Why can’t Hay River find even a single doctor to live in the town?

Hay River hasn’t had a doctor living in the town since 2019. After the latest spell without even a locum physician, a nurse says other staff are burning out and worried.

Julie Green, the NWT’s health minister, says Hay River’s health authority should have seven doctors on staff. But four years have passed since even one part-time doctor actually resided in the community.

Instead, the town’s health system limps through sustained periods of either no physicians at all – with nurses calling doctors elsewhere for help over the phone – or one locum physician (a travelling doctor temporarily brought in from elsewhere) on call around the clock.

“Things are messed up,” said a registered nurse in Hay River who spoke with Cabin Radio on condition of anonymity as they were not authorized to discuss the matter in public.

They described a spell last summer of “about seven weeks with no doctor in town at all” and said another week-long period took place in February, with more zero-physician weeks expected in April and this coming summer.

“We are absolutely at the risk of losing nurses. Nurses are burnt out. We are exhausted. We are basically in an abusive relationship with our employer,” the nurse said.

“It’s dangerous. We haven’t had anything happen but, if this is going to continue on, it’s just a matter of time.”

Hay River’s health authority told Cabin Radio it is working with the NWT’s health authority, which recruits doctors on Hay River’s behalf, to fill some, or even one, of the many gaps.

“We anticipate the number of physicians in community to continue to fluctuate for the foreseeable future,” the town’s health authority – known as HRHSSA – stated, adding that the summer is “traditionally a difficult time” to attract doctors.

“HRHSSA continues to monitor and assess the impact a lack of practitioners is having on our staff, residents and community,” the statement continued.

“We recognize not having a physician in community is concerning and we have worked to put practices and processes in place to ensure staff are supported in delivering care within their scope of practice.”

More responsibility, more stress

In the NWT’s legislature, Hay River South MLA Rocky Simpson said Hay River’s inability to hire even a single resident doctor – for years – was “placing residents’ health and life at risk.”

As of earlier this month, Simpson said the town had one locum physician in place.

The nurse said even with one locum, dangerous situations can easily happen. That doctor has “no relief and handles all of the emergency cases, all of the chronic stuff, everything,” they said.

When Hay River is down to one or zero doctors, the nurse said the town health centre’s 14 inpatient beds are closed and anyone requiring hospital admission is medevaced to Yellowknife or elsewhere within eight to 36 hours of presenting.

“In those situations, the nurses take on more responsibility and more stress,” the nurse said, “because you don’t want to call that physician unless you absolutely have to – you know they were there all day and they’ve been there all night.

“We’ve been told the reason doctors don’t want to come here is because they don’t want to work alone, which is completely reasonable. We’ve been told we’re just difficult to staff, here, which is problematic. This isn’t changing. It’s not getting any better. Nurses are being forced into impossible situations. We’re not being asked if we can do this. We’re being told this is what’s happening.”

Green says this “isn’t just a Hay River problem” and the NWT as a whole has a 45-percent vacancy rate.

“The best thing that can happen here is word of mouth from existing physicians and medical people to their networks, to encourage them to give the NWT a try,” the health minister said in the legislature earlier this month, questioned about the shortage by Simpson.

Hay River’s health authority hopes the locum physicians who visit the town can become “a good pipeline for recruitment” as they see the community “in advance of making a longer-term commitment.”

But the local authority is ultimately in the hands of the broader NWT health authority, which has an agreement to recruit doctors on Hay River’s behalf.

That system “is not working,” Simpson said, asking if Green has considered handing back direct control of doctor recruitment to Hay River.

Green said the memorandum of understanding on hiring between the NWT and Hay River health authorities “is now under review to determine what the best way forward is.”

She added: “It is unclear to me that not having this MOU, or not having some kind of formal arrangement, would serve Hay River any better than it’s being served now.”

The minister argues that the larger, territory-wide health authority has more hiring resources with which to do the work of tracking down doctors.

However, that comes with a responsibility to hire for the territory as a whole, meaning Hay River is not necessarily the priority once a doctor is found who wants to come to the NWT.

“The doctor may have a preference to go to a particular community … but there is also a triage applied to where doctors are needed,” Green said in the legislature, explaining the hiring system.

“The highest priority always is the Stanton emergency room,” she continued, referring to Yellowknife’s hospital, “because all of the regional health centres and acute care centres call into Stanton for advice on dealing with emergencies. There isn’t a specific Hay River doctor recruitment campaign. It is done for the NWT as a whole.”

Simpson, responding, said Hay River “couldn’t do any worse” on the town’s behalf than the NWT health authority’s recent record.

‘Nurses rallied’ on K’amba Carnival weekend

For Hay River’s nursing staff, being told there’s a 45-percent vacancy rate across the NWT doesn’t mean much.

“There’s a 100-percent vacancy rate here,” the nurse said, adding that part of their frustration stems from the perception that no other NWT community with space for physicians seems to so regularly deal with having none.

“None of us signed up for this,” the nurse said. “We didn’t sign up for a position as a nurse in a hospital with no physician. We signed up for a position as a nurse with physician coverage.”

Though virtual care – whereby doctors elsewhere in the world provide services by phone or video – became a much bigger phenomenon during the Covid-19 pandemic, the nurse said that can’t approach the level of service offered by a physician present in person.

“You present to me, I assess you, I call a physician and tell them: ‘This is the assessment that I have. What do you want me to do?’ But that physician is not there to administer any life-saving skills that they have, that registered nurses can’t perform,” they said.

“They’re not there to physically assess the patient with their eyes, to listen to their organs, or to touch them – or even look at them. That physician is over the phone, relying on that nurse who has a regular RN degree and not any specialty training.”

Earlier this month, the nearby Kátł’odeeche First Nation hosted its annual K’amba Carnival at the same time as dogsled races and a large children’s hockey tournament took place.

The nurse said staff at the health centre were so concerned about what might happen – with no doctor and so many things taking place – that “some of the nurses rallied and went to our senior management” to request that something be done.

“You need to get us a doctor here for at least the weekend,” the nurse said managers were told. “For three days, we need to have a physician in town.”

A doctor was duly flown in from Yellowknife, the nurse said, referring to that as a “Band-Aid fix to a huge problem.”

Asked about this incident, Hay River’s health authority provided an indirect response that did not challenge the nurse’s account.

“As part of our ongoing recruitment efforts, physicians continue to travel to Hay River based on availability, which can be planned well in advance and/or within days,” a statement from HRHSSA read.

“We are very grateful for those practitioners willing to assist in short notice, both locum and those who are resident in other communities in the NWT who have travelled here to provide coverage.”

The nurse, meanwhile, said they learn about some of their community’s physician shortages the same way other residents do: HRHSSA’s Facebook page.

“Two weeks ago, when this current physician shortage started, we had not yet received any communication from our management that it was even happening,” they said.

“I learned about it by reading a post on Facebook. That’s how I learned about it. And I’m a nurse.”