December 2, 2023

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‘Focus Saskatchewan’: Retiring family physician concerned for her 3,500 patients

“I’m leaving and there’s nobody that I can say will take your care, will prescribe your meds.”

That’s what Saskatchewan doctor Marlys Misfeldt is being forced to say to her patients after announcing her retirement this December after 42 years in the field.

She says she has more than 3,500 patients, roughly the population of Battleford, Sask., and said all of them will have to rely on walk-in clinics in Saskatoon once she’ hangs up her stethoscope.

The Canadian Institute for Health Information showed the province lost 159 doctors between 2020 and 2021, yielding the lowest per capita rate in the country.

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“You can’t keep up with the backlogs that are now sitting at the door,” said Dr. Annette Epps with the Saskatchewan Medical Association.

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“Situations like (Misfeldt’s) really kind of shed light on how urgent it is that we get some transitional measures and gap measures in place. We need to explore how many Dr. Misfeldt there actually are and what we can do about that.”

About 90 doctors and specialists have come to the province recently, but even the province’s new incentive and retention programs aren’t doing enough.

“There’s lots of them that are getting to that point where they want to retire and we want to be able to replace them with good quality physician-led primary care in their communities,” said health minister Paul Merriman in March.

Merriman had just announced several plans to bring health-care workers to the province including more money for after-work hours and more complicated care, however, the funding hasn’t actually been provided yet.

It has been shown to be very cost-effective and also very high quality, I guess clinically effective. What’s key with this model of compensation is the care model,” Epps said.

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Saskatchewan introduces new payment model for family doctors

The model is supposed to be family physician-led with a team backing the lead.

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“It’s meant to decrease what we call episodic care,” explained Epps. “This way it’s all kept in something called the patient’s medical home.”

The current funding model does not support this kind of service because it has physicians doing tasks that don’t usually fall within their practice, which is where the government’s new compensation plan comes in.

“Those patients get a medical home with that family doctor, and that family doctor is compensated simply for having those patients on their roster and providing that assigned basket of services,” Epps said.

However, the new compensation models are only agreements as of right now. No funding has actually been put forth yet, but the government has talked about switching models over the next year.

The only program that is currently receiving funding is one that entices doctors to choose rural areas for their practice.

“I went to those smaller towns in undergrad,” said University of Saskatchewan medical student James Macaskill. “I was just so struck by the fact that, you know, for example, in some of those smaller communities, it wasn’t just that that community didn’t have a family physician, but all of those neighboring communities didn’t.”

Macaskill, who is from Dundurn, south of Saskatoon, wants to go into medicine but hasn’t decided on a specialty yet.

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He said he thinks it is great that the province is implementing new incentives, but he isn’t necessarily optimistic about the future.

“We have this little skeleton of a plan,” said Macaskill. “But there’s a lot of words in there that require immense work to be done to actually foster that. To say we use this capitation model that involves a number of different allied health-care professionals. I mean, just in that sentence, that is sort of like from a policy perspective, an incredible amount of time and energy that needs to go into looking at what exactly does that entail? 

“Where do we pull our funding to get the extra help from those allied health-care professionals?”

Misfeldt said there are no recruiting incentives for urban physicians.

She said she met with one doctor who wants to help take over some of her 3,500 patients, but her program conditions force her to work in a remote area.

“She wants to work,” said Misfeldt. “She lives in my area. She would love to take my practice. We called people. We’ve asked people. They all say, sorry, she has to do this type of program and it can’t be in a bedroom community of an urban centre.”

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The Saskatchewan government announced funding for additional seats in medical schools in the province, but there is no guarantee the seats will result in more family doctors or will produce practitioners quickly enough to supply the current demand.

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“That’s still at least three years of medical school, and it’s definitely not going to be implemented this September. So you’re still looking at four or five years once the program is in place,” said Misfeldt.

She said that pay and workload are driving students away from family practice.

“If you can make more money by staying in school a couple of years longer with less overhead and have to manage only one specific system of the body, why would you do family practice?”

Chantal Couris with the Canadian Institute for Health Information confirmed that medical schools are producing fewer and fewer family physicians.

“When you look at the change year over year, what’s interesting is despite the fact that it’s still growing, what we noticed and when you look by family physician and specialties, which are two categories of doctors within this profession, is just the growth base is slowing down a little bit for family physicians.”

He noted this isn’t just a problem in Saskatchewan – is a nationwide trend.

“You have to pay family practice better. You have to show them some respect,” said Misfeldt.

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Alexa McEwan from Francis, Sask., is a fourth-year medical student who just went through the matching process and said while she wants to practice family medicine, she’s hesitant to stay in the province.

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“I’ve actually matched to a family medicine residency program in on Vancouver Island,” McEwan said, adding that watching the government handle the physician shortage and the COVID-19 pandemic was “disheartening.”

“It felt like there was a lot of disregard for some of the scientific practice, especially preventative aspects that the medical community was trying to communicate to the government,” she said.

Couris said that to move forward and look at a more long-term plan for the future of the health-care industry, the province needs to do more research.

“Definitely a lot more data and a lot more analysis and a lot of understanding of how this can inform decisions for planning for the long-term solution.”

– with files from Global News’ Nathaniel Dove