No easy solution to doctor shortage in town

Coun. Sandra O’Connor is pushing to bring a nurse practitioner to town, hoping it will happen sooner rather than later.

She is concerned about the 6,000 residents of Niagara-on-the-Lake who are without a doctor in town, and this is the first step toward improving local health care for them. 

With the help of Lord Mayor Betty Disero, a team of advocates that includes Bonnie Bagnulo, the executive director of the NOTL Community Palliative Care Service and representatives of the local family health team, and the backing of council, she is hoping for success. They have run into a roadblock, she says. They were told by Niagara Health at a June meeting that the funding is still in place for a nurse practitioner, but she is now hearing they have to get approval for the funding, and hoping that’s only a temporary hiccup and can be worked out — she hopes for some good news later this week.

But that is really just the first step.

This week the country’s 13 premiers began meetings to talk about health-care funding to address a severe shortage of doctors, nurses and other health workers, pointing to a lack of federal funding to increase health care resources.

NOTL is not immune to that problem, but as premiers are well aware, there isn’t a simple solution.

O’Connor, in her discussions about the need for a nurse practitioner, has learned how badly NOTL is in need of doctors, and the prognosis for attracting them is not good.

“NOTL has the highest percentage of Niagara residents 65 years of age or older, with over 30 per cent in that category,” said O’Connor. “No other municipality in the Niagara Region is 30 per cent or greater.”

Dr. Karen Berti, one of the Niagara North Health Team’s family physicians, has worked and raised a family in NOTL, and remembers a time 10 to 15 years ago when the town had its own doctor recruitment committee.

That is no longer the case, she says, although the family health team is in need of doctors. They are down one, with the others dividing up the roster of those patients, but in recent years the population of town has grown more than 30 per cent, while health care resources have not, making NOTL considerably under-serviced.

The Ministry of Health pegs patient rosters at 1,360 per doctor, but that is based on 18 per cent of patients being over 65, says Berti.

Forty-two per cent of her patients are over 65, and even patients over 50 have more health issues, taking up more of a physician’s time. The majority of those moving to NOTL are over 50, she says.

“Family medicine has always been complex in nature,” says Berti.

But it’s becoming more difficult, with the growing number of seniors in NOTL and the complex care they require. “They’re not just coming in with a cold and a cough.”

O’Connor says when she talked to members of the Niagara North Family Health Team, she was told they have the longest wait list for a doctor that they have ever had.

Berti says she and some of the other doctors don’t even keep a wait list. “It just perpetuates the problem. Why would I have a waiting list when I can barely provide care for the number of patients I have?”

And it’s not just family physicians who are struggling, she adds, it’s specialists as well, creating issues with getting referrals for patients who need them, and delays for everything from imaging to surgeries.

“It’s tough, and it’s everywhere,” she says. “Every specialty is suffering. Every health care worker is having a difficult time.”

Doctors, nurses and all health care workers are exhausted, says Berti. Many were burned out before the pandemic, retiring or choosing to leave their profession, and it’s only getting worse. “Retention is as important as recruitment.”

Niagara Region has had a recruitment and retention committee since 2001, with a goal of trying to attract doctors to all of the municipalities in an under-serviced region.

But it’s a competition, says Berti, and NOTL, with its high percentage of seniors taxing a doctor’s workload, and no extra remuneration as determined by the province, is not attractive to new doctors.

The cost of living, the cost of homes and office space, the gaps in the school system and the issue with transportation to some schools are all factors that discourage doctors from choosing NOTL over some of the other municipalities, she says.

“It’s just a lack of a fundamental resource, and everyone competing for it.”

But there are some positives in local health care, she says.

Given the older population, some people have been sick, and some have died from COVID, but overall, “NOTL has done well during COVID.”

NOTL has “a great family health team,” she adds, “and great resources. We could just use more of them.”

And at some point, as the pressure from the pandemic eases, “there needs to be some time and energy spent on recruiting more health care workers to the town and the region.”

O’Connor says while municipal governments are not to get involved in health care, the Ontario Medical Association says municipalities have a role to play in health infrastructure.

In NOTL, the first step is bringing another nurse practitioner to town, who will work for and be paid by the Niagara Health system, she says.

Health infrastructure can also include an urgent care centre, and that is something else she hopes to advocate for in the future.

O’Connor has recently learned that Fort Erie, one of the municipalities under-serviced and competing for new physicians, has created a community health care services committee, and a bylaw was passed to allow the town to work on recruiting and retaining physicians. “Fort Erie is actively seeking family physicians to join the existing medical community,” the town website says. It lists some of the incentives it will offer doctors, including “an exciting, lucrative” package for new physicians that would include relocation expenses, and adds “we would be happy to showcase our community and the surrounding attractions on a site visit that we will arrange and fund for you and your spouse.”

O’Connor says she “would not discount the creation of a committee to help find us some doctors for Niagara-on-the-Lake.”