Relying on short-term doctors may harm health care in Canada’s eastern Arctic

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The Qikiqtani General Hospital in Iqaluit. A new report published in this month’s journal of the Canadian Medical Association identifies physician turnover in Nunavut as possibly hurting patient care. (CBC)
Nunavut, in Canada’s eastern Arctic, suffers from a shortage of permanent or long-term doctors and nurses and if the territory is like other jurisdictions where transient physicians and nurses are the norm, that’s not good for patient care.

These findings were published earlier this month in the Canadian Medical Association Journal. The report, “Addressing provider turnover to improve health outcomes in Nunavut” documents the territory’s reliance on transient medical professionals in its health-care system.

The report states that although there’s not enough research to say exactly how that affects health care in Nunavut, studies of other regions with transient medical workforces suggest it’s not good.

Gwen Healey Akearok is one of the authors of the report, and the executive and scientific director of the Qaujigiartiit Health Research Centre in Iqaluit.

“In our review we found that it’s been reported that people stay sicker for longer or may be delayed in finding out what may be causing their health issue,” she said. “It’s very serious.”

According to the report, in 2014-2016, “more than half of the physicians working in Nunavut were on contracts for fewer than 20 days at a time.”

As for nurses, there’s no detailed data on turnover rates, but in 2016, 62 per cent of community health nursing positions in Nunavut were vacant. Most of those positions were filled on short-term contracts.

The problem with high physician and nursing turnover is lack of continuity in patient health care. It’s too easy for temporary physicians to overlook — or not be aware of — what could be important patient background during client consultation or diagnosis. Patients can feel isolated in a system where care providers are regularly replaced with unfamiliar faces.

“Some of the challenges include not feeling like they’ve developed a trusting relationship with their health-care provider and then they may not go back and complete treatment or continue to seek care,” Healey Akearok said.

“There may be medication errors or a refusal to continue to take medication that they might need.”

Recruitment not the problem

Recruiting health-care workers is not the problem: there is no shortage of physicians and nurses willing to move to Nunavut. The problem is, the move is usually only for a short while.

Dr. W. Alexander (Sandy) MacDonald is a co-author of a report published earlier this month on how care-giver turnover in Nuanvut affects patient care. (Submitted by Sandy MacDonald)

“People are interested in coming here for … our beautiful land, our beautiful communities, and the beautiful life we live here,” HealeyAkearok said. “But [they] are reluctant to stay because of the high cost of living, the cost of travel, [and] at times they reported challenges with finding employment for their spouses.”

Coupled with the demands of being away from family while living and working in Nunavut, this means doctors and nurses don’t stick around for the long haul.

“I’ve worked with so many locums in 17 years I lost track of them,” said Dr. W. Alexander (Sandy) Macdonald, another of the report’s authors and chief of staff for Nunavut’s Health Department when the report was written.

“I’m sure there’s thousands of people have passed through Nunavut,” he said.

The obvious solution is to develop more Inuit doctors and nurses. MacDonald said progress has been made on that front, but it remains a long-term solution.

In the meantime, recruiting doctors and nurses who move to Nunavut for longer terms is critical to improving health care in the territory.

But there’s room for other solutions, especially in communities too small to support a full-time doctor.

“We have many physicians who live outside Nunavut, but who keep going back to the same community year after year,” he said.

“There’s a physician that’s been going to Naujaat for eight or 10 years,” he said.

“That physician knows all the people in town. He knows the nurses well, he knows the system well, and even though he doesn’t live in Nunavut, that’s the kind of continuity that you can achieve … given the sort of circumstances that we have now.”

Written by Walter Strong, based on interviews by Donna McElligott

Related stories from around the North:

Canada: Inuit elder has waited months in southern city for access to home dialysis, CBC News

Finland: Finland’s elder care needs funding boost to meet Nordic standards: researcher, Yle News

Sweden: Fewer people suffering strokes in Sweden, Radio Sweden

United States: Alaska TB rate dips but still among the U.S. highest, Alaska Public Media

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