winter 2013

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Discipline of Family Medicine an integral part of primary care in Newfoundland and Labrador


Terry Upshall Photo

 

L to R: Rana Saunders, front, a fourth-year medical student, learns under the supervision of preceptor Dr. Danielle O'Keefe at the Family Medicine Clinic in the Torbay Road Mall in St. John's. Kendra O'Keefe enjoys the attention.

With over 10,000 patients at four family medicine teaching clinics across St. John’s, full-time faculty of the Discipline of Family Medicine at Memorial make significant contributions to patient care.

By Dr. Cathy MacLean

With over 10,000 patients at four family medicine teaching clinics across St. John’s, full-time faculty of the Discipline of Family Medicine at Memorial make significant contributions to patient care. We provide coverage 24/7 and see patients in clinic after hours and at home. Until recently, all first-year residents rotated through one of the teaching units in St. John’s. We also provide care to out of town families with children at the Janeway and for those at Emmanuel House and Howard House. In addition to our family practice services, our faculty are involved in providing care and on call services in rehab, long-term care, palliative care and maternity care.

Our faculty are involved in an evening prenatal clinic, do 130 deliveries per year and cover the case room for obstetrics for a half day per week, in addition to covering maternity care call. At the Miller Centre Ross Clinic, family physicians manage 35 LTC beds, 10 palliative care beds and 10 rehab beds for a total of 55 and cover the entire hospital when on call. We work collaboratively with nurse practitioners to care for 100 frail elderly and those with complex disabilities in the community through hundreds of house calls. Others provide palliative care services and participate in on call coverage. Full-time faculty also cover three personal care homes with 35 residents in St. John’s including call. We do consults in psychotherapy, palliative care and care of the complex elderly as well as sports medicine and adult rehab. We also do occasional consultations on psychiatry inpatients.

We also support nurse practitioners at the MacMorran Centre and Buckmaster’s Circle. In many cases we are supporting highly complex patients that are often underserved. Of particular note, would be the countless hours of clinical care that is provided to new immigrants and refugees through the Gateway project and special well women clinics at the Family Practice Unit.

Academic family physicians fulfill multiple roles. For example, in addition to undertaking clinical and consulting activities, an individual physician may be an educator, a researcher and an administrator. We run the largest residency in the medical school and all undergraduate students are placed in rural sites for mandatory 8-week family medicine rotations. Many of our faculty also participate in leadership activities that contribute to local, provincial, and national organizations.

Dr. Paul Patey was national President of the CFPC from1984-1985 and Dr. Cheri Bethune served in this role from 1996-1997. Drs. Heather Flynn and Norah Duggan were recent NL Chapter Presidents. Last year, Dr. Marshall Godwin was named national Family Physician Researcher of the year. Bob Miller was the NL Family Physician of the year in 2011 and Michael Jong and Mo Ravalia have also shared this honour in the past. Pauline Duke received a national CFPC Equity and Diversity Award for her work with the Gateway Project. Dr. Wendy Graham, one of our rural full time faculty, is President Elect for the NLMA.

We have been successful in obtaining investment for research in primary health care including the establishment of the Primary Healthcare Research Unit (PHRU). Approximately $15 million in research funding can be attributed to projects affiliated with the family medicine faculty, including $4 million in the past six years with family physician faculty members as principal investigators. Our work results in approximately twenty publications annually in a broad range of journals as well as national and international presentations.

Dr. Leslie Rourke has focused her academic work on the Rourke Baby Record (see www.rourkebabyrecord.ca) which is used across Canada and beyond as the standard of care for infants and children. Dr. Godwin has been involved in the development of a national website on prevention (see www.preventioninhand.ca), which is also being promoted nationally.

As an academic unit, we have 80 residents who are oriented and organized through our office in St. John's, which involves organizing 1,000 rotations. We also organize undergraduate placements with 275 part-time faculty in over 40 communities in Atlantic Canada, Nunavut and the Yukon. Faculty development for family medicine teachers is organized and delivered by many of our full-time members locally and through distributed programs.

Memorial’s Discipline of Family Medicine has been nationally recognized for our success in training family physicians for rural practice. Last year we received the Keith Award from the Society of Rural Physicians of Canada (SRPC) for producing the largest number of graduates practicing in rural areas 10 years after graduation. This marks the fifth time we have received this prestigious award.

We have two PhDs, four emergency medicine physicians and five rural full-time faculty in the discipline. Several of our faculty work outside of family medicine including in eHealth. Two of our faculty are assistant deans (in Student Affairs and in Admissions), one is a director of continuing medical education at Professional Development and Conferencing Services, and one is the director of the Primary Healthcare Research Unit.

Although our faculty are part-time clinicians juggling multiple roles, they highly value their clinical work. Most have their roots in rural practice and many have had practices in St. John’s for over 25 years. Our patients come from a large geographic area, extending well beyond St. John's and we are very grateful for their involvement in teaching our residents and other learners. The faculty members in the discipline are enthusiastic about family medicine and appreciate their multiple roles as an integral part of primary care in Newfoundland and Labrador.

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