'Patient Lottery' in Gander, NF Will Provide Better Care for Almost 2,000 Residents

In May of this year, the community of Gander, NF elected to hold a 'lottery' style selection of patients for two newly arrived Family Physicians. Although innovative, this approach is unlikely to help in solving a worsening shortage of doctors nationwide.

Gander is a small rural community of approximately 10,000 residents on the northeast coast of Newfoundland, Canada. While normally highlighted by travel magazines for its rugged coastline and small-town charm, it received national attention earlier this year for an odd response to the addition of two new GP's – Dr. Amanda Scott and Dr. Celine Dawson – to their local medical clinic. The call rang out that a 'lottery' would be held, patients queued for hours, at the end 4,000 names were entered into the draw—an astounding 40% of the population. The CBC reported today that the lucky winners would be contacted, beginning Monday, while leaving 50% of those entered into the 'draw' with no GP at the end of the process. While Gander's solution to its shortage is unique, the shortage of primary-care physicians (reaching crisis proportions) is not isolated to it or other rural communities in Canada. According to a recent StatsCan report (2007), over 4 million Canadians (8.25 %) have no family physician—a rise of 3 percentage points from the previous study in 1997. A Decima Research poll from 2006 raised this figure to 17% of the total population–based on a approximately 1,000 respondents. In response to the compounding issue of unacceptable wait times, Dr. Calvin Gutkin (Director for the College of Family Physicians of Canada at the time) had this to say:

Every Canadian should have the opportunity to have a family doctor. Tackling family physician shortages should be the first step in any wait time strategy.

As recently as 2004, the Canadian Institute for Health Information reported that only 9% of Canadian doctors worked in rural (pop. less than 10,000) communities, which is further complicated by only 2% of these communities having any local physicians. While some have argued that this critical imbalance is more of a function of the remoteness of smaller communities, several studies over the decades have reported a slow migration of Canadian health professionals to other countries where the pay is higher, multi-tiered health care is common, and / or certain specializations are lacking. Gander seems to have found a partial solution to their immediate crisis. Yet, 4 million other Canadian citizens must further over-burden our national – in truth provincial – health care system(s) through the use of emergency rooms, walk-in clinics, and community health centres. Fredericton, NB has responded to its own crisis through the use of the River Valley Health Patient Registry accessible through a toll-free number (1.800.554.5959). In Ontario, British Columbia, and other provinces, doctors now commonly 'screen' new patients to determine whether any pre-existing conditions will make caring for them 'difficult'—smoking, other lifestyle choices and obesity have resulted in denial of service. Alberta continues to lobby for a two-tiered health as a solution to prolonged wait times. Even dermatologists are expressing concern as a shortage in their ranks is predicted to lead to incomplete care for skin cancers and other common illnesses. It's clear that there is no ready solution to this national crisis, as each region of the country cobbles together local responses to it. What is also clear is that continued pressure must be applied to our local and national parliamentarians to engage in multilateral discussions. Canada continues to be held up as a standard of national socialized health care in the global community. It is past time that our true standard of care at least approaches our reputation for it.