Health Minister Randy Delorey’s characterization of the cause of 10 doctors leaving St. Martha’s Regional Hospital in a year has drawn a strong reaction.
“As with any profession, it is normal to have people retire or pursue new opportunities while others join an organization in a given year,” Delorey was quoted in The Chronicle Herald on Monday.
“Antigonish is no exception, within the last year there were some doctors who retired or pursued new opportunities but seven new doctors began practicing in Antigonish ...”
Members of the medical community The Chronicle Herald has heard from since then said that there are systematic issues driving doctors away that need to be addressed. But they also fear that speaking out will hurt recruitment efforts.
One of them agreed to speak on condition that their name not be used.
“I know the community will know (who I am), but I’d rather it not be explicit for anyone who might search my name online,” said the young doctor who left St. Martha’s for a job in British Columbia.
“... there’s a larger issue, a system issue, that needs to be addressed in Nova Scotia before you can start to expect doctors wanting to work there.”
For the sake of airing some of the systematic issues hampering doctor retention in our broader health care system we are providing the requested anonymity.
Fresh start, or road block?
“I came to Antigonish because it seemed like a fresh start for a new doctor, a parent, a spouse. What I found was road block after road block.”
The specialist was lured to St. Martha’s Regional Hospital fresh out of school with a large signing bonus, promise of a family friendly community, and a guaranteed salary known as an alternative funding plan on a five-year contract.
After 13 years of medical school, the doctor came with student loans “significantly higher than most mortgages in Antigonish,” a spouse and child.
“While training, life continues and interest rates build up and most of us don’t start working until our 30s, at which point, we have no life savings, no retirement plan, nothing,” said the doctor.
“I came to Antigonish because it seemed like a fresh start for a new doctor, a parent, a spouse. What I found was road block after road block.”
The first cause of stress was burnout.
Antigonish is a regional hospital offering 24 hour services and specialists. But it’s not a large hospital, which places a heavy stress on staff. In this doctor’s case it meant working a full-time schedule plus providing full-time coverage for ten days out of every 30. While on call the doctor couldn’t be more than twenty minutes from the hospital and had to be available to respond on a moment’s notice.
“It also meant that my partner was the default parent to our child, as I didn’t know whether or not I’d be available to do drop-offs, pick-ups, bed time routine, etc. What I didn’t expect coming to Antigonish was how limiting my work would be for my spouse.”
Not the only burnout
“Apart from my full-time duties I was either on call, pre-call or post-call every day of my life. I had zero ability to modify that.”
The issue of burnout was also cited by Dr. Jeannie MacGillivray, another doctor who has left St. Martha’s in the past year.
In February the sixth generation Antigonisher told The Chronicle Herald the Nova Scotia Health Authority essentially forced her to resign after refusing her proposals that would see her work slightly less than a full-time schedule with a corresponding decrease in pay.
“I was burnt out and I just needed a little bit of help,” said MacGillivray, a general surgeon.
“Apart from my full-time duties I was either on call, pre-call or post-call every day of my life. I had zero ability to modify that.”
The doctor who is the focus of this story wasn’t from Antigonish and also lacked the support of extended family for childcare.
Most daycares in Antigonish close for the summer, which added another stress to the family’s first and only year in the town.
Coupled to the life stresses and long hours was the issue of money – with a huge student loan debt and a spouse who effectively couldn’t work due to scheduling, money mattered.
Though the alternative funding plan with its guaranteed salary looked good on paper, it didn’t pan out as well when the actual hours of work were factored in. So the doctor switched to the fee for service model. As a specialist the doctor was making 62 per cent of what they now make in British Columbia.
Even getting paid at all could be frustrating.
An honest day's work...
“Now why in the world would anyone give up their rest day, leave their family behind, to come work for straight time which they are unlikely to see anyway due to taxes?”
Additional stipends are provided every three to six months for the aforementioned 24 hour on-call shifts and to offset the large costs of carrying the required insurance to practice.
“Except that every time the time comes to get paid, it feels like we’re pulling teeth, begging and asking for our money,” said the doctor.
“There are administrative delays after delays, excuses after excuses and our payments are often months late. And that’s assuming you follow-up and make sure you actually got paid.”
While the doctor said repeatedly that “St. Martha’s is a great hospital” nurse staffing shortages provided additional frustrations.
“That for some reason is an issue that is denied by people in administrative positions who run hospitals yet clearly have no understanding of how a hospital should actually be run,” said the doctor.
“Nurses are asked to come and work beyond their scheduled hours yet are not offered any overtime pay. Now why in the world would anyone give up their rest day, leave their family behind, to come work for straight time which they are unlikely to see anyway due to taxes? So guess what happens? Nurses decline to come in for extra hours. Road blocks are put up. Physicians, like myself, are told we can’t provide the care we are capable of providing and are then asked to call LifeFlight to transfer patients out.”
After just a year in Antigonish the doctor chose to sever her five-year contract early, pay back the original signing bonus with the required 25 per cent in interest and take a job in British Columbia.
“The poor remuneration, the lack of social integration, the lack of flexibility for myself and my spouse due to high work demands, the lack of family support, the constant road blocks put up by (the Nova Scotia Health Authority) were simply not worth it,” said the doctor.
“... Did the financial hit sting? Yes. Would I do it again? Without a doubt. At least I bought my freedom back and that’s priceless.”
The road ahead
The Nova Scotia Health Authority doesn’t comment on individual employment situations.
However, St. Martha’s medical site lead Dr. Jeremy Hillyard told The Chronicle Herald last week that two of the ten doctors who have left Antigonish over the past year have listed pay as a reason.
“Some people left for family reasons, some had some issues with changes to licensing regulations. Some go for what we would call lifestyle reasons — either less call or more money or both,” Hillyard said.
There have also been an additional seven doctors — four of them specialists — recruited over the past year. Talks are ongoing with another two specialists.
In the meantime the hospital has seen increased wait times for elective surgeries and for patients to see internal medicine specialists.
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