For decades, Louise Nichols and her husband were patients at the Group Health Centre in Sault Ste. Marie. Even when their doctor retired a few years ago, that didn’t change.
“We’ve had several replacements for him,” says Nichols, now a senior citizen. “Some were temporary doctors, some were nurse practitioners.”
But last year, not long after her most recent nurse practitioner left the GHC, Nichols suddenly discovered that she and her husband had been “de-rostered” — leaving them unable to access any of the Group Health Centre’s services, including its same-day clinic.
“I've been going there since I was a young kid but now I’m out,” Nichols tells SooToday. “What’s happening to all the people who were patients there? Those patients are getting pushed out.”
Nichols says she and her husband now have no choice but to use walk-in clinics that offer only virtual telemedicine appointments. Like so many others in the same situation, she has also endured waits of eight hours or more at Sault Area Hospital’s emergency department just to see a doctor.
“We always said if we won the lottery that the Group Health Centre would be the first place we would donate to. Not now,” Nichols says. “They should be looking after the people that have been there over the years and not just toss them aside.”
Nichols is definitely not alone in her frustration. A spokesperson for the Group Health Centre tells SooToday that over the past six years, approximately 2,800 patients have been de-rostered due to a shortage of primary care providers (PCPs) — a number that will keep climbing in the months and years to come.
“Unfortunately, given that almost 31 per cent of our current PCPs are nearing, at, or over the age of retirement, and the average roster size for a PCP at GHC is 1,400 patients, this number is expected to significantly increase over the next few years,” said Giordan Zin, the GHC spokesperson, in an email to SooToday.
Bottom line: A growing list of local patients — many of them elderly — are suddenly without a doctor or nurse practitioner at the most vulnerable stage of their lives. Along with the stress of trying to find alternative care, many feel betrayed and abandoned, having wrongly assumed that the Group Health Centre would look after them for life.
“I was a member there for over 40 years and all of a sudden I was told I was no longer on their list,” says Randy Parlow, another de-rostered patient. “My father was an Algoma Steel worker who made major contributions to the Group Health Centre when it was first built.”
After his family doctor retired, Parlow was cared for by nurse practitioners at GHC. He said he has had some continuity in his health care because his last nurse practitioner now works at a local I.D.A. pharmacy, fills his prescriptions and can refer him to a specialist if that need arises. But he’s still upset.
“My wife is still being seen by a doctor at Group Health and she’s asked if her doctor can take me on but their plates are full,” he says. “Every general practitioner in Sault Ste. Marie, their lists are full. None of them seem to be taking on any new patients.”
Lorri Morrar was notified last fall that her GHC nurse practitioner would be leaving her practice in November 2022. She said she was notified in writing that GHC was “aggressively recruiting new nurse practitioners willing to practice at Group Health Centre.”
She was able to access the GHC same-day clinic until Feb. 11. Now she can’t.
“I feel like I’ve been kicked to the curb,” Morrar says. “I’ve been there for 40 years.”
Morrar says a friend who had been without a primary care provider for four years — several years less than herself — has been assigned to a new family doctor.
“I’m like: ‘Okay, this doesn’t make sense.’ She called me back later and said her husband got a nurse practitioner. Why have they thrown some people to the curb and why are there other people getting doctors when we’ve been waiting for 12 years?”
Physicians who see patients at GHC are members of the Algoma District Medical Group (ADMG), a separate corporate entity. There are currently 55 primary care providers practicing at GHC, caring for approximately 57,000 rostered patients. Those providers include:
— 36 physicians practicing full-time family medicine; 10 of them, or 28 per cent, are over the age of 58
— six full-time nurse practitioners practicing family medicine
— nine locum physicians temporarily contracted to provide family medicine; seven of them, or 78 per cent, are over the age of 60
— four locum physicians temporarily contracted to support the GHC same-day clinic
The staffing challenges facing the Group Health Centre are no different than in other regions of the province, especially across northern Ontario. Veteran doctors are retiring at the same time as more and more medical school graduates are choosing to specialize instead of pursuing family medicine.
“Every community across the country is currently experiencing the same crisis — not enough new physicians or NPs are entering the profession to replace the number of healthcare providers who are at the end of their careers,” says Zin, the GHC spokesperson.
Zin says the Algoma District Medical Group will need to recruit 10 new primary care providers within the next two years to stabilize patient rosters and accommodate upcoming PCP retirements. Since April, two PCPs have been recruited, one left the organization, and two others who had planned to retire have pushed back their plans due to the lack of replacement PCPs.
That means that nine PCPs still need to be recruited over the next two years to service the approximately 57,000 patients rostered with the 55 PCPs who practice at GHC.
“Without those nine PCPs, it is likely that a considerable number of patients will need to be de-rostered, as there will not be nearly enough PCPs available to care for a roster size of nearly 60,000 patients,” Zin says.
What is being done to recruit more doctors in Sault Ste. Marie?
The Northern Ontario School of Medicine (NOSM) has been a primary source of recruits for the Algoma District Medical Group. From 2018 to 2022, they lured 10 PCPs with ties to NOSM, eight of whom graduated from the NOSM Sault Ste. Marie Family Medicine Residency Stream.
But in an email, Zin says that “unfortunately, in recent years, interest in the local NOSM Family Medicine Residency Stream has declined to the point that this year, there are no graduating NOSM residents based in Sault Ste. Marie starting a Family Practice in the Sault.”
Zin says that the Sault’s medical community is in regular contact with students training in northern Ontario as well as trying to recruit graduates from the other family medicine programs offered in Ontario. The Sault, he adds, is also trying to recruit doctors from outside of Ontario and Canada.
As far as incentives are concerned, the Northern Physician Retention Initiative (NPRI) offers taxable financial incentives to eligible physicians who establish a full-time practice in eligible communities within the province. Those grants range from $80,000 to $117,600 and are paid out over a four-year span. The NPRI also allows eligible physicians in northern Ontario to receive an annual retention incentive of $7,413, paid at the end of each fiscal year as long as they continue to practice full-time in the region.
Zin says some stop-gap measures have been put in place to keep as many patients as possible in the care of GHC and not de-rostered. Officials have been able to bring retired physicians and nurse practitioners back to work on temporary contracts as well as provide short-term contracts to locum physicians.
De-rostered patients who spoke to SooToday say they should at least have continued access to GHC’s same-day clinic. But Zin says that is not an option. Unlike a walk-in clinic, the same-day clinic at Group Health is considered as an urgent clinic for GHC patients who cannot see their doctor that day because the doctor may already have a full schedule, is on vacation, is sick or working at Sault Area Hospital that day.
Caring for the 2,800 de-listed patients at the same-day clinic “would present a severe resource challenge for the organization,” Zin says.
In the meantime, de-rostered patients are left scrambling to find other options.
Holly Cormier has a doctor, but the Sault resident is concerned about the well-being of her elderly father. His doctor left the Sault three years ago.
“Normally, in the past, Group Health Centre would allow someone to have a few months access to their same-day clinic when your doctor left but in this case they didn’t do that for my dad,” she tells SooToday. “They just dropped him. Gone.”
Her father now uses walk-in clinics or the SAH emergency department.
“That’s a problem,” Cormier says. “At his age, come on. I asked my doctor to take my dad and they said no. I’ve called doctors’ offices and asked if they will take him on and the first question they ask is: ‘How old is he?’ Then they say no.”
“I talked with a doctor in this city who was quite frank with me and said we don’t want to take on an elderly patient because their needs are high and they take a long time.”
The Ontario government’s Health Care Connect refers Ontarians who don't have a family doctor to one who may be accepting new patients. But Cormier said she has little faith in the program.
“Health Care Connect has an incentive to take on a patient but it doesn’t seem to be worth it for them to take on somebody with high needs,” she says. “My dad doesn’t have high needs but he needs to be checked and have a physical follow-up occasionally and he needs his prescription refills.”
She says she contacts Health Care Connect about every six months to ask if they have a doctor for her father. The answer is always no.
“This is not right,” she says. “If it was their father without a doctor, how would they feel?”