We’re Medical Specialists and See One Side of the Family Physician Shortage You Should Know About

Dr. Shaina Goudie is a rheumatologist in St. John’s. Dr. Boluwaji Ogunyemi is a dermatologist, also in St. John’s. (Submitted by Shaina Goudie and Boluwaji Ogunyemi)

This column is the opinion of Dr. Shaina Goudie, rheumatologist from St. John’s, and Dr. Boluwaji Ogunyemi, dermatologist from St. John’s. For more information on CBC Opinion Section, please consult the Faq.


The health care crisis in Newfoundland and Labrador has been in the spotlight in recent months, from an exodus of family doctors leaving the province to the medical association’s suspension of contract negotiations with the government provincial.

It’s a sad reality that nearly 100,000 patients in our province do not have a family doctor.

One would guess that even more do not have access to a stable and consistent family physician due to the high turnover of physicians in some rural areas.

The lack of continuity in these cases is almost as difficult as having no one at all.

The family physicians here are beyond their capacity, stretched in every way, and the consequence is that their patients may not be able to access them as easily as they once did.

Nearly 100,000 people do not have a family doctor in Newfoundland and Labrador, according to the provincial medical association. (iStock)

Since many practices are already seeing more patients than they can handle, this forces some patients to wait several weeks just to get an appointment with their family doctor.

As medical specialists, we cannot remain silent on this issue.

Knowing that our family medicine colleagues do not have sufficient support – and that the people of our province do not have access to the care they deserve – is something we must give our voice to. We see ourselves as allies of family physicians and want to help shed light on this serious shortage and the inequity it creates, particularly in rural areas of the province.

It’s called a bottleneck for a reason

We must also talk about the ripple effect that the lack of family physicians has on the care that patients can receive from specialists.

A shortage of family physicians can create a bottleneck for specialist services. In an ideal situation, a specialist would complete a consultation and then refer the patient, if necessary, to the family doctor for continued management, with a clear plan in place.

When there is no family doctor to refer the patient to, how do you discharge a patient with their care plan?

The short answer is, we often don’t.

Many of us continue to follow patients we would not otherwise, as follow-up with a family doctor is not possible for one in five residents of this province. This limits our ability to provide other patients in specialized practices – and thus reduce their wait times.

Goudie and Ogunyemi say the shortage of family doctors in Newfoundland and Labrador is putting additional pressure on emergency rooms. (Paul Daly / CBC)

Second, when a patient does not have a family doctor, it is difficult to access a specialist in the first place. The consequences of this situation are twofold. One of the results is that patients have no choice but to go to their local emergency department to treat conditions that are not really urgent. This obstructs the already strained emergency services.

Other patients will wait and wait and wait, not wanting to go to the emergency room or an appointment, until they feel so bad that they have no choice. By the time the referrals are made, patients have too often passed a stage in their disease for early intervention.

What happens next?

The result is that the patients that specialists see are often at a more advanced stage of the disease. They require more aggressive intervention and there are fewer effective management options.

In late rheumatoid arthritis, it could mean permanent joint destruction and loss of function. With late onset melanoma, it can mean major surgery and possibly chemotherapy.

It also creates, over time, a kind of two-tier system, in which patients who have access to a family doctor are better able to access not only primary care, but also specialist care, than patients. patients without a family doctor.

Some patients mistakenly believe that if a doctor is a specialist, he or she should know everything about primary care as well.

Specialists are not trained as family physicians and lack their knowledge and expertise, let alone their long-standing relationships with their patients. We are regularly asked questions about everything outside of our own areas of expertise.

Some contemptuously say that specialists should just accept this, try to build their knowledge of primary care and accept that if we want to work in Newfoundland and Labrador, it comes with the territory.

There is no substitute for family physicians. No other medical specialists and no nurse practitioners.

It cannot be. Don’t obstruct, don’t deny patient care in front of us, and not just because we have to focus on what we have been trained to specialize in.

Doctors who do double the work is not the way to bail out a system that is broken. We will always do our best for our patients. But we also need resources, respect and support to be put into primary care urgently.

Without family medicine, we cannot move forward.

Frankly, there is no substitute for family physicians. No other medical specialists and no nurse practitioners.

The delivery of health care in Newfoundland and Labrador is in crisis. Our province needs deliberate, urgent and effective action from policy makers because we cannot afford to see this house of cards collapse.

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