Submitted by:
Dr. Leah Koetting

Some of you may remember me as the resident doctor who worked with Dr. le Roux in the fall of 2014. Some of you know me now as your family doctor. Some of you think I look far too young to be doing this.

Don’t worry! That will change with time.

I would like to thank you as a community for making me feel welcomed and wanted here. It is due to your friendliness that I approached my fellow-residents and suggested we all come to work here together. They were willing to take the leap and come largely because of my glowing description of the community. Thank you for extending your warm welcome to us all.

If I may, I would like to address some recent frustrations and challenges from the public that have come to our attention. Over the past two years you have seen five physicians leave or retire, and you have seen five new physicians come. So some people are asking why there are still people who don’t have a family doctor, and why it takes so darn long to get an appointment. How come there aren’t any obvious improvements yet?

These are good questions.

We’re trying to make the transition from your previous doctors as seamless as possible, but it’s going to take some time. We are still new doctors in your community, and we want to be thorough as we get to know you. Someday when we know one another well, we’ll be able to get through appointments faster and see more people each day. But until then, we don’t want to rush anyone or miss any important issues. You deserve our very best.

Secondly, some of the duties expected of primary care physicians in the region have changed. The Prairie Mountain Health region wants to make sure everyone has excellent care and that all necessary services are provided. That means that all the new doctors take turns in the hospital providing dialysis and chemotherapy, in addition to caring for hospital patients and seeing patients in the clinic. We have all agreed to provide these services in order to be better able to cover for one another and prevent burnout. We are happy to provide these services at the hospital, but it means that even our full-time doctors are not really in the clinic full-time.

And finally, three of us are currently working part-time. Two of the doctors travel to Swan River two weeks a month. I myself am a new mother, so I’m also working half-time. That means that the number of full-time bodies in the clinic is really only 4.5, not six. This, combined with our hospital duties, means we aren’t able to see the same number of patients that all the retired physicians were seeing.

We still need more doctors.

However, we are delighted to be here. And we welcome the challenge of working through these issues with you and growing together as a community. We ask your patience in the meantime. We are all currently experiencing growing pains, but we are going to get through this even stronger than before!

Some commonly asked questions and answers.

How many doctors are presently employed at the centre, and who? Which doctors are still yet to come and when will they join the practice?
The Swan Valley Primary Care Centre opened on July 21, 2015 with Dr. Mousavi and Dr. Adegboyega. Dr. Fung joined the clinic in August. Dr. Fine and Dr. Andani joined in September on a part time basis and they alternate two weeks with one another. Dr. Koetting came February 1 and is also working part-time. We’re looking forward to more doctors joining us in the near future: Dr. Tyler Burnside this summer and Dr. Savannah Webb in 2017 (both are originally from the Swan Valley). 2019 will bring the addition of Dr. David Cazakoff (originally from the Pelly, SK area). We are also actively working to recruit additional doctors. Currently we have the full time equivalent of 4.5 doctors.

Are all of those doctors intending to remain at the SVPCC long-term?
We are all happy to be living and working in the Swan Valley, and look forward to being part of this friendly community for years to come.

Are any of the doctors still taking new patients?
Some of the doctors are still taking new patients. A few have been in practice for some time already and are full. As well, a couple of doctors are making plans to pursue additional training to better serve the Valley’s needs. These doctors are not accepting new patients right now because their existing patients will have to be cared for by others while they’re away for training. However, they will be taking those patients back and accepting additional patients once they return to the community.

Does the centre take walk-ins or is it by appointment only? Are there associated wait-times?
At the moment, the clinic takes patients by appointment only. There are a number of same-day slots available every day, but these often fill up soon after opening. In the near future, we hope to be able to offer walk-in service too. Right now, however, there simply aren’t enough physicians onsite to be able to do this without increasing wait-times for other patients. We anticipate current wait-times will improve as the clinic is staffed with more healthcare professionals, like doctors, nurse practitioners, and/or physician assistants.

What are the advantages of having a practice in which multiple doctors work together in close quarters?
We have the benefit of collective knowledge and experience. We can ask for a second physician’s opinion immediately, if needed. The primary care clinic is also home to an Outreach Clinic, staffed with a registered nurse. In the future we hope to see the clinic become home to more professionals, such as pharmacists, nurse practitioners, physician assistants, and others. This would increase the clinic’s efficiency and reduce wait-times. We also have two treatment rooms in which we can perform outpatient procedures that used to have to take place at the hospital.
 
Is this type of practice beneficial to the continuing development of young doctors? How?
The first few years of medical practice are difficult. As modern medical knowledge expands, there’s more and more for new doctors to know and retain and be able to manage. A group practice like this provides a strong collegial base for freshly trained doctors to grow in knowledge together and benefit from their more experienced colleagues. It also fosters ongoing learning. In addition, any medical students or residents training in our clinic will benefit from everyone’s different backgrounds and approaches. It’s also an excellent recruitment tool; residents who have a positive experience may return to work here after graduation.

What sort of on-going training and education are the younger doctors continuing to take part in?
We are seeking extra training in order to meet the area’s needs. Renal dialysis and chemotherapy are already very important services in the community, and restoring obstetrics to the Swan Valley Health Centre has also been frequently mentioned as a great need. All of these things require extra training in addition to residency, which means that doctors pursuing these will need to spend time away from the community now and then.

In addition, ongoing training and education are an expectation of all doctors at all times. Please be assured that we are staying up to date with medical research and changing practice guidelines in order to continue to offer the best possible care to Valley residents.

I’ve heard that some of the doctors are interested in reopening maternity services at the hospital. Is this true?
The entire health care community is working very hard to make this happen. The nurses at the hospital are already registering for the courses they will need in order to offer safe obstetrical and post-partum care. The physicians who are planning to provide this service are making arrangements to enhance their skills as well, so as to be optimally prepared.

It is important to stress that only those doctors with the desire to provide obstetrics and the training to do so will be attending deliveries. There will be a separate obstetrical call group in order to handle deliveries; it will not necessarily be the doctor who is on call in the emergency department. More information about the provision of maternity services is expected to be unveiled in the near future.
 
What does the Valley need in order for maternity services to be restored?
Ultimately, to provide full-service obstetrics, we will need an anesthetist and a family doctor with advanced surgical skills who can perform caesarean sections. It is, however, extremely difficult to go from zero to full service all at once. While the doctors are receiving this training, our aim is to get low-risk obstetrics started, so that there is a comfort and familiarity with uncomplicated deliveries before we add the more complicated aspect of c-sections.

This is still a work in progress, however, and will come in stages. Once obstetrics reopens, only low-risk women will be able to deliver here at the beginning. As staff gain experience, it will be easier to make the transition to full-service obstetric care when those doctors who are training in surgery and anesthesia skills return.

We all know deliveries happen in this community occasionally as it is, even though they aren’t planned. We want the Swan Valley Health Centre to be prepared for them in a more intentional way, in order to provide the best healthcare for everyone.

Would you say that having so many new doctors has taken the burden off of the existing doctors?
In a way, there aren’t actually very many new doctors: there are five new doctors, making six at the clinic, but as mentioned above, three are part-time. As a result, we aren’t able to match the number of patients the previous physicians were caring for. They’ve left big shoes to fill, and while we’re trying, we’re not able to fill them quite yet. The burden is heavy for everyone and will continue to be as other physicians in the area retire and some of our colleagues pursue additional training in things like anesthesia and surgery.

Frankly, we still need more doctors. We remain extremely understaffed, so we are continuing to work with Prairie Mountain Health, our local communities and organizations like RISE in ongoing physician recruitment and retention efforts.
  
What can we do going forward?
We remain committed to providing timely information regarding the status of medical service in the Swan River Valley. We ask for your patience and understanding as we take meaningful steps forward. We want the primary care centre to be built on a very strong foundation of collaboration, trust, and good medicine.

Please also know that we are doing our very best to meet the needs of the community and surrounding area. We’re investing in extra training, getting to know the individual needs of our patients, recruiting additional healthcare workers, and learning to work together as a clinic. And while these things cannot happen overnight, they are all important to building a solid foundation for healthcare in our region. Together we are striving for the best health of all in our beautiful Swan River Valley.