The medical centre’s doors are open, but the doctor is not in at Baldur in the RM of Argyle.
According to Bob Conibear, chair of the Baldur Health Care Committee, the community lost its single physician last year to health problems. The void was then filled by a part-time nurse practitioner and a decision will be made in May whether the position becomes full time.
“It’s a big impact,” Conibear said. “You have a nurse practitioner, which is great to have, but there’s a lot of things that they can’t provide.”
According to provincial guidelines, a nurse practitioner can prescribe most medications, order and interpret most diagnostic tests, provide vaccinations and perform minor procedures such as stitches.
The Baldur Health Centre has no emergency room, but contains a clinic, pharmacy, personal care home and transitional unit for patients awaiting transport to a bigger hospital. With only one nurse practitioner available, the facility has become reliant on teleconferenced-in specialists and is not open consistently, Conibear says, and the result leaves residents travelling to Brandon or Boundary Trails Health Centre near Morden, both over an hour away.
“Killarney is an option too, but it’s so loaded up with things, you can’t get in there, so basically you’re heading to Brandon or Boundary Trails,” Conibear said.
Baldur’s story is not unique and it is one repeating across rural Manitoba, where small-town hospitals have fought for years to both draw physicians and keep them once they arrive.
About 28 per cent of Manitoba’s population is rural — ranked in the middle of other provinces, although 10 per cent higher than the national average — and 63 of the province’s 73 hospitals lie in a rural area, according to the Provincial Clinical and Preventive Services Planning for Manitoba report.
The report, released in February as part of health-care cost reduction efforts, also found that Manitoba falls below the national average on both regular access and regular contact with a doctor.
“The biggest thing is, when people are recruiting to small towns, nobody wants to be the only doctor there. So if there’s one or two doctors there, people don’t want to relocate to a community like that,” Killarney-Turtle Mountain Mayor Rick Pauls said.
The RM of Killarney-Turtle Mountain is one of several areas in southwest Manitoba to make headlines after taking active measures to recruit or retain staff.
Last year, the municipality spent $250,000 in taxpayer funds to bring in two international doctors, one from Ireland and one from England. Both are employees of the regional health authority (RHA), leaving the municipality with a bill of $250,000 to cover recruiting fees, resettlement costs and legal fees.
“The RHA recruits for the region,” Pauls said. “So when it’s looking for the region, it’s looking for a lot of these larger centres — Brandon, Dauphin — as well. It will get a doctor for the region; place them where the need is, but it’s not necessarily the best fit for the doctors themselves. So when we get these international medical grads, what a lot of times we see happen is they won’t stay for longer than four years. As soon as their return-of-service agreement is done, they leave.
“What we did is we took the approach to specifically recruit for our community, so these doctors knew that they were going to be practising in Killarney; this is the hospital they’re going to be looking at; this is where they could possibly live; this is all the amenities that they have in our town and we sold them on the town rather than coming here to be a physician. We think because of that they’re going to be here long term.”
About 3,500 people live in Killarney, with about 12,000 in the surrounding area potentially reliant on the hospital, Pauls said.
The two doctors arrived over the last six months and bring the health centre’s staff to five.
“It’ll definitely ease up on some of the times for a regular checkup, but we’ve never lost any services because of (staffing lack,)” Pauls said.
Recruitment is the latest, but not first, effort to draw physicians to Killarney-Turtle Mountain. About five years ago, the council purchased a condo to house temporary physicians, a model that has since spread to Glenboro, 70 kilometres to the north.
A two-bedroom apartment was rented in March to house storm-stayed staff and the temporary doctors, or locums, the community of 650 has become increasingly reliant on.
Tracy Rimmer of the Glenboro Health Action Committee says 1,800 to 2,000 area residents rely on the local health centre, but staffing has declined from three physicians to one, who is near retirement age, plus a nurse practitioner about to go on maternity leave. The decision to take a more proactive approach already appears to be helping though.
“We have already noticed that medical professionals are more willing to come here rather than go to, say, Carberry and have our situations taken up there by ambulance,” she said.
The committee has raised funds to rent the apartment for a year, although Rimmer has said the group intends to maintain the space long term.
Prior to March, locums were lodged with residents, a situation Rimmer says discouraged temporary doctors from working in Glenboro. She added that there have been instances where no doctor was available.
The Glenboro facility is equipped for acute care and includes a clinic and personal care home.
Like Killarney, the committee hopes to actively recruit a physician to the area and has been in contact with both the Killarney-Turtle Mountain council and Prairie Mountain Health.
“This is not a situation where we are telling the province that the health region is not doing its job,” Rimmer said. “This is a situation where we feel that communities have to step up and do their part. The health region is doing the best it can, but this is not a unique story. This is just one community saying, ‘We’re going to better our odds if we possibly can.’ All of the lobbying and all of the criticizing of the health-care administration, it doesn’t help. Just get out there and do this for yourself. If your community needs a doctor, then find one.”
Prairie Mountain Health CEO Penny Gilson said that “many” communities besides Glenboro and Killarney have taken an active role in recruiting and retaining health-care professionals.
“Prairie Mountain Health (PMH) works in partnership with the communities – sometimes a joint effort yields success with PMH focusing on the practice environment side of things and the community on what the community specifically has to offer as people need to make a choice to ‘live and work’ in the communities,” she said.
In March, Prairie Mountain Health was handed a $17.5-million “savings target” by the province and was told to cut 15 per cent of management positions. The health authority has not commented in detail on its financial standing, saying only that talks with the province continue.
“PMH would obviously prefer that all health-care vacancies, not just for physicians but all health-care workers, were filled but that is not the reality so the region continues to try and ensure as much service access as possible with the resources available while continuing ongoing recruitment efforts,” Gilson said.
Jason Falk, chair of the Carberry Health Action Committee, says it is “hit and miss” to maintain the three doctors and one nurse practitioner needed to keep the Carberry Health Centre at full capacity. The facility currently co-ordinates with Glenboro so that one of the two locations will have emergency care at all times, Falk said.
The Carberry Health Centre currently employs two physicians and one nurse practitioner and has worked, “with very limited success” with the RHA on recruitment, Falk said.
Unlike its neighbours to the south, however, the committee has turned recruitment efforts inward.
“Going forward, it’s what we can do at a grassroots level as far as educating our own students, our high school students, informing them of the possibilities in health care and what’s involved in returning to rural practice and the advantages of it,” Falk said.
A contingent from the committee will travel to Winnipeg later this year for University of Manitoba career fairs, also in the hope of health professionals.
For Rimmer, the fight to recruit and retain doctors has deeper implications than a slightly longer drive for her next checkup. She has argued that urbanization and the aging farm population (Statistics Canada estimated that the average age of farmers had grown to 54 years by 2011), may affect the viability of small towns into the future.
“Health care is one aspect of the sustainability of our rural communities and it’s a slippery slope,” she said. “Every little bit that we slide down that slope, whether we lose our emergency rooms, whether we lose our acute care, and basically all of these rural hospitals turn into personal care homes, that takes things away from our community that sell our community (and keep) people here, and (bring) new people in.”
According to 2016 census data, the Municipality of Glenboro-South Cypress had modest population growth from 2011 to 2016, although more detailed data on age is expected in May.
According to the Provincial Clinical and Preventive Services Planning for Manitoba report, 18.5 per cent of the population in Prairie Mountain Health was over 65 years, well over the 15.1 per cent provincial average.
Bob Conibear shared Rimmer’s concern, particularly in view of provincial discussion of health-care reforms, although his response was more moderate.
“You have to have your basic services,” he said. “I mean, we know we can’t have everything, but you certainly have to have your clinics and then you can advance out from there. That’s our big concern is to keep the small places open.”