We have no choice but to hire contract doctors, Nunavut’s medical boss says

Dr. Sandy Macdonald speaks March 14 to reporters about the use of short-term doctors in Nunavut. (PHOTO BY SAMANTHA DAWSON)

The use of “locums,” or short-term contract doctors, is a necessity for Nunavut’s health care system, Dr. Sandy MacDonald, Nunavut’s director of medical affairs, said March 14.

The number of locums practicing in the territory each year has risen by 67 since 2003.

“If we didn’t need them, I wouldn’t have hired them. I’d rather not use them. But when the choice is between having them or nothing, then we have to make a difficult decision,” Macdonald said at a March 14 news conference.

In 2011-12, 144 different family doctors working in Nunavut, most on short-term contracts.

But that number has increased over the past 10 years. In 2003, 77 doctors worked in Nunavut.

Most stay for periods of two to four weeks, with the minimum period for a short-term contract at two weeks.

That two-week minimum period for a short-term doctor contract is also used in the Northwest Territories.

“One year we did raise it to four weeks and right after that the whole market collapsed, and we had to crawl back down and get one-weekers and six-dayers — and it was awful,” Macdonald said.

It takes about nine doctors working every day to keep the doors open at the Qikiqtani General Hospital, which serves residents of the Baffin region and Iqaluit.

“The numbers add up a bit,” Macdonald said.

In 2003-04, 77 various family doctors worked in Nunavut; 103 from 2006 to 2008 and 120 in 2010-11.

At the same time, the number of days they worked increased from about 2,200 in 2003-04 to about 4,500 in 2007-08 and up to 7,912 in 2011-12.

And that big increase in service hours for Nunavummiut adds up to good news, Macdonald said.

This is because Nunavummiut are getting more medical services and better care than in the past, he said.

“We have about 30 positions in the territory that we fund for doctors. Most of those are family doctors. That’s where the crunch comes,” Macdonald said.

Out of the 30 positions, “we’d like to have about two thirds of those be long-term.”

Long-term is considered to be a contract of one year or longer. But that’s easier said than done.

However, in Iqaluit, there’s been a permanent surgeon at the hospital for the past 16 years.

“Where we run short is for family docs. Of the 30 positions, 28 of those are for family doctors,” Macdonald said.

The budget for paying doctors in the territory now stands at $24 million a year. Over a 20-month period, $11 million of that budget was spent on hiring 120 short-term hires.

But bringing in short-term doctors is a normal practice for Nunavut and other northern jurisdictions.

Often, that happens when there are no alternatives and no one to cover emergency shifts.

“We had no doctor to work Labour Day weekend emergency nights. One doc who’d worked here on and off for three or four years said, ‘I’ll give up my Labour Day weekend and come up and help you out,’” Macdonald said.

This was welcome news, Macdonald said, because “we can’t close the hospital and say go to the one down the road.”

In Iqaluit, there are 12 long-term doctors, and two in Rankin Inlet.

People in Rankin Inlet are happier now, as they’d been living without a permanent family doctor for six years, Macdonald said.

“It’s changed the game over there. Everyone’s happier. They’re enjoying life there, [and] they’re starting to find problems that I didn’t know existed,” Macdonald said.

Other doctors work most of the year in Arviat in Baker Lake.

The use of short-term doctors also prevents doctor burn-out and helps make their life “sustainable,” Macdonald said.

It’s not “an optimal situation” because patients don’t get continuous care by having the same doctor, he said.

But doctors try their best, he said.

“If I’m concerned about a patient and I have to go away for a week off, I’ll tell [Patty] DeMaio or one of the others, this patient is going to come and see you… or make a note in the chart saying please make sure you follow this up,” he said.

However, the Government of Nunavut wants to recruit long-term doctors.

But “we’re in a competitive market,” Macdonald said, adding “we’ve got a lot of interest in Nunavut right now.”

Macdonald has some good news to report: two Nunavut land claims beneficiaries are enrolled in medical school in Calgary and Montreal.

The news conference followed a news story on CBC North that reported from April 1, 2011 to Dec. 31, 2012, 120 doctors were hired for locum contracts at the Qikiqtani General Hospital in Iqaluit at a cost of $11.5 million.

That report, based on documents obtained through an access to information request, said a short-term emergency room doctor is paid $2,100 for a 12-hour shift, a contract obstetrician earns $2,500 for a 24-hour shift, and a doctor working eight hours in the clinic earns $1,200.

The temporary doctors are also provided with return airfare and housing, the report said.

CBC North reporter Jane Sponagle was not allowed to attend the by-invitation-only GN news conference.