Stephanie McDonald
Northern News Services
Published Monday, September 10, 2007

NUNAVUT - It took 10 doctors to do the work of one during the 2006/'07 fiscal year in the territory. During that period 150 doctors passed through Nunavut hospitals and clinics; the hours they worked was the equivalent of what 15 full-time doctors could provide in the same amount of time.

Dr. Treena Greene is the chief of family practice at the Baffin regional hospital in Iqaluit. Nunavut has a revolving door for doctors, but she has been working in the territory for five-and-a-half years. - Stephanie McDonald/NNSL photo

Director of medical affairs Dr. Sandy MacDonald admits that while doctor staffing levels have improved since he began six-and-a-half years ago, there is still a shortage in the territory. Funding has been provided for 21 positions, 14.5 of which are currently filled.

Of the $240 million budget for Health and Social Services, approximately six percent, or $16 million is dedicated to the physician services budget.

There is no shortage of interest in doctors coming to Nunavut, but the challenge is finding those willing to practice outside of Iqaluit, and to find physicians willing to work longer than a week at a time.

"The optimal scenario would be to have full-time doctors who live in Nunavut and are part of the community," MacDonald said.

These doctors offer stability and can provide better care as they know the population and its needs.

Currently the Baffin regional hospital in Iqaluit is staffed with 10 doctors with another doctor in Pond Inlet. The communities of Iglulik, Cape Dorset, and Pangnirtung, each with populations over 1,000 people, are supposed to receive a visit from a physician every three weeks. The smaller communities on Baffin Island are to receive a doctor visit every four to six weeks.

"Due to staffing, we haven't been able to do that," admits Dr. Treena Greene, chief of family practice at the Baffin Regional Hospital.

The priority is to keep the emergency room in Iqaluit open, have a doctor who is able to deliver babies at the Baffin hospital and a physician who is able to perform surgery.

When doctor staffing levels are low, doctors must fill these roles before being freed to visit the communities.

"It takes most of our doctors to just cover Iqaluit," Greene said.

"They're supposed to be getting much more regular visits than they're getting," she said of the communities on Baffin Island.

When doctors aren't able to make regular visits to Nunavut's communities, a greater responsibility is shouldered by nurses, more patients are sent out of their communities for care and the doctors that are available are given a larger work load.

The situation is more critical in the Kivalliq and Kitikmeot regions.

"The primary role is played by community health nurses," MacDonald said. "Doctors are only involved if the situation is too complicated."

For the month of August there was no doctor in Rankin Inlet, although doctors were available 24 hours a day, seven days a week via telephone in Iqaluit if a nurse had concerns about a patient. Staffing levels have since increased.

Doctors from Yellowknife are flown to the Kitikmeot region for a week at a time. The health centres in Rankin Inlet and Cambridge Bay have in-patient facilities built and ready to use, but no medical staff to operate them.

Burnout is a major cause of the high turnover rate among doctors in the territory.

"Young docs don't want to work 80 to 100 hours a week," MacDonald said. "No one is going to stay if all they do is work."

When doctors visit the communities, they work with home-care services, group homes, inmates, liaise with nurse practitioners, staff TB and diabetic clinics and visit other federal programs that require a physician to be present, Greene said. This is on top of seeing patients that have waited for a doctor to come to town.

"The people in this territory get good medical care based solely on the health team that is here," Greene said.

"There are some systemic problems that need to be fixed, but we're getting there."

In the next six months MacDonald will be working on a plan to increase doctor levels in the territory.

Some suggestions to improve the level of service is to have more doctors in Iqaluit taking calls from the communities as well as doctors from the south.

Doctors who have worked in the territory before, but practice in the south, will be encouraged to adopt a community.

They will take the calls from the nurses in that specific community and make regular visits.