A Yukon doctor is concerned that physicians will be taken out of their family practice to provide inpatient services that they might not be comfortable with. The concern comes due to a potential gap in services at the Whitehorse General Hospital that could be gouged by a new unilateral contract from the Yukon government.
That doctor is part of a small team that has been caring for people admitted to hospital beds over the past few years. The News agreed to withhold the physician’s name given the small size of the local medical community.
The Whitehorse hospital has been changing the way it provides inpatient services. Doctors currently providing inpatient care at the hospital are having issues fully covering the schedule and have indicated that they won’t have full coverage starting Jan. 3, 2024, according to the Yukon Hospital Corporation. The Yukon government has confirmed an expression of interest will go live soon to get more doctors.
The News has not seen the contract or the expression of interest.
The physician the News spoke with said the doctors providing a trial “hospitalist” program gave notice that it’s no longer viable in its current form. That triggered the hospital to come up with a back-up plan on how to staff the hospital.
The Whitehorse hospital has historically operated on a “doctor of the day” model with local general practitioners providing care to people admitted to hospital beds, per the hospital corporation’s spokesperson. Now the hospital corporation and the health department are trying to establish a “hospitalist” service in which a dedicated group of doctors is focused on providing care to inpatients.
The unnamed doctor indicated the contingency plan is concerning.
“The back-up plan essentially is that they’ll mandate the community physicians to work in the hospital, which means that they’re taken out of their community practices and mandated to work in the hospital,” they said.
Physicians were trying to negotiate a salary agreement with the Yukon government, according to the unnamed physician. They said an offer, which is coming down unilaterally from the government, falls short of what doctors can make working at the local referred care clinic, or “down South” for less work.
The unnamed doctor is taking on flexible work Outside that will bring in almost double what the Yukon government is offering and involve less responsibilities. They could potentially return to the territory.
But that physician fears other doctors will leave forever — meaning that Yukoners will wait longer to see a doctor particularly given the lack of a walk-in clinic in Whitehorse and rising number of emergency room visits and hospital admissions — due to what they call a breakdown in contracts.
Health critic Brad Cathers of the Yukon Party said he has heard from a couple of physicians who said there’s a lack of clarity about what will happen and that they hadn’t signed on to provide services. He hasn’t seen the details of the request.
“What we would like to see is an arrangement worked out between the physicians, the hospital and the government that provides stability and continuity of service going forward in a way that is stable, predictable and is providing fair and appropriate compensation to the doctors for their services while being reasonable for taxpayers,” he said.
A hospital spokesperson said the scheduling problem is primarily due to recruitment. As of an Oct. 31 email to the News, Jessica Apolloni of the Yukon Hospital Corporation said it doesn’t mean there won’t be physicians providing hospital services or that there won’t be physician coverage for the hospital unit.
Apolloni told the News its physician leadership is working on a solution that could see all actively privileged hospital physicians temporarily contribute to provide inpatient care.
With a shortage of doctors in the Yukon and across the country, the hospital corporation admitted it will potentially need to recruit more physicians when it moves away from a fee-for-service model.
A fee-for-service model, as opposed to a salary, means that doctors are paid by the number of patients they see per day. However, the volume of patients seen in hospital can fluctuate on a daily basis.
The hospital corporation and the health department are working towards issuing an expression of interest to get “hospitalist” physicians for long-term “sustainability and improvement” of inpatient care at the hospital, Apolloni said. That includes fairly and equitably paying doctors and effectively managing limited health system resources.
Most hospitals in Canada have shifted or are in the process of shifting away from the “doctor of the day” approach to a “hospitalist” model so that general practitioners can devote their time to clinics and the hospital can provide more consistent physician coverage and ultimately improve patient outcomes, per Apolloni.
Over the past two years, Apolloni said, the Whitehorse hospital has been taking a “modified doctor of the day” approach with a dedicated roster of three doctors covering seven days a week during the daytime and on-call support after hours.
Dr. Alex Kmet is president of the Yukon Medical Association. He said he hasn’t formally heard from physicians who say they won’t be providing hospital services come the new year, but there’s lots of conversations about how evolving care in the hospital has led to challenges in ensuring consistent service.
“Until people clearly declare their intents, it’s always hard to know where things are going to land, especially in this time of health-care-system challenge and with all of the competing opportunities across the country. I think people are always looking for ways to improve their working lives, and that’s not just true of physicians,” he said.
Kmet noted there are fewer doctors on average working in the Yukon. According to a report released in March by the Canadian Institute for Health Information, Kmet said there are about 24 doctors per 10,000 people across the country compared to 20 doctors per 10,000 people in the Yukon.
Kmet indicated that number shows a problem.
“It impacts the ability for people to access the care they need when they need it,” he said.
He added that most doctors working in the Whitehorse hospital also have a family practice.
“Historically, part of providing family practice care to a panel of patients often included caring for your own patients. But that doesn’t help people — Yukoners — who don’t have a family doctor when they need to be cared for in the hospital,” he said.
Kmet said the Yukon government has committed to working with the medical association and the hospital corporation to ensure that a “hospitalist” system is properly resourced and doesn’t create gaps in care.
“It’s quite common for hospitalist programs across Canada not to use a fee-for-service-based remuneration model and in this circumstance, you know, the physicians here who are doing the most active work in the hospitalist program development have indicated that that’s also the appropriate mechanism to support physicians providing that service,” he said.
“We’ve got commitment from the government that they want to provide that non-fee-for-service remuneration model and that they’re working to have it out this week.”
A spokesperson for the health department told the News the Yukon government is working with the hospital corporation and “hospitalist” physicians on a request to formalize the “hospitalist” program at the Whitehorse hospital.
By email, Zachary Burke with the Health and Social Services department said family doctors have been supporting their own inpatients and the “doctor of the day” model provides inpatient care to patients without a family doctor. The “doctor of the day” model, in place since 2008, was put into place during a time of growing demand for inpatient services that required a shift from the existing way of doing things.
In 2020, one doctor decided to try out the “hospitalist” approach, which now involves three doctors as “additional family doctors have now handed over care for their patients to the physicians who are providing hospitalist services.”
The hospital is due for another shift due to the changing nature of physician practice and increasingly complex health-care needs, per Burke.
“We remain committed to working with physicians, the Yukon Medical Association and the Yukon Hospital Corporation to ensure this new model of inpatient care is properly resourced and able to continue to provide stable and high-quality inpatient care to Yukoners,” Burke wrote.
Contact Dana Hatherly at dana.hatherly@yukon-news.com