A lack of family physicians is a growing problem, and the province needs to rethink how it delivers health-care services, says the Newfoundland and Labrador Medical Association.

"It's a complex situation that's been going on for a long time," says Dr. Charlene Fitzgerald, head of the NLMA.

The association commissioned Narrative Research, formerly Corporate Research Associates, to conduct a phone survey, asking people how many of them are currently under the care of a family doctor.

That phone poll was conducted from Aug. 8 to 25, with a random sample of 400 adults. Results are accurate to within 4.9 percentage points, 19 times out of 20.

Of those asked, 81 per cent of people reported that yes, they do have a family doctor, while 19 per cent said they did not. The percentage of people without a doctor amounts to as many as 99,000 residents, the NLMA said.

You can't walk in and have your congestive heart failure, diabetes, emphysema and depression managed in a walk-in clinic. - Charlene Fitzgerald

For the people who responded they do not have a family doctor, most people reported attending a walk-in clinic service to get their required medical care. Another 42 per cent said they go to the emergency room, while 13 per cent said they go to a general hospital intake for medical services.

"The first step to finding solutions to a problem is really seeing what the problem is," said Fitzgerald, adding that the NLMA has hired a consultant to look into how many family doctors are practising on the ground, how many will be needed in five years, and how many will be needed in 10 years.

"This is foundational work that needs to be done, and we're going to be releasing it to government once it's done and obviously to the public."

The NLMA is meeting with Health Minister John Haggie and department officials on Wednesday to discuss the latest poll numbers.

Exodus of family doctors

In the meantime, Fitzgerald said the "erosion of family medicine in Newfoundland and Labrador is not news," adding it's been ongoing in rural parts of the province for years.

"Rurally, we've seen for many, many years a rotation of family physicians who come and serve for short periods of time and go out, leaving again a new family physician to come back in — if the patients are lucky," she said.

"Now the problem is even inside the overpass, where recent retirements, as well as difficulty in recruiting new-to-practice family physicians, has led to a crisis in family medicine, to the point where patients are adrift."

Fitzgerald said family practice is a fairly popular discipline at Memorial University's medical school, with more and more students opting into it.

"However, our numbers show that at the end of their residency training, very few of those actually go into comprehensive community-based family practice," she said, adding that many of those who finish their residency here often opt to leave.

Boosting that retention rate, she said, should be the first priority addressed by the province.

About one in five people in Newfoundland and Labrador do not have a family physician, according to a poll commissioned by the NLMA. (Shutterstock)

"It's sad to think that they're leaving and working in practices elsewhere, after we've spent a lot of effort and resources in training them, so the recruitment and retention has really got to bump up," Fitzgerald told CBC's St. John's Morning Show.

Another rung on the ladder to improving the delivery of health care in the province is reconsidering the current approach.

Walk-in clinics not the answer

Fitzgerald said the family practice of old is a model that doesn't serve the needs of modern patients, and instead, a collaborative, team-based approach is better for everyone.

In addition, she said, consideration should be given to changing the way doctors are paid, and structuring it around the concept of a patient roster, where a physician is caring for and ensuring the good health of a list of regular patients.

That's the kind of care people going to walk-in clinics won't get, she said.

"Most patients come in on multiple medications, with multiple problems, and they need time and effort and co-ordinated effort. This can't be performed in a fee-for-service system," Fitzgerald said.

"Walk-in clinics are designed to provide one service quickly, and patients nowadays don't need one service quickly, or if they do, many more need comprehensive continuous family medicine care."

Fitzgerald said more patients now than ever have multiple lifelong conditions that need regular care and attention, and a family physician and team-based approach can be addressed only with consistent care.

"That kind of problem can't be addressed as a walk-in — you can't walk in and have your congestive heart failure, diabetes, emphysema and depression managed in a walk-in clinic."

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