Glen Vienneau
Northern News Services

Yellowknife (Jun 28/00) - The shortage of doctors and nurses is not new in Yellowknife. For nurses such as Candy Grim, they see first-hand how the current doctor shortage affects the people needing care.

With almost 14 years of nursing experience working at the Stanton Regional Hospital, Grim has seen many health-care workers in transition.

First starting in the surgery unit at the hospital, Grim also spent seven years as the supervisory nurse in psychiatry. Now stationed in emergency for the past two years, Grim says seeing several of the best doctors leaving the North sometimes makes her wonder why she stays behind.

Yellowknifer: How does the doctor shortage affect the hospital?

Grim:: It affects the hospital, it affects the whole community. It affects us as health-care consumers because the doctors have lost many of their co-workers from the clinics that have not been replaced on a full-time basis.

That decreases the number of family doctors in the community. When that happens, what they tried to do is get people to come up as locums.

Yellowknifer: Then, what happens?

Grim:: Some doctors do come up as locums and work through the clinics. So they see a load of clients that have been affiliated with that clinic for some time. Recently, as well, we've got locum doctors that just come up to do emergency on-call and perhaps as anaesthetists in the operating room, or whatever else they're doing, but, do not have a clinic per say that they work out of.

So, the clinics lose people that they can't replace on a full-time basis.

The doctors that are left in the clinics, try to absorb all the patients that have made that their family clinic. That gets to be overwhelming to the point where they can't accept new patients, perhaps new people moving to Yellowknife.

There seems to be a whole bunch of them recently that present (themselves) 'I'm new to Yellowknife, I can't find a family doctor.'

They just can't accept any more patients into their practice because they're already overwhelmed with numbers.

Yellowknifer: What happens then, they (patients) come here to emergency? They have no alternatives?

Grim:: Yes, or else they go through several clinics if they can squeeze in a appointment.

But, there's no consistent doctor caring for them or their family. Mostly, we see a backlog from the clinics, because they're booked well in advance, weeks in advance, and booked solid.

So, clinic stuff ends-up coming to the emergency.

Yellowknifer: Now, you mention doctors are overwhelmed. How similar is the case for nurses?

Grim:: Well, nurses do, as well, have to be careful for burnout. It's different in a way.

When the doctors in the clinic are caring for more patients because some of their co-workers have left, they're carrying an excessive load. They don't only see people in the clinics. They come into the hospital after hours to deliver babies, to see in-patients.

They can get calls at all hours of the night from nurses concerned about patients that have been admitted to the hospital.

So, there are times where they may get very little rest. As more doctors leave, the load on the doctors that are left here increases.

The more the load increases on them, the more they are stressed and it's very difficult to retain people in that sort of situation.

The physicians here love their work, but, they need to have a life, too. Just like any person in the community.

But, the shorter we are for physicians, the harder the ones left behind have to work and to take care of the community and the territories.

It's the same for nurses that work in hectic, understaffed conditions. (But) I think our staff to patient ratio for nurses here is still fairly decent.

But, they don't stay in those work settings a long time and you can't recruit and retain.

Yellowknifer: Is retaining nurses a problem in the communities (NWT)?

Grim:: There's a problem with keeping nurses in the communities. That and the cost of living, and the cost of airfare and everything else in and out of the North impacts us. Nobody wants to live up North for those reasons.

When you can live in the south and be flown up, and stay in a community at a month at a time and then flown home to the nice climate, the lower cost of living, the highways, why would you live in a community where you are isolated and expected to work like sort of 24 hours of being available? It just won't happen.

Yellowknifer: Some mines, that's what they do. They fly them (workers) home for two weeks, then come back for two weeks to work. Is this similar to what we're seeing with locum doctors.

Grim:: They (miners) don't make the territories their home. That impacts us in a big way and you just think of the fallout.

In fact, I find it mind boggling how we can't just sit down and see the financial impact to the government. I mean, give them (doctors and nurses) housing allowances, they become part of the community.

They get to know the people in the community so they work more efficiently with them. I buy goods in the territories.

People that are here for two weeks in and two weeks out are not shopping in Yellowknife. Or, not spending any vacation time here. They're not invested in the North at all and that's a shame.

Yellowknifer: Having a doctor, who is more permanent here, is it better than having a locum coming in and out? As far as working conditions?

Grim:: They make things work more efficiently. When somebody is here for six shifts and then gone again, you just sort of start to learn (to build a team) and then it's gone.

Now, you've got somebody new to learn with all over again. You can't work as efficiently like that.

Yellowknifer: Does that add to the stress?

Grim:: It adds a little bit of stress, although I must say that our working crew here, physicians, nurses and everybody, are top notch. The people it does stress the most are the patients, I'm sure, because they see a doctor once and twice.

They like them, they like the care they've received, but that doctor disappears from Yellowknife. New people coming to town are having a very difficult time finding family physicians. Which is not efficient either in that sort of scenario.

I mean, there are ways of communicating information from physician to physician, but in a run of a busy day, if you can't follow through with a patient, if they have to see a different doctor each time, they may end up having the same diagnostic test repeated unnecessarily because there's no follow-through.

If you've got your family doctor you're seeing them about a problem they know what they already done. They know what the results are. They know where to head next.

When you see a different doctor every time for this health concern of yours that is not resolving, they start from ground zero again. And follow-up appointments with your family doctor, when you don't have a family doctor, who do you go to see? You come back to the emergency, and see yet a different doctor.

It's very frustrating for patients, it's frustrating for the whole system. And even the people that have family doctors in town, if they're having a crisis at home with a child that's acutely ill.

That can be from anything from a very painful ear, vomiting, diarrhea anything. Whatever that they want to get in and see their family physician about, they can't wait for three weeks to have that appointment. And they can't. If there's a kid in pain, they aren't going to wait. And the child is suffering, nobody wants that.

Yellowknifer: Sometimes, they (parents) don't know what's a real concern or not?

Grim:: That's part of it, too. People don't know what to be concerned about.

In Yellowknife, it's a very transient population. Not many people have their mothers, fathers and their family around to call and say `What did you do when you had little kids?'

That's not available for people up here, so they go to their health-care professional for what they may have years ago looked to their family for. It's much easier to go to the emergency or go to see a physician than call long distance to somewhere half the way around the world to get the support that you need.