Muskoka Algonquin Health Care, which manages both the Huntsville and Bracebridge hospitals, is currently facing a staffing crisis in internal medicine at its Bracebridge site.
In the interim, Bracebridge doctors who are not comfortable treating a patient with an acute medical condition are being told to consult with their colleagues in Huntsville and/or transfer those patients to the Huntsville hospital.
The problem
The Bracebridge hospital – South Muskoka Memorial Hospital (SMMH) – is required to keep a roster of four general internists, with each one on-call for one week of the month. SMMH was down to three internists but two of them recently resigned, leaving the hospital with just one internist as of the first week of September.
Internists are often described as a doctor’s doctor. They specialize in internal medicine and the care of patients, particularly intensive care patients with acute medical conditions – the type of conditions some family physicians may not feel comfortable treating. They also provide back-up for emergency room physicians and consultative advice for their colleagues in general.
Huntsville District Memorial Hospital has a roster of four internists on rotation, although it should have five as it also serves as a district stroke unit. But Huntsville’s situation is not as dire as its sister hospital and, with the shortage of internal medicine coverage at South Muskoka Memorial Hospital, internists in north Muskoka are being asked to fill in the gap.
The internists already have more than enough to manage with their own out-of-hospital practices while being on-call for the Huntsville hospital one week per month, and they’re feeling pressured by administration, according to a source, who also said it’s likely that same pressure caused at least one of the internists in Bracebridge to resign.
The interim plan
Bubela would not comment on the reasons for any resignations, but did summarize the options available to Bracebridge physicians until the issue is resolved. She said they could look after patients themselves if they feel comfortable and able to do so while also consulting with their colleagues in Huntsville or other hospitals via telephone, or they could transfer patients to be looked after at Huntsville hospital.
“If there is no capacity in the system at Huntsville or in Bracebridge, CritiCall, which is the emergency arm of placing patients in Ontario, are also well aware and understand that we may be requiring their assistance more often than we might have in the past. And we would actually ensure that people are connected with the care that they need and they would be CritiCalled out to another organization,” said Bubela.
If we have exhausted our internal resources, no physician here would be asked to look after patients they do not feel comfortable to look after. That’s why there are a number of supports that are being put in place including transferring a person out of the hospital. MAHC CEO Natalie Bubela
When we spoke with Bubela on September 19, she said an estimated five to six patients had been transferred to Huntsville hospital from Bracebridge around the second weekend of September and, at the time, half of Huntsville’s intensive care unit patients had come from Bracebridge.
While it looks to hire more internists, MAHC administration is hoping to fill the gap in internal medicine coverage with locums and said the impact on its budget would be negligible. “Locums are people who are not a full-time commitment to the hospital but they come on an episodic basis and will pick up some shifts. And that is what we are working on largely right now to try to stabilize the situation until we can hire full-time people,” explained Bubela, who also cautioned: “If we have continual issues, if our ability to recruit locums comes to a point where we believe we’re tiring our physicians, etcetera, then we’ll need to look at other options, but at this point what I have outlined as our strategy is what is in place.”
In a memo from MAHC Chief of Medical Staff Dr. Jan Goossens to his colleagues, he asks them to be patient and outlines the interim procedure to follow. “I know this situation has caused a lot of angst and uncertainty amongst the medical staff. I appreciate your patience during this time,” he said in the memo. Read it here (PDF).
A shortage of internists in Ontario
Bubela said there are shortages of internists throughout organizations like MAHC in Ontario. “In fact, they totally staff their departments with locum physicians. We’ve been exceptionally fortunate to have full-time physicians here,” said Bubela. She cited 97 full-time internal medicine jobs available on the HealthForce Ontario website, a marketing and recruitment agency, and also noted another 137 jobs for internal medicine in Ontario on a part-time or locum basis. “So it is a difficult position to recruit to and we are not unique. This exists province-wide in terms of being an issue.”
MAHC is not just looking for internists but a Medical Chief of Staff as well as Dr. Goossens has decided not to renew his contract. (Read the story on Doppler here.) Bubela said Goossens will remain in the community and on the roster for internists in Huntsville, while continuing to pitch in where he can in Bracebridge.
MAHC hires a headhunter
While the organization has been actively advertising for medical internists for years, in July it ramped up its search and hired a headhunter, which Bubela referred to as a more “focused approach where the headhunter actually physically goes after people trying to convince or let them know what a wonderful opportunity we have in Muskoka. And I do believe we have a wonderful opportunity here to potentially start fresh with a new group of physicians and hopefully that works, but there’s no guarantees,” said Bubela.
“I am very confident that with the quality of physicians and front line staff we have here, that we’ll get through it. And the more optimistic and positive we are about this I think the easier it will be to recruit people who want to come to our community and be part of this wonderful community and provide the kind of care that we want our communities to receive,” she concluded.
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A single site does not magically reduce the number of patients who need to be cared for nor the number of internists required to provide that care. The fact that both communities continue to grow due to folks choosing to retire in beautiful Muskoka means that whether it’s a single site or not, we still need 8 internists in total to manage the patient load, not five.
Rob – you consistently ignore the fact that the new hospital building in Port Sydney will never happen. All levels of government have rejected it, including the province. It is not nor will ever be the solution or even a solution. What this situation illustrates is that in many ways the availability and desire of Physicians to locate in a particular place can often have a great impact on the delivery of services, despite what the administration and Board may desire. You can’t force a Physician to work where they don’t want to. Therefore a service will no longer be offered if there isn’t a Physician to deliver it. We had this situation happen here when Dr. Dale retired as our Ob/Gyn. He was not replaced and now the nearest Specialist is in Orillia. I sincerely hope MAHC is successful in recruiting Internists for the Bracebridge site.
I can only hope that this article is not going to initiate a wave of comments about how Hospital A is now Huntsville’s. As in the previous comment, what it does illustrate is a shortage of specialists. I have consistently averred that a new, staged hospital in Port Sydney should be the preferred alternative. Initially, maybe it would not be much more than an ICU with all five internists, and a repository of all the most recent, capital assets; supportable by the LHIN budget.
There are no end of uses to which the existing hospitals may be put. Such a scenario also buys time to allot resources appropriately; to add stages to the new facility intelligently; and to make a start on this building when infrastructure monies are plentiful.
I rest my case. Last month I wrote that what is more important than brick & mortar was the recruitment of Doctors & Nurses. Well this should be the priority for years to come. Therefore I encourage building 2 identical facilities with significant emphasis on ambulatory, emergency room, intensive care and observation beds. You already transfer significant number of patients south for more extensive services.