seen them discussed publicly.

What do Wakaw citizens really need? Are physicians the only providers who can meet these needs? Are they the best suited to meet these needs?

How have circumstances changed so that newly-recruited physicians will stay?

How do other similar Saskatchewan towns manage without physicians, or a hospital?

Are inpatient hospital admissions the most appropriate way to provide care?

This is a complex and emotional issue for a small town. An aging population worries about access to the care they need. The town is concerned about job loss.

This is also a political minefield. (In an election year, no less!) Imagine being a politician who’s sincerely concerned for the well-being of Wakaw residents, and wants to raise some of these questions. Would you risk being pilloried by political opponents with accusations of insensitivity to the healthcare needs of the rural electorate?

It seems unlikely that Wakaw will be able to maintain a resident group of physicians. It’s time for someone to lead the discussion toward a more suitable, contemporary and sustainable solution.

4 comments:

  1. So Well Spoken!! I work as a family doctor in rural Sask, ON CALL is one of the most challenging aspects of the work --especially when many many people come to emergency with trivial things at ALL hours of the night and day. Emergency use has increased so much over the last few years. I also find the people that cry over the loss of physicians, thought nothing of coming to emergency at 02:00 am with a cough they have had for 2 weeks or a small cut they sustained at 7:00 pm (but they stayed out until one and then came in). We are often told "we make big bucks to get up at night". This disrespect and lack of any personal courtesy makes rural family medicine very challenging. If the communities do not start to appreciate the services they have and not abuse them they will soon have none. Case in Point.

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  2. Thanks for this comment from the front lines!

    A related point: During these debates over emergency/on-call coverage in rural areas, I have never heard anyone ask about the welfare of the physician. What happens when a solitary doctor is on call, and he/she gets ill? There's no other doctor for miles around. Paradoxically, the person with the worst access to medical care in rural Saskatchewan is the physician!

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  3. Wakaw is too small to support a family doctor, the 2 who very very publicly derided for leaving did so because there were not enough patients in village sized Wakaw, and they made substantially less than the nurses.

    Wakaw should have clinics staffed a few days a week by a doctor from Rosthern and/or Humboldt

    In the mean time, Saskatchewan continues to throw an ever increasing medical school class size at the rural family physician shortage, rather than come up with any sort of targeted plan.

    Don McMorris lacks any kind of vision as a health minister. Would be nice to hear the government's plan on recruiting and retaining rural physicians, if they have any. As is, most resident physicians are personally angry at McMorris and the Sask Party and list them as one of their reasons they'd like to leave Saskatchewan!

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