I like to take on a new patient’s whole family, so I can treat them as a unit
Tuning in to patients
Shelburne family physician Dr. Leanne DeLong is working hard to care for patients in a rural community hit hard by doctor shortages
She’s only been practising medicine for a year and a half, but Shelburne, N.S., family physician Dr. Leanne DeLong is already a master of tuning in to the needs of her patients.
“It’s about taking their concerns to heart and really listening to them,” she said. “Often, it’s addressing simple things, like helping them find a medication that works for them or taking their mental health issues seriously. It’s so satisfying to validate someone’s concerns, give a listening ear and tailor treatment to individual circumstances.”
Dr. DeLong grew up in Vernon, B.C., a rural community in the Okanagan Valley. “There were no doctors or professionals in my family, but I knew I wanted to do something in the health field,” she said.
She initially studied social work in B.C. and then did an undergraduate degree in nutrition and kinesiology at Acadia University in Wolfville, N.S. “Before that, I’d never been east of Alberta,” she said.
Studying family medicine was a natural progression. “I became more interested in a broader scope of practice. I’d developed counselling skills in my social work training and I liked offering dietary and lifestyle counselling.”
She headed back to the west coast for medical school at the University of British Columbia. But returning to Nova Scotia was always her goal. After graduation, she came back and did her residency in Barrington, a small community in Shelburne County.
While at Acadia, she’d met her husband, who is from Caledonia, near Kejimkujik National Park. He runs a kayaking business, training guides and giving tours. They now live in Shelburne with their two-year-old daughter.
“A rural area is a great place to raise a family,” said Dr. DeLong. “The pace of life is slower and there are lots of recreational opportunities to explore.”
But being a family doctor at the only medical clinic in Shelburne means Dr. DeLong rarely slows down.
The community has been grappling with a shortage of family doctors, which has left many people without access to primary care and caused significant ER closures at Roseway Hospital, the centre that serves Shelburne and the surrounding areas.
“Patients often come to their first appointments very sick,” Dr. DeLong said. “I’ve had a few first visits with patients where an end-stage cancer diagnosis was made on the initial visit or within the first few months in my care.”
At her clinic, Dr. DeLong collaborates with three family physicians, three nurse practitioners, two family practice nurses and one resident. “Working with a small group of providers, you have a close relationship and you can strategize how to care for your community,” she said.
The team works hard to provide care for the orphaned patients in their community. “We take on all pregnant patients who are without a provider, so they get pre-and post-natal care, and all children aged five and under, so they get their immunizations.”
When she started the job, Dr. DeLong took over half of a patient roster from a retiring physician. “It’s a lot of pressure, but I am still building up my practice,” she said. “I like to take on a new patient’s whole family, so I can treat them as a unit.”
While she finds the work rewarding, Dr. DeLong says her days are long and hectic. She’s on call every fourth day and one weekend each month for orphaned patients admitted to the hospital. “I round on all of the patients in the hospital and take care of any admissions on that weekend.”
With the closest regional hospital a one-hour drive away, Roseway Hospital provides important health-care services that people in the community would find challenging to access elsewhere. Dr. DeLong worries about how service cuts are affecting patients. “A few years ago, they were doing more procedures here. Now, people have to travel a lot for care.”
The erosion of services, coupled with the limited access family doctors have to specialists, makes it hard to recruit and retain the family physicians the community urgently needs. “Some new recruits aren’t comfortable working in a setting without specialists,” said DeLong.
Specialists are not based in Shelburne; an internist from Liverpool visits the community each week, while a gynecologist and an ENT provide monthly clinics.
Dr. DeLong thinks that doctors and medical students need mentorship opportunities to see what it’s like to work and live in a rural community. “It helps you develop a comfort level of working in an area with fewer services,” she said. “You get to know the environment, not just for medicine, but also the lifestyle and culture of the community. It might influence their decision to do an elective or a rotation.”
Boosting the resources available to family doctors is also crucial to attract more recruits. New-to-practice physicians like Dr. DeLong are often carrying heavy debt loads from medical school. “For me, it’s a matter of continuing to do this heavy workload because I have so much debt to pay I can’t take a break,” she said.
Subsidizing the overhead costs of running a practice in a rural location could help ease the burden. The average family doctor spends between 30 to 40% of their earnings on overhead, which includes things like rent, staff costs and supplies.
Adopting a better compensation model for family doctors that reflects the work they do is also key. “There’s no consistency in how physicians are paid, even in equivalent centres,” DeLong said. “At our centre, we’re not compensated for working on-call.”
Until these issues are addressed, Dr. DeLong worries that people in her community will continue to face challenges accessing the health care they need. “I worry that the health-care system has failed patients who are unable to access treatment.”
Knowing that her work is making a difference to patients is what keeps DeLong going during difficult times. “Listening to patients and affirming what they’re doing is really rewarding for me. The realization that I’m doing a good job doesn’t come often, but once in a while you know that you’re doing something right.”