Yellowknife (June 11/03) - Leonard Smith has fond memories of the year he left Yellowknife to practise medicine in Vernon, a small city surrounded by fruit orchards and ski slopes in British Columbia's North Okanagan.

"It was a beautiful place to be, nice and warm, with lots to do: skiing, swimming; we could grow stuff in the garden, there was fruit and lots of produce. It's a beautiful spot."

Family doctors back specialists Family doctors are warning that failure to reach a settlement with specialists could end in a general exodus of medical professionals from the Northwest Territories. "Some family physicians may elect to look for work opportunities in other communities," Health Minister Michael Miltenberger was warned in a letter signed by 18 doctors. Dated May 14, the letter was sent to the Yellowknifer Tuesday. Talks between the territorial government and specialists are due to resume June 28. The specialists have resigned effective July 1 and some say they will leave the territories if there is no settlement. The family doctors said in the letter that without the support of specialists they will be unable to provide local care in high-risk pregnancies and some emergencies will have to be transferred to southern hospitals. The absence of specialists would "greatly curtail" the practices of family doctors and might inspire some to look to communities "where they could utilize their skills to the fullest," the letter said.

The topper, Yellowknife's lone ophthalmologist recalled in a weekend interview with Yellowknifer, was that "I didn't have to work hard and I made tons of money."

Nevertheless, Smith returned to Yellowknife, where he and his family are "part of the community.

"My wife was born and raised in Fort Smith. There are a lot of relatives and when we're raising our kids we thought it was good to be close to family."

Smith and his family enjoy a comfortable life here, with a home on the waterfront, and a float plane for hunting and fishing trips.

But after 19 years in the North, he's ready to leave if the territorial government doesn't find more money for physician specialists.

"I don't want to, but if we can't come to an agreement on a new contract then I don't have much choice," Smith said. The territories' 13 physician specialists are paid an average of $314,000 a year. The government is offering $400,000 for the last year of a two-year contract. Smith and his colleagues want $500,000 according to information released by the government. To back their demands, they have threatened to resign on July 1.

"It's not hard for an ophthalmologist to make a good income in the South. I have colleagues billing $800,000, $900,000. There is overhead, but it's not that bad."

The negotiations are not just about money, Dr. Ken Seethram, president of the Northwest Territories Medical Association, said in the same interview.

"The big issue is burden of call," said Seethram, Yellowknife's only obstetrician.

"It's something physicians are struggling with right across the country. What's the call? That's the first question we get from doctors who are thinking of locating here."

The College of Physicians and Surgeons recommends that doctors not be on call more than one day in five.

In Yellowknife, lone physician specialists are "on call 24-7. You're attached to the beeper. Whatever you're doing, you drop and go right away," Seethram said. Smith and Seethram say they work 60 to 65 hours a week. A full-time pediatrician logs 70 hours, the lone general surgeon about the same, and anesthetists even more.

Seethram says the workload, isolation, and earning potential have made it impossible to attract specialists to the Northwest Territories. There are 13 physician specialists in Yellowknife who fill 14.1 equivalent positions.

The government has budgeted for 18 positions, but ideally there should be 30 to 35, Seethram says.

Stressful situation

Seethram says the territories provide "a solid minimum level of care" that covers basic medical needs, but it requires a team, not individual specialists, to keep it running.

In the South, surgeons can consult with colleagues on complicated cases, but "here, you're it. You're alone.

Not a lot of people are willing or have the skills to handle the worst complication. It's a stressful thing."

Negotiators for the government and the specialists will not meet again until June 28, three days before the doctors say they will walk out. According to the doctors, the government chose the date after the doctors rejected binding arbitration as a way to settle outstanding issues.

If the talks fail, the government has recruited four doctors to provide temporary help, but their services could cost as much as $1,500 a day plus expenses.

"It's an expensive way to provide medical service and there is a cost in care value," said Seethram.

"Where is the patient in all this, seeing doctor X one week, doctor Y the next? The loss of continuity is in no one's interest."

And if it comes to finding permanent replacements, Smith predicts that the government will come up empty. The total package - salary, location, workload and quality of life - "are just not recruitable." Seethram and Smith pointed to the settlement with family practitioners and said they are "looking for something comparable, in terms of the overall package, lifestyle benefits, and base pay to reflect the work we do as specialists."