We need to make community family practice more attractive. Unless we address the overhead burden, doctors will stay away.
Dr. Alison Wellwood
Strengthening the foundation
Dr. Alison Wellwood learned at an early age about the valuable role comprehensive family physicians play in their communities. “I grew up with the backdrop of my mom being a person in demand in our small town,” said Dr. Wellwood, who has practised family medicine in Wolfville for 13 years.
Her mother, Dr. Heather Wellwood, was a family doctor in the community for decades. “For many years, my mom was the only female family doctor in Wolfville,” recalled Dr. Wellwood. “I remember walking around with her and seeing how patients talked to her and the relationships she had with so many people.”
Those interactions inspired Dr. Wellwood to pursue her own career in family medicine. “It’s the conversations with patients and the relationships you build that drew me to family medicine,” she said.
Even today, it’s the deep connections with patients that make her job so fulfilling. “Patients will ask for my advice, ‘How do I broach this difficult topic with my kids,’ or ‘A specialist has suggested I change medications – what do you think?’”
As a community-based family physician, she says, “You have a totally different depth of knowledge with your patients. We specialise in our patients. Patients feel that and value that.”
Dr. Wellwood studied medicine at Dalhousie Medical School and completed her family medicine residency at its Moncton, N.B., teaching site. She then returned to Wolfville, practising for seven years alongside her mother until her retirement. The younger Dr. Wellwood helped recruit a friend from med school, Dr. Benjamin Sabine, to take over her mother’s family practice.
Over the past six years, they have joined colleagues to build a collaborative family practice team, supported by Nova Scotia Health (NSH) and Acadia University’s Centre of Lifestyle Studies. The collaborative clinic now has six family physicians, two family practice nurses, kinesiologists and a social worker. Dr. Wellwood is a part-owner of the building. “We’re the only collaborative group of family doctors in Wolfville and we support thousands of patients in the community,” she said.
The building next door to the collaborative practice is the former Wolfville hospital; it now houses an after-hours clinic where Dr. Wellwood and her colleagues care for the growing number of people in the community who don’t have a family doctor. Many physicians in this area have recently retired, leaving more than 12,000 people in the area on the waitlist for a primary care provider, according to NSH in December 2022.
The lack of access to rostered primary care will compound social inequities, says Dr. Wellwood. “Unfortunately, the groups who have been subjected to systemic discrimination will suffer most when they lack the support of a health home. We’re doing our best, but we need support to build better teams and to recruit more family doctors.”
Dr. Wellwood has a full roster of patients and has provided care in many additional community settings over the years, including working at Acadia Student Health, providing obstetrical and inpatient care at Valley Regional Hospital, doing house calls, procedures and providing palliative care. She represents physicians on the Doctors Nova Scotia Fee Committee and recently joined the Master Agreement Negotiations Team.
In September 2022, she paused her inpatient care role at Valley Regional Hospital. She wanted to scale back her workload to provide better access for the patients in her own family practice. “When I do hospital shifts, I fall behind with my own patients,” said Dr. Wellwood. “I want to be able to accommodate my own patients myself.”
Since making the change, she has been able to provide more same- and next-day appointments. “It means I’m seeing my patients before they become seriously ill – I don’t want my patients ending up in the emergency department. It’s about access to care and balancing the needs of my patients.”
She cites overhead expenses as a major obstacle to recruitment and retention in community-based family practice. When Dr. Wellwood provides in-patient or hospitalist care, her equipment, supplies and overhead costs (such as rent, utilities and salaries for administrative staff) are covered.
That’s not the case at her own family practice. Like other community-based family physicians, about 30% of her income goes toward these expenses. “I pay out of pocket for every garbage bag, piece of paper, sharps container, alarm system, computer and printer. I pay for utilities, rent and my staff.”
Dr. Wellwood wasn’t prepared for the business side of running a family practice. “It wasn’t part of my medical education. Taking off my clinical hat to be in the small-business mindset takes me away from providing patient care.”
Overhead costs and the responsibility of running a business can also push new medical graduates away from community family practice, but having help covering those costs makes family practice more attractive. A recent survey by Doctors Nova Scotia found that 80% of family physicians and learners would practise or continue to practise comprehensive family medicine if overhead costs were covered.
“New physicians are turning instead to hospitalist care, emergency care, virtual care, hospice care, walk-in clinics or locum work where there’s no overhead,” Dr. Wellwood said. “All of these roles are important, but we need to make community family practice more attractive. Unless we address the overhead burden, doctors will stay away.”
She says collaborative family practice teams also need support beyond money – such as having staff ready to step in to cover when team members are sick or need time off. Dr. Wellwood says effective respite for physicians is important in making teams thrive, too. “Family doctors still respond to their own urgent labs and paperwork when they’re on vacation – we have a commitment that never ends. Having more locum time and incentivized cross coverage would support the teams so it’s sustainable and seamless when people need to be away.”
Improving work-life balance for family physicians will help stabilize and sustain the care they provide and help them continue to play their important role in their communities.
“When I can help people, it drives me forward. When I look for support and the system fails me, it pulls me down,” Dr. Wellwood said. “We’re all motivated to help as many people in our community as we can, but we need a system that helps family doctors do their work well.”