Enticing doctors to stay in rural communities requires a variety of benefits, namely an improved work-life balance
Bridget Stringer-Holden (she/her) // News Editor
Andy Poystila (he/him) // Illustrator
On the last night of his honeymoon in the Bahamas, Dr. Eric Paetkau changed the course of his life with one phone call.
In his hand, he held a list of 50 locations in British Columbia that were hiring doctors. The career advisor had recommended St. Mary’s Hospital in Pender Harbour, which served the Sunshine Coast’s population of 9,000 people. She’d said it just seemed like the place for him.
That night in 1959, he sat at the hotel on the phone, speaking with Dr. Al Swan: “Are you still looking for help?”
The man on the other end of the phone paused for a moment before saying that yes, he was still looking.
Making his way to the Sunshine Coast immediately with his new wife so that Swan could go on vacation, Paetkau was surprised when he showed up to work. One of his first patients was a large 75-pound German Shepherd.
A man came into the hospital and Paetkau recalls him saying, “Doc, you’ve got to pull a tooth on my dog, he’s got a toothache.” Paetkau explained that he’d never dealt with dogs, nor had he pulled teeth. He remembers the guy responding, “Well, get a book and read up on it, I’ll sit here and wait… the doctors here pull teeth.”
It was a Sunday, so Paetkau took some time to read up on it, and at the end of the day, successfully pulled the dog’s tooth.
Arriving in a small rural community in the midst of a doctor shortage meant Paetkau had to become a jack of all medical trades. He was often the only doctor working, and had to pull teeth, put down animals, act as a coroner, and deal with everything from logging accidents to delivering foals.
Sechelt is now in a similar situation—albeit on a larger scale. St. Mary’s (Sechelt Hospital) now serves all 50,000 Sunshine Coast residents and will likely be stressed due to Sechelt Medical clinic’s closure at the end of last year.
About 5,000 Sunshine Coast residents are currently without a physician, and the number is only growing as physicians move away or retire, according to the Sunshine Coast Division of Family Practice.
Pender Harbour’s only physician, Dr. Colin Sutton, also left in mid-November and does not currently have a replacement. A local search firm has advertised the role both locally and internationally, but the 70-plus hours work weeks and the 30-kilometre drive to the Sechelt Hospital—which is required to fulfill the hospital part of the role—makes the role undesirable for any physician wanting a work-life balance.
While doctor shortages are an issue across Canada, rural communities are especially affected because of the long hours physicians are required to work to ensure everyone is treated. One-fifth of Canadians live in rural communities, but only eight per cent of practicing Canadian physicians serve those communities, according to a 2020 article in Canadian Family Physician.
One problem that remains to be solved in the long hours, as rural practitioners are more likely to do out-of-hours work, as shown in Rural Remote Health.
When Paetkau was a general practitioner in Pender Harbour, he found this to be more like 70 hours a week as he had to work until everyone was taken care of. Sutton, the physician who left Pender Harbour in November, sometimes worked over 70 hours a week, while male physicians in Canada were only shown to work 52.2 hours on average according to a 2020 survey conducted by the Canadian Medical Association.
“We didn’t get out of the clinic until seven o’clock, but nowadays, doctors shut down at 4:30 p.m.,” says Paetkau. “It’s hard to do if you’re in a small rural area and something happens and you’re off hours—in an emergency, you have to go.”
The long hours also bleed into a healthy work-life balance. “My career had taken a heavy toll on my family who had to endure constant disruptions to planned events, vacations that had to be taken off the coast, and my long absences,” Paetkau said, recalling that once he didn’t see his then teenage daughter for almost three weeks.
Despite the demanding hours and extensive responsibility, Paetkau fell in love with the Sunshine Coast immediately upon arrival and has yet to leave. “I didn’t come to stay [but] I knew within a couple of days, I never wanted to leave,” said Paetkau, who ended up working at the hospital for 42 years until 2002, when he began doing locums and hospital accreditation work across Canada. He still lives on the coast though, minutes from the hospital.
While retired now, he found that a three-month rotation is a feasible way to address the shortage. Another surgeon from Williams Lake who was struggling to handle being a solo surgeon decided to come and share the Sechelt practice with Paetkau after Swan left.
“We knew that three months was something we could handle,” Paetkau says, adding that it was a stressful three months, but better than both of them burning out. This allowed him time to travel with his family and do hospital accreditation work across Canada. “If they had doctors that could do relief work [that would be of immense help], but there’s no such thing unfortunately.”
He also found that hands-on training for nurse practitioners helped alleviate the strain on the system. However, his main hope for the coming years is simply more doctors. “I don’t really know any other answer than just more doctors. If a doctor doesn’t want to go to someplace and a place can’t attract a doctor for other reasons, they’re just not going to go.”
The rural Sunshine Coast came with its drawbacks but afforded him the chance to practice a wide scope of skills, in a variety of settings. Paetkau was also able to participate in continuity care over patient’s lives, and he continued to run into at least a dozen former patients at the care home where he took his wife for respite care until she passed in December 2023. Both of those are influential factors in the choice to practice in a rural community, according to a 2017 report by the Society of Rural Physicians of Canada.
Also mentioned in the report was independence and the ability to partake in decision-making. That’s one drastic change that Paetkau noticed over the course of his career. “In the beginning, when we started off at Garden Bay, there was a hospital board of volunteer citizens in the community, and any decisions that had to be made, they would just sort of say to us—’well you decide,’
While they weren’t major decisions, they involved reconfiguration of operating rooms and other alterations around the hospital that made their, and the nurses’ lives, easier. “We made a lot of decisions in those days, and then eventually when the hospital moved to Sechelt, the board took over making all those decisions,” he said, adding that doctors don’t really get a say in hospital decisions nowadays and it would be nice to be consulted more.
While Paetkau doesn’t have all the solutions, the Rural Road Map Implementation Committee is working to find solutions to rural healthcare shortages and advance the Rural Road Map for Action to ensure quality healthcare in Canada.
“All of these difficulties—the bureaucratic upheavals, the physician shortages and the constant pressure of being on call twenty-four hours a day—are both challenges and opportunities not unlike those the medical community was facing when I [started my career],” Paetkau said. “Like the old challenges, these new obstacles will eventually be dealt with.”
