Hospital referral system needs more stability
Speaking from experience, Dr. Bonisteel says, “there’s a huge leap from two (staff members) to three, in terms of lifestyle or just having a life.”
Finding the money
Comparing the situation in obstetrics/gynecology with surgery, he said, apparently there are two surgeons currently operating at the Carbonear hospital. They are using locums ever three weeks or monthly to cover off a weekend of call for general surgery.
“Quite likely they’ ll be able to recruit a third person (surgeon) there, so there must be funding for that.
“I don’t see why there couldn’t be funding for a third obstetrician/gynecologist. It’s a matter of will. Are they willing to try? When Oscar Howell says, ‘we’re doing all we can,’ he means we’re doing all we can with the resources we have currently, not we’re doing all we can, and we’re trying to look beyond the resources we have and we’re trying to advocate or lobby for more resources. No, it doesn’t have anything to do with that. It’s got to do with we’re doing all we can to try and return the status-quo.”
Referral stability needed
While Eastern Health says it plans to continue using the services of locums until their full- time staff recruitment efforts have been fulfilled, the corporation acknowledges, “locum coverage will be sporadic over the next couple of months.”
Dr. Bonisteel’s take on locum coverage?
“The locums are really only there to provide an emergency type of service, an urgent care type of service. The locum might be there for a month, a week or even a day, and doesn’t provide a stable referral base to whom you’d readily refer.”
That’s why his obstetrics/gynecology patients are going to St. John’s, he explains.
“Until they have a couple of fulltime (specialists) and we get a sense of what they’re like, there’s not going to be any more referrals made there (Carbonear).”
The veteran physician says once a community-based physician, family physician, general practitioner, “establishes a pattern of referral, they tend not to go back on that. So if this goes on long enough, and I establish a pattern of referral to St. John’s, and I’m satisfied with the care … and consultation provided, it might take more for me to go back to an old pattern of referral to Carbnear hospital. It’s going to take more effort to get back there, unless they have something really good to offer,” he concluded.
GPS doing deliveries
Pointing out Eastern Health does not have any policy against GPS being involved in obstetrics, Dr. Howell said last month, “we would like to see GPS who practice in the area back in the hospital and doing deliveries.”
Dr. Howell said he is talking to four new GPS they’re hoping to recruit for Carbonear, some of whom have expressed interest in doing obstetrics.
“The issue of GPS opting out of obstetrics is not a local problem, but a problem right across the country,” Dr. Bonisteel said last week.
“The rate of GP participation in intra-partum care, doing deliveries, has fallen off markedly. If they could do intra- partum obstetrics, that would be great. I’d like to see the hospital support them in that.
“But with the current generation of physicians more attuned to lifestyle and less likely to punch in 60, 80 and 100 hours a week,” Dr. Bonisteel allowed, “they’re less likely to follow their own obstetrics. Only those who are really committed to the provision of that service are going to do so.”
Since his own practice has turned more towards the elderly, Dr. Bonisteel says he now only refers about 50 patients to the city for obstetrics/gynecology services.
But some of his colleagues refer more patients to specialists.
While there are lots of specialists in the city, he points out, “they’re already fairly busy, and the added referrals from this catchment area, with a population of 70,000, is only adding to that busyness. To expect St. John’s to absorb all of that is not reasonable.”
As the tertiary care centre for the whole province, he noted, the city also provides more highly or sub-specialized care for all of Newfoundland and Labrador.