Originally published in Island Ad-Vantages, August 29, 2019
Traditional healthcare model changing to meet modern demands
Stonington practice to welcome new doctor
by Faith DeAmbrose
Island Family Medicine may have gotten a new name this year, but the issue of recruiting physicians to the small, rural, family practice has remained a challenge for more than a decade. With a growing population and an increase in the number of summer residents that make the island their part-time home, the lack of a full complement of health care providers has led to longer wait times for patients.
The medical practice is part of Northern Light Health, which is composed of more than 1,200 physicians, nine hospitals and 127 individual locations, including hospitals in Blue Hill and Ellsworth as well as community clinics in Castine, Blue Hill, Bucksport and Stonington.
At Northern Light Primary Care–Stonington, there are three providers. Dr. Charles Zelnick sees patients three days a week (and spends one day on administrative work); physician assistant Marianne Vandiver sees patients two days a week; and a new full-time doctor will start in September replacing Dr. Sara Moorhouse who was hired in a temporary capacity until August 31. “This will bring us up to [two full time equivalent] doctors as of September. We are still recruiting for another additional provider,” said Zelnick.
Zelnick said that when he began his employment at the Stonington clinic in 2008 there were 2.75 full-time equivalents, “and that was about what the community needs, I think.” He said that between 2.75 and 3 FTE would meet the needs of the community year-round.
The summer months see an additional swell at the clinic, with a demand for acute visits and check ups. “A surprising number of people who spend the winter away consider [the clinic] to be their primary care provider,” said Zelnick.
Wait times can also vary depending on the provider. A routine appointment with Dr. Zelnick can take about a month to schedule, appointments with Vandiver can take six to eight weeks. “We expect to be able to work down [wait times] when a new doctor” arrives in September, Zelnick said.
He said three to five “same day appointments” are set aside each clinical day, reserved for people who are ill, who have urgent needs, or have recently been sent home from the emergency room or hospital. If additional doctors are at the clinic on a given day, that number may increase.
Challenges of recruitment
“There are a lot more jobs than there are doctors,” said Zelnick, noting that practicing in a rural setting often means long hours and reduced pay compared to working in hospitals or in larger cities.
And, for many, recruiting a doctor to a rural clinic often means that entire families have to relocate. “The main way to recruit and keep a local doctor is to recruit the spouse and family into being part of the community, in my opinion. We have an advantage in being located on a beautiful seacoast, but our remoteness works against us,” said Zelnick.
Some primary challenges for a family could include limited job opportunities for a spouse, longer travel times to attend schools, and a lack of after school programs or daycare, found a 2011 study in the Journal of Rural Health.
Clinical nurses help lighten the load
The island practice also employees two nurses, Sandy Eaton and Anne Perkins, who help in a variety of ways, including seeing patients in some circumstances.
Eaton, a Licensed Practical Nurse, has been at the practice for 40 years. Eaton and Perkins “often see patients on their own for blood pressure checks, wound care, urinary tract infections and sore throats. They also handle most phone calls and help me manage my prescription refills and heavy paperwork load,” said Zelnick. Perkins has been trained as a Practice Nurse, added Zelnick, and can independently see Medicare patients for their annual wellness visits.
Part of addressing the labor shortage is a change in the traditional model of care, explained Tammy Dickie, Director of Physician Practices for Northern Light. “We are changing and reforming the model and allowing employees to work to the top of their license.”
“We’re not the only clinic facing this issue,” said Dickey, noting that it is becoming a common occurrence in family medicine.
More than just a clinic
The island practice has been on the front lines of the opioid epidemic for many years. It treats approximately 18 patients who are in medically assisted treatment for opioid dependence. As part of a treatment plan, those patients need to be seen every three months and must undergo additional screenings as required by state law. “The new rules for prescribing opioids for chronic pain or other controlled substances have placed a heavy burden on the staff,” said Zelnick.
While the burden may have increased, said Zelnick, the work being done around drug addiction, as well as an increase in telemedicine, has set the practice apart.
“Northern Light Blue Hill Hospital has been at the cutting edge of providing mental health and substance abuse care in this rural community. We were one of the first practices in the area to have an embedded trained social worker therapist, and we also have telepsychiatry where patients can get very high-quality medication management over the internet, right in our office.”
Zelnick said that it has been helpful in treating anxiety, depression, substance abuse, and mood disorders. “This has really helped so many of my patients and I am grateful for the support of mental health, as it is generally poorly reimbursed and not a money maker for the Northern Light system,” he said. “But they have recognized the needs of this community and supported us.”
Healthcare is so much more complicated now than in the 1980s, said Zelnick. As the practice continues to recruit and retain staff, Zelnick said there are things patients can do to help.
“It really helps me when patients go along with filling out the forms, seeing the nurse, etc. Systematic care really does improve health outcomes,” he said. “It’s not all about the doctor anymore.”