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Ontario Medical Review
Oct. 25, 2021
Kurt Kleiner
OMR writer

This article originally appeared in the Fall 2021 issue of the Ontario Medical Review magazine.

Incentives needed to attract specialists

Training more specialists through northern medical school first step

Dr. Saara Rawn began practicing in Sault Ste. Marie, Ont. two years ago — one of two full-time rheumatologists in the city. She quickly found herself not only managing her own patients but consulting with doctors all over northern Ontario. 

“It got to the point where I was getting 40 urgent consults plus regular consults a day. Which is not sustainable,” Dr. Rawn said. Despite restricting her practice to only the surrounding Algoma District and limiting patients to mostly those suffering from inflammatory diseases, after only 24 months in practice her wait-list is already a year long.

“I had a patient today telling me that they feel that care in the North is like living in a Third World country... There’s so much waiting. There are so many services that are just not available,” Dr. Rawn said.

Originally from Bruce Mines, a town about 45 minutes away from Sault Ste. Marie, Dr. Rawn earned a Ph.D. in biochemistry and went to McMaster University for medical school. “I had always intended to come back. And so I’m happy that I was able to open a practice here.”

Health care in northern Ontario suffers from many problems, including a lack of general practice physicians. These problems are made worse by a shortage of specialist care, which can lead to long waits, extra pressure on general practice doctors trying to pick up the slack, and burnout for overworked specialists.

Northwest Ontario would benefit from 10 more psychiatrists to support existing services and remote and rural sites, said Dr. Jack Haggarty, a psychiatrist in Thunder Bay. Currently, Kenora has only one for its large catchment area.

“There has continued to be a shortage in both depth and breadth of services. And I know that we’ve also recently lost to retirement and relocation five psychiatrists in the last two months.”

Dr. Haggarty is originally from Windsor, went to medical school at McMaster University, and before going into psychiatry, practised family medicine in Newfoundland and Labrador for three years.

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For more than 25 years, Dr. Sarah Newbery and five other doctors – including her husband and four friends – have helped build a stable family health team in Marathon, Ont.

“I had a patient today telling me that they feel that care in the North is like living in a Third World country... There’s so much waiting. There are so many services that are just not available.” —Dr. Saara Rawn

He decided to go into psychiatry after taking a temporary position in a psychiatric hospital in Thunder Bay. “I remember thinking, ‘Forget cardiology, this is where the underserved population is’.”

Some of the gaps in specialty care can be filled by specialists who work remotely from other parts of the province. For instance, Dr. Rawn is part of an effort to set up a system where four rheumatologists would provide remote care to the Sudbury area, supported by nurse practitioners in the community. Likewise, Dr. Haggarty said, patients in the North often get remote care from psychiatrists in southern Ontario.

But both doctors say there needs to be more specialists practising in the North, as well as other health-care providers who can support them. Training more specialists locally through the Northern Ontario School of Medicine, and providing more residencies in the North, will be part of the solution, both doctors said.

“I think it’s important we are all familiar with the lay of the land... Knowledge of geography, familiarity with the culture is important,” Dr. Haggarty said. “There is no substitute for being in a community.”

Kurt Kleiner is a Toronto-based writer.