Deep rooted problem to blame for ER woe

Doctors can read a map. They may not teach that skill in medical school, but it's a safe assumption.

New Tecumseth is one hour away from anything money can buy. And doctors have money. Even graduates will eventually drive a Porsche - or at least afford one. Money is not the real problem.

About half of Ontario's communities are designated medically underserviced. It's not limited to remote outbacks where the moose outnumber the natives. Cities too.

This is a deeply rooted problem which has been present here for at least a decade. New physicians have opened offices in New Tecumseth, but that gain is offset by deaths, retirements, and relocations. Factor that with a population expansion and the math is simple. We're at least six doctors in the negative.

It shouldn't come as a surprise that Stevenson Memorial Hospital (SMH) would eventually feel the impact. Last month, the hospital's board of directors faced a grave situation: there were 17 shifts in the emergency department that could not be filled. This was not a one-month case. Local doctors in particular, but the nurses as well, reached a burn out point. The medicos have their daytime patients and are also expected to handle hospital duties on shifts. But each day, week, month, and year, it was falling on to fewer shoulders.

The board decided the only solution for the time being was to close the ER beginning August 31 between 10 p.m. and 7 a.m. News leaked out sooner than the hospital had planned and the shit hit the fan.

The hospital board has been unfairly blamed for letting this problem fester. SMH has spent several years searching for doctors, contrary to what The Alliston Herald would have its readers believe. Its been to recruitment fairs, and lobbied to be designated underserviced so that it could qualify for the Ministry of Health bonus programs offered to entice physicians to these areas.

New physicians, particularly those in specialized medicine, are being aggressively recruited by hospitals from across the continent, let alone in Ontario. Small town life may have its benefits, but not enough for many with six figure salaries.

SMH can not come close to offering new doctors the compensation packages that large urban centres can.

So now we have a community task force established about three years to late that harbours good intentions but skewed priorities. 

This mix of municipal, hospital, and medical representation has been provided with a $1.5 million budget and so far its big idea is the possibility of plopping a modular turn key office on the hospital property with the hope this could do the trick. Not likely.

During most of the 1990s, Dr. John (now deceased) and Dr. Brenda Derjanecz were advertising their turn key practice which came complete with equipment and a few thousand patients. In other words, ready made riches. There were nibbles, but in the end, when they were practically giving it away for free, it still was not enough. 

The practice died and patients were left to find alternatives. Some did, many could not.

The problem will not be solved at the local level. It falls to the provincial government and to some extent Ottawa.

Medical schools and teaching hospitals have to change. Med students are only allowed to perform residency at teaching hospitals. And the closest many come to a real emergency on a regular basis is on Thursday nights at 10 p.m. on NBC.

An intern at a teaching hospital is surrounded by specialists. They're not being trained to handle on their own everything from a broken fingernail to a broken neck.

At a Toronto hospital, when the victims of a serious multi-vehicle accident are wheeled in, a team of specialists are on hand with the latest medical gadgets. Student doctors are on the sidelines watching it all unfold playing very minor roles.

A doctor at a small community hospital like SMH, doesn't have that luxury. Here they're on the front line of any emergency. They're role is to stablize the patient so it's safe for them to be transported to the big city. In many cases the wait could be more than one hour.

This scares the life out of many new graduating doctors because they're not prepared. But this can be solved by the provincial government stepping in and forcing changes to residency rules. Students need exposure to small hospitals where they'll recieve hands on experience.

Collingwood's hospital sponsors a program called the Rural Ontario Medical Program (ROMP). It's a program that offers new doctors the opportunity to intern under the watchful eye of a doctor with teaching credentials. Dr. Stephen Cudmore, New Tecumseth's coroner with a practice in Beeton, is a graduate of the program.

ROMP's main hurdle is that it is voluntary, and only available to those that have already graduated from medical school. That means participants, who at that point can begin practicing medicine, forgo that for a while longer to gain experience in a small hospital setting. Again, because students are not permitted to leave the teaching hospitals.

Simcoe Grey MPP Jim Wilson, a former Minister of Health, is very well acquainted with ROMP. But during his stint as minister, one of his solutions was to force doctors to work in underserviced areas.

While many can agree that something drastic is necessary, that certainly wasn't the answer.

Mr. Wilson should be lobbying his government to make changes to how medical schools confine their students to the large hospitals.

There are other issues including the fact that many new doctors don't want to work in the ER or at a hospital. They want 9-5 office hours and weekends off to enjoy their lifestyle. Also, many doctors are married to other professionals and it's not a simple matter to just pack up and leave. There are growing numbers of female doctors who have their unique issues about locating to a small town. But these matters are really out of anyone's hands.

Attack the problems at the root and that's the medical schools. The Ministry of Health has to step in and revamp residency rules. Mr. Wilson can do the community a great service by lobbying his government to make these changes, and also to fund the expansion of ROMP.

Without core shifts, the task force risks squandering $1.5 million on a lot of wine and cheese.