Eight is not enough when it comes to doctors in the City of Humboldt.
Last week, the doctors in Humboldt - who currently number eight - notified the public through a letter to the editor that there is a doctor shortage in this community.
Prior to November 1 of this year, they were functioning "reasonably well" with the patient flow at the Humboldt Clinic, they wrote - they had nine doctors servicing between 30,000 and 35,000 people.
However, their number has now dropped to eight, with the departure of two and the addition of just one replacement. With the population of the area growing, they are feeling the pressure, and need the people they serve to help them get through this tough time.
The Journal sat down with two of the doctors at the clinic - Dr. Carrie Levick and Dr. Kevin Ledding - on a lunch break last week to talk about the situation and what the public can do to help.
So why isn't eight doctors enough for this area?
"We have between 35,000 and 40,000 active charts," stated Ledding.
Divided up among eight doctors, that's about 5,000 patients each - or 14 for every day of the year. That's a big workload for any profession.
Why do they have so many charts?
"A lot of the smaller communities (in the area) have lost physicians," explained Levick. Doctors have moved away from Watrous, Wakaw and Lanigan, and their patients have started coming to Humboldt.
"Humboldt has grown in size (as well)," Levick said. "A lot of elderly patients... have moved into town with the new seniors' housing available, and because there are more health services (here).... We're kind of a hub for a lot of people that don't want to go to Saskatoon."
The Humboldt doctors also service a lot of the smaller, rural communities, holding itinerant clinics in Watson, Quill Lake, Middle Lake and LeRoy.
Between those clinics, assisting in the operating room at the Humboldt District Hospital (HDH), and acting as the on-call doctor for the emergency room (ER) at the HDH, it's not often that all eight are actually at the clinic all day.
"On any given day, there are usually four or five in the clinic, not eight," Levick said.
So what can patients do to help this situation?
Show up
"First, and it's so important, don't not show up for your appointment," Levick said.
Those requesting a non-urgent appointment at the clinic will be offered the first one available. You can also put your name on the cancellation board so you can be called in sooner if an appointment opens up.
For the cancellation board to work, however, people do need to call in if they are not able to make their appointment. Appointment times are being wasted because people just aren't showing up.
If people give enough notice, the clinic can call people on their cancellation board so that time isn't wasted.
On the day of their interview with the Journal, there had already been five no-shows for appointments, and it was only noon.
"We could put a walk-in into those spots," Levick said. "But we have to have time to phone those walk-ins to come in."
When there isn't that time, and they are already running a wait-list, for someone just not showing up is pretty disappointing and frustrating.
Make a list, and check it twice
Patients should come into their appointment with a short, concise list of what they need from the doctor.
Two to three things is what a doctor can usually deal with in a regular appointment time, Ledding indicated.
Seven or eight things mentioned in "by the way" comments can cause doctors to go over their appointment times, which backs up their day.
Doctors at the clinic usually see between 40 and 50 patients per day, so one long appointment can have them rushing to catch up for the rest of the day.
Patients need patience.
"Extending a bit of patience and understanding that they will have to wait" would help tremendously, Levick indicated.
It's difficult, she added, when a physicians is racing from room to room, dealing with patients as efficiently as they can, to be greeted with comments like "Well, it's about time," or "I could have died in here, waiting for you."
"Those comments... it doesn't help," Levick said.
Patience is also required sometimes when booking an appointment.
The clinic is presently booking four to five days in advance, and patients have to plan appropriately.
"If you are required to see a physician for a prescription renewal, book your appointment in advance. If your doctor requests you to come back in two weeks, book your appointment right away. If you require a traffic medical SGI gives you 60 days to get this done - book it in advance," the doctors state.
Those who show up with non-urgent symptoms and ask to be fitted it need to realize that they will have to wait, the doctors added, because they are already booked.
Know when to use the emergency room.
Any time someone starts experiencing urgent symptoms, they should, by all means, use the ER at the HDH.
However, a patient's perception of what is urgent and a physician's perception of the same can be two completely different things, Levick noted.
Because you don't feel well doesn't make it a dire problem that needs instant medical attention, she noted.
For example, someone who's had a sore throat for three or four days should not seek medical attention at the emergency room at midnight.
Urgent symptoms do include chest pain, shortness of breath, paralysis, numbness or garbled speech, active bleeding, injury to a limb where you are unable to bear weight, fever if you are on chemotherapy or under three months of age, severe headaches, severe abdominal pain and seizures.
They do not include ingrown toenails or a sudden need for routine blood tests.
Doctors in Humboldt can presently see between 30 and 40 people in the emergency room on a Saturday, including non-urgent cases.
It seems some people are treating the emergency room as a convenient way to see a doctor without taking time off work to come to the clinic.
An emergency room is for emergencies only, Ledding stressed.
The cost to taxpayers of seeing people with non-urgent issues at the ER is about four times what it would cost if those people would make appointments at the clinic.
There is no doctor at the HDH all the time, to cover the ER, Ledding and Levick explained.
The doctors from the clinic cover the ER in 24-hour shifts. When a patient comes into the ER, the nurses are required to call in a doctor, pulling them either away from their patients at the clinic, or away from their families at night.
"In an actual emergency, we are happy to get up," Levick said about those middle of the night calls to the ER. But to get there and be asked to refill medication, do routine blood testing, or look at a laceration that doesn't require stitches - things that they could deal with at the clinic during normal office hours - is frustrating.
Ledding suggests people take a moment to think: "Would I go if I had to pay for this out of pocket?" And make their decision based on the answer to that question.
Health care is not free in this province, he pointed out - a portion of income tax does go to health care.
People who do come to the ER with non-urgent issues should be prepared to wait, Ledding added. If there is a line of non-urgent cases, an extra doctor likely will not be called in to deal with them more quickly.
Talk to your pharmacist.
Sometimes, people don't need to see a doctor in order to get treatment for things like colds.
Medicines for cold symptoms can be picked up at a pharmacy. Pharmacists can also be consulted for advice on painkillers. Also, other health services, such as massage therapists, can be utilized before seeking an appointment at the clinic, the doctors noted.
Hold your temper.
"Please do not yell at our office staff," Levick requested.
Some people have already let loose their tempers at the front desk of the clinic, she said, when the wait times are not the fault of the clinic staff.
The doctors at the clinic are doing the best they can at the moment, Levick noted.
"We don't want to not see people," she said, but there are just so many hours in the day.
Respect boundaries.
Doctors are people, and they do things that people do - like get groceries and go to hockey games. To have patients approach them with medical issues while they are out of the office can be disconcerting.
"It's uncomfortable to do consultations outside a professional environment," Levick said simply.
Fixing the issue
The Saskatoon Health Region and the Humboldt Clinic are working on recruiting more doctors to this area - to have 12 in Humboldt would be great, Levick noted. However, getting doctors interested in coming to rural Saskatchewan is an ongoing battle.
Still, they are fighting the fight. The Humboldt doctors recently met with medical residents in Saskatoon, and invited them to Humboldt to see the place.
Rural Saskatchewan just isn't as appealing to most doctors as the bigger cities are, the two explained.
Why?
Because for previous generations of doctors, their living was their life.
"They would be a doctor 24/7," Ledding said.
But doctors these days, while they may love their work, just like anyone else, want to have a life outside of work. They want to spend time with their families, and take holidays. And that's sometimes tricky in rural centres where they are required to be on-call often.
In Humboldt, doctors can potentially be up for 36 hours in a row, if they are called in overnight, for they are still required to see patients at the clinic for eight hours a day, as well as cover the ER.
Also, Ledding noted, the kind of medicine that's practised in rural parts of the province can be daunting to some.
In urban centres, he explained, specialists are just an elevator ride away. In rural areas, general practitioners have to deal with all sorts of issues, from heart attacks to broken bones, on their own.
"There's no specialist to call in," Ledding noted. "Dealing with acute situations... you have to rely on your own resources."
"You have to have an advanced skill set," Levick agreed.
And while that's what attracted her to rural medicine, it can be intimidating for some people.
"I like the challenge of it," she said. "But you either like it or you don't."
Plus, they added, after attending university for years in an urban setting, some doctors just aren't willing to give up that lifestyle.
But there are advantages to rural life, these doctors feel.
Doctors in a rural community often stick together and offer support to each other, Levick noted.
"There's a closeness that's not always present in the cities," she said.
"There's a great collegiality and back-up (in Humboldt)," Ledding agreed. "Everybody helps each other out."
Ledding just officially joined the Humboldt Clinic this year. He came to Humboldt, he said, because he had a good experience while here as a medical student and a medical resident.
"I think it's great. It's a good size," he said of why Humboldt appealed to him. "And from a practice point of view... there's a greater variety of demographics I can see here (than in other small towns)," he noted. "It a great practice variety. And it will be great once the new hospital (opens) up."
