Hi and Welcome to the A & J PEI Treasures E Jean Simpson Author Blog Post and Podcast. I’m your host, Jean coming to you from the beautiful Province of Prince Edward Island, Canada!! The blog post and podcast is an opinion piece and only reflects this author’s opinion and not that of any other entity. I hold no designations in politics, economics or medicine. I am retired from the mental health field and I am a humanitarian and speak from that viewpoint only. Whether you agree or not, at least I hope it makes you think. This week, I explore another angle of the health care crisis. If you want to find out more, then stay tuned…!
It seems that the health care crisis is taking its toll in Atlantic Canada. I have to state that I mostly focus on Prince Edward Island this time with a few anecdotes about situations in New Brunswick. Of course, the problem doesn’t just exist solely in Atlantic Canada but since I’m here, it is most salient here. In New Brunswick, a request for information created a kerfuffle in my family because the person who went in introduced themselves like a Paramedic or looked like one, which my father accepted. This resulted in a wild goose chase and apologies to the PANB. I was then forwarded to the Extra-Mural nurses and have made contact with the association to find out about it. Is it a valid study, is it not a valid study? I hope to find out. An email from PANB suggested it doesn’t exist at least under their purview. I’ll find out more from the Extra Mural Nurse Association soon, hopefully. This time I was able to give detailed information to them about exactly what the study was, who was giving the information to my father, what they were there for, what they did, and the date. At the very least, it should lead to the correct Extra-Mural nurse. This is traceable and easier to get explanations settled for all involved. My parents are competent to make their own decisions, but I also want to make sure that there are not just arbitrary people wandering around. They don’t have doctors but have a nurse practitioner. Still awaiting word…however in the meantime, another agency name has come up. So, either one hand doesn’t know what the other is doing or there are too many hands that don’t have a body. As a daughter of elderly parents, this is quite disconcerting…because are there arbitrary bodies wandering in and out or is the system so badly messed up that no one knows who is doing what? Neither prospect is all that encouraging.
Currently, in the Maritimes, there is trouble at the OK Corral (to use an outdated phrase). It takes the form of people literally dying in the ER and I found two articles immediately. They both come from Global news and involve people dying in Emergency rooms in New Brunswick. The first one talks about finding someone who seemed in distress later unresponsive. They had been waiting for a doctor https://globalnews.ca/news/8993519/premier-blaine-higgs-replaces-n-b-health-minister-after-patient-dies-in-er/. Now, sadly yet another case in New Brunswick follows right on the heels of the first but this one seems shrouded in mystery at the moment and this will create more stir I would imagine https://globalnews.ca/news/9013261/nb-second-er-death/. Whether or not it is warranted, time will tell. What is more sad, this doesn’t surprise me and I’m sure it isn’t just in the Maritimes as I remember other cases over time in different Provinces. I won’t go into details here, as I have in the other Health Care Crisis article, but I was in emergency in serious condition. When the on-call doctor finally got to see me, I had spent a good 10 or more hours in Emergency and the chipper doctor came in and announced that their goal for the night was that I would not bleed out on them. So, the fact that people are dying in emergency is not a new or surprising thing to me and I’m lucky not to be one of them. It certainly is sad and definitely points toward there being a huge crisis.
Meanwhile, on the Island, various emergency hours and hospitals are an ever revolving door of opening and closings. https://www.princeedwardisland.ca/en/information/health-pei/emergency-department-wait-times. Having had to use the Emergency Department myself, I have found that, with a serious infection requiring IV treatment, I was made to wait in Emergency no fewer than 8 hours at the time. Having no doctor, I was reliant on Emergency to determine if I was finished with IV treatment, needed to have the IV removed etc. I got to wear it home for a few days to make things easier for them giving the treatments. Was it fun? No, but I do understand the need to make things faster and easier for the hospital staff so I sucked it up and wore it for a few days. For them every second counts and the less of them I have to use up, the better. This was pre-COVID. I cannot imagine how much worse it is for medical staff currently. In the IV case, a visit to a doctor would have just resulted in me being sent to emergency as it was not easily treatable. I still bear a small scar on one side of my eyebrow from it. The last time in for this situation, I was told I could just have the IV removed and sent out to the waiting room. I went back after a time and told them that I just needed the IV removed, and I think this was done relatively quickly in triage. My husband has had his own stay in Emergency. No short trips when one has to go. Not for the faint of heart. I’ve been there on a valid emergency for hours and hours. The length of time resulted in a lot of people just giving up and leaving and they had to come out and call names to see who was still there. It cut the list dramatically. So, staff are overworked, stressed and patients are getting testy. I can see both sides with sympathy. I’m sure no one is having fun with the situation. This does not fix the problem though. Of course, there are walk-in clinics, but those are also overrun. People on the Island are recommended to call ahead even for the walk-in clinic. So, there are lines waiting to see them too. They suggest calling ahead to make an appointment and make sure they are open. So, I think the days of speculation about health care crisis are over and days of how do we deal with it have arrived.
Also interestingly the information from the PEI Quarterly Report (https://www.princeedwardisland.ca/en/information/finance/pei-population-report-quarterly) states, “The data shows Prince Edward Island’s population is estimated to be 167,680 as of April 1, 2022. This represents a yearly increase of 5,084 persons or a 3.1 per cent annual growth rate.” The population is the largest growth since 1951. So, the growth of population is high, yet what do we have for medical care? Well, there is 811…if you’re sick and not sure how sick you are. A nurse can help you figure that out. Then 911 if you need urgent care. There are overrun walk-in clinics. There is Emergency. There are online doctors who refer you to a doctor if you’re on medication. There are walk in clinics where you need to call ahead.
The most interesting thing that I have found is that https://www.princeedwardisland.ca/en/information/health-pei/emergency-department-wait-times has links to the various hospitals in the Province of Prince Edward Island. If you click on the link for each hospital, it will show you the wait times. Most interesting of all these is the fact that Prince County Hospital has wait times that are double or more that of all the other hospitals. I’ve seen this more than one time. It would be interesting to determine what affects the wait times in this particular Hospital. Are the other hospitals similarly afflicted, did I check at a strange time, is there something more that is harder at the Prince County Hospital (PCH)? What is making for double the wait times at least on the one or two checks I did, though my husband has checked it and depending on time there are more or less long waits? Is it larger population, fewer doctors, more of something or less of something? Interestingly, wait times are far shorter in the main City of Charlottetown than in Prince County Hospital. In some ways, I would expect that this would be the case with it being a larger center, there might be more doctors attracted to it. However, the other wait times in other areas seem to be similar to Charlottetown. What are the factors that influence this? Is it a lack of doctors? Lack of retention? Organization? Housing? Availability of resources? Availability of leisure time activity? What are the root causes? Can they be addressed? A cursory glance shows that PCH has only 5 of the 11 needed physicians for emergency (https://www.cbc.ca/news/canada/prince-edward-island/pei-pch-foundation-recruitment-money-1.6481159). Meanwhile Queen Elizabeth Hospital in Charlottetown has 12 out of 14 (https://www.cbc.ca/news/canada/prince-edward-island/pei-emergency-room-doctors-shortage-1.5151962). At the same time, King’s County has hired on dedicated emergency room doctors (https://www.cbc.ca/news/canada/prince-edward-island/pei-kings-county-memorial-hospital-montague-emergency-room-doctors-hiring-1.4702806) and have limited hours. So, it seems that at least partly, the discrepancy is related to lack of doctors. It might be useful to see if there is a difference in protocols as well. This is past the purview of this blog post and podcast.
I’ve been in Summerside, PEI lately and there has been an increase in the number of houses being built. So, they are addressing one of the issues that are claimed in this newer article about locum doctors by creating more housing which might address a myriad of issues. https://www.cbc.ca/news/canada/prince-edward-island/pei-locum-doctor-summerside-no-house-1.6536268. The question remains…why are they not able to get doctors? I’ve lived here for several years and I have yet to be able to get a doctor for more than one or two visits. I have finally, in total frustration pulled myself off my medications. I love my Province, but to be honest, the health care situation is terrible. Is it worse in other Provinces? Some have more difficulty than others. How many other people are either self-medicating or not using medications?
This article https://www.princeedwardisland.ca/en/information/health-pei/patient-registry-program# quotes 7,194 people awaiting a doctor in Prince County. In the Prince County area alone (https://en.wikipedia.org/wiki/Prince_County,_Prince_Edward_Island) they show a population of 46,234. On the Island, there is a population of about 167,680 and there are 24,976 people without doctors. Doing the math, using the number from the quarterly report, it makes for approximately 1 of every 6 people do not have a doctor on the Island. The number increases to about 1 in 7 needing a doctor in Prince County. My husband and I are two of those and we are nearing 60 years old with no doctor in sight. My parents, in their 80’s and in the neighboring Province of New Brunswick are seeing a nurse practitioner. The numbers fluctuate between counties on Prince Edward Island. Some are worse than others. Simple Google searches will serve to point you to the population county information if you want to figure out your own county. Further, we estimated that if a doctor takes 2000 patients in a year (https://www.physicianleaders.org/news/how-many-patients-can-primary-care-physician-treat) though the article suggests more than 2000, I use this lower number as a starting point, they would need at least 3 doctors in Prince County alone to get rid of the wait list. It would take approximately 12 doctors to barely cover the patients on the entire wait list.
It seems that, there “are currently 17 medical schools in Canada with an annual admission success rate normally below 7.5%. As of 2021, approximately 11,500 students were enrolled in Canadian medical schools graduating 2,900 students per year.” (#’s are those of Wikipedia) https://en.wikipedia.org/wiki/Medical_school_in_Canada. This leaves us with more questions such as; is the issue one of limited numbers? Is it part of the grand exodus to big cities? Or is it simply that Canada needs to train more doctors and other medical staff? Is there a need to refine the procedures in Emergency? Prince Edward Island seems to be taking steps to try to remediate the situation by building more housing in Summerside and there is talk of opening a medical school. We can’t reduce the requirements to become a doctor, nor can we deny doctors who do meet the requirements. Reducing requirements would result in more damages. Minimum standards must be kept or patients are harmed. You can generally tell when doctors are not meant to be doctors or are not good with patients as they have reduced patient loads and people seek other doctors. They will show up with poor retention and notes of other doctors covering for mistakes. Everyone suffers. I cannot blame the medical association for making sure that standards are met. However, you see the effects of doctors being at a minimum and lack of alternatives in some of the issues that crop up in the news. For example, this CBC News article discusses a mystery neurological disease that turned out not to be so mysterious. It shows the effects of minimal ability to get second opinions https://www.cbc.ca/news/canada/new-brunswick/new-brunswick-brain-disease-environmental-factors-1.6415707. They relied on one neurologist and after having the results examined, determined that it was not a mystery illness. Often doctors need to confer and if you’re the only one in a large area, this might not happen. Of course this creates distrust and there are people screaming about conspiracies. The problem is that they had it explored by 6 different neurologists and they came up with actual diagnosis in most of the cases. Conferring with colleagues might have avoided this issue. So, is it a conspiracy or simply a much needed collaboration finding different answers? It is just one more example of the high cost of not having enough medical practitioners.
I did a short check to see how many doctors they seem to think they need in Canada. There seems a shortage of answers that suggest specific numbers. They quote things about doctors per 1000 people showing Canada having 2.4 doctors per 1000 people and USA as 2.6 and Australia as 3.8 as comparisons. https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=CA. This does not seem to solve the problem either. I also see that in Alberta, some doctors were looking for patients https://bc.ctvnews.ca/hundreds-of-family-doctors-accepting-new-patients-in-alberta-as-nearly-a-million-british-columbians-without-1.5888738. It seems we need to find the confounding factors and determine how to address them. One factor that I see mentioned is that retention is good for doctors when they are trained in a Province, therefore, having the medical school open in Prince Edward Island seems at least one step toward solving this shortage of doctors problem. So far, so good. In the meantime, we have a long wait for the first doctors to graduate as they need to have the school able to accept patients and train them. So, what to do in the meantime? PEI is working toward solutions, but right now, more is needed. Hopefully recruitment and exploring things with medical personnel will lead to better use of resources and use of more.
The more I look at the crisis, there is a big complicated problem because it seems to open more questions than it answers, but at least I hope it makes you think! Maybe we need to be asking better or more questions, maybe we need to look at how best to use the resources we have while we wait and try to recruit what we can. We could definitely use some more medical personnel in all of Canada and the problem seems to fluctuate. If you want to be in on the ground floor of new potentials, then maybe becoming a doctor on the Island, this is the place for you (make sure they add it to the contract you sign…tell them Jean sent you…LOL). I know I’d back you on finding the solutions. I’ve already tagged the Premier on my posts. Seems they are taking the health care crisis as seriously as possible given the actions over the past year or two. Given the increase in housing and trying to open medical training they are taking that initiative. By the way, the program has been announced…just need it finalized (https://www.upei.ca/medicine). Thanks for listening to my podcast and/or reading my blog post and thanks for your interest in A & J PEI Treasures!
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The Health Care Crisis… – E Jean Simpson, BEd, BA, MA Author A & J PEI Treasures
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