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Doctor shortage wanes in hospital, new health centres

"Last summer we were barely able to cover our emergency room"

SARA MINOGUE

Until recently, doctors in the Baffin Regional Hospital faced "a war zone," as Nunavut's Nunavut's medical director, Dr. Sandy Macdonald, puts it.

"Last summer, it was awful here," Macdonald said. "We were barely able to cover our emergency room."

Now, with 11 doctors in the Baffin region, seven slated for the Kivalliq and four planned in the Kitikmeot, Nunavummiut are slowly approaching the same level of care available to people across Canada.

Until 2004, Nunavut had the lowest ratio of doctors to population in Canada. While Ontario had 100 doctors per 100,000 people, Nunavut had just 25. Even Nunavik, with a population of just 11,000 - smaller than the Baffin region - had 14 full time doctors, at a time when the Baffin had just eight.

That changed this year when the number of doctor's positions funded by the Government of Nunavut went up from four to seven in the Kivalliq and from two to four in the Kitikmeot.

Macdonald, who is in charge of all doctors, also has plans to hire visiting surgeons, anaesthesiologists, a psychologist (pending cabinet approval), a paediatrician and student residents. The time put in by these visiting experts will be the equivalent of 30 full-time doctors, a number that Macdonald says is sustainable for Nunavut's population of 30,000.

So far, just three out of the seven Kivalliq doctors, and two of the four Kitikmeot doctors have been recruited, but in Macdonald's opinion, the more physicians he is looking for, the easier it is to make hires.

"No one wants to come into a failing proposition," Macdonald said. "No one wants to be the only doctor left on deck as the Titanic goes below the waves, but if they know they're coming in with a good sized group, it's easy to recruit people, and for every doctor we recruited last year, it was easier to recruit the next one."

For now, the Kivalliq has three short-term doctors, who will be replaced when full-time doctors are found. People in the Kitikmeot will receive care from two doctors who travel from Yellowknife until two more full-time doctors are placed there.

That, Macdonald said, should suffice until the two regional health centres are up and running, and keeping patients overnight.

The challenge is still trying to keep people, and provide continuity of care to Nunavummiut. Doctors who stay for a year or more are considered long-term.

Three doctors in the Baffin, including the chief of staff, Dr. Botha, are leaving this fall. All have been replaced, but Macdonald would like to see more doctors who make a longer commitment.

"It's always going to be a challenging physician's job here," Macdonald said, "but I want to make it so people can do it year in year out and have a life, to go camping and enjoy other things that they enjoy here and not spend every day of the week in here, which is what in the past people did do and there's not many that can make it work."

Pay level is one way to attract doctors, and Nunavut stays competitive. Macdonald is also working towards creating a more supportive environment for doctors within the Government of Nunavut's department of health and social services - which currently employs all doctors in the territory.

That means developing the rules, regulations and protocols of patient care. These are factors, Macdonald said, which determine the quality of care in Nunavut. Macdonald characterizes the physician infrastructure in Nunavut as "very underdeveloped."

In the future, he hopes that new doctors' committees - such as the death review committee through the coroner's office, and the territorial medical advisory committee - will allow doctors to use experience on the ground, with patients, to influence policy.

"The point of that is to try and coordinate the physicians services with all the other services we provide here," Macdonald said.

By 2010, when the GN's Care Closer to Home is closer to being a reality, Macdonald hopes to see 15 doctors in the Baffin, eight in the Kivalliq and five in the Kitikmeot, which a cohort of surgeons, aenesthesiologists, psychologists, paediatricians, and medical students adding up to 42 full-time positions.

One way of getting there will be training Nunavummiut.

The GN is already looking for potential medical students they could support financially in exchange for a return-of-service - or, a certain number of years working in the territory once their training is complete.

It takes six years to become a fully accredited doctor.

"There are no Inuk doctors from Nunavut," Macdonald said. "We're hoping to have four to six doctors from Nunavut in about 10 years."

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