N.W.T. doctors say pay hike for locum physicians a good start

The Northwest Territories Medical Association says it is pleased the territory is increasing pay for locum physicians, but that the size of the increase will determine how effective it is.

The N.W.T. Health and Social Services Authority (NHSSA) announced on Wednesday it will boost pay and introduce new incentives for locum doctors starting June 1, including long-term bonuses, travel stipends, and night shift premiums.

The announcement came after warnings from physicians about crisis-level staffing and possible ER closures at Stanton Hospital in Yellowknife, along with calls to urgently raise locum ER pay.

The health authority has not disclosed how much more it will offer but says it aims to be more competitive nationally.

"This is a national marketplace for physicians. We don't have enough emerge docs, or really any physicians, in Canada," said Dr. Courtney Howard, president of the N.W.T. Medical Association and an emergency room doctor.

"So it will just depend on the relative change with regards to our competitor jurisdictions."

Howard says it would help if the amount of pay increase was made public to get the word out, especially as staffing shortages are anticipated until at least August.

"People have already booked a lot of shifts and are booking quickly," Howard said.

While calling the move a good short-term step, Howard says doctors still want to know the contingency plans if there are closures. Officials have said that closing the ER at Stanton is not an option. 

"OK, well, what is the backup plan?" Howard asked.

"Because the doctors in the territory right now are looking at that schedule and have not been informed of any backup plan."

Other incentives

Howard says the premium for night shifts has also been a long time coming, as the territory currently doesn't pay extra for night hours.

She also says the structure of the long-term bonuses is not optimal. For example, the long-term locum bonus is paid only after 75 clinical days.

"I think some other jurisdictions offer sort of a signing incentive to get you to commit and then finish off with the other part of the incentive at the end of the time period," Howard said.

She's also unclear about the travel stipend. She wants to ensure the policy doesn't penalize those traveling farther or to remote communities.

"Does this penalize people who are coming from farther away? For instance, we get a lot of locums from Vancouver and also some from Toronto. Now with the direct flight, it takes half a day to get here from Vancouver, but a full day to arrive from Toronto," she said.

Howard says retention of physicians will be important in the long-term. 

"We know care is best provided by people who know their patients, who know the system, who know and love the territory."

Health Minister Lesa Semmler says health systems across the country are in crisis, and her department is working on various long-term reforms to improve primary care in the territory. That includes a focus on team-based clinics. 

Her team briefed the legislative assembly's social development committee on Thursday about the framework for reforms aimed at equitable care.

"Only 59 per cent of N.W.T. residents aged 18 and older have reported having access to regular health providers in 2023, compared to an average of 84 per cent in Canada. Indigenous residents face even worse gaps," Nina Larsson, director of community, culture and innovation, told the committee.

The reforms will roll out in four phases through December 2025, including research, site visits, and community engagement.

'A lot of talk,' MLA says

Range Lake MLA Kieron Testart expressed frustration at Thursday's briefing, saying he wants to see results. 

"We're just not seeing actions yet. We have a lot of talk. We don't have anything concrete," Testart said.

He said working toward more equitable medical care is important, but it won't matter much if the territory doesn't have enough health-care staff to provide that care in communities. 

"That's how dire it's getting," Testart said.

Dan Florizone, public administrator of the health authority, said Stanton Territorial Hospital often feels overwhelmed. But he says that adding resources is only a short-term strategy.

"What we need to do is uncover what's the root of the problem," Florizone said, pointing to the territory's aging population and rising chronic disease rates.

"Our supports at home or as close to home as possible… have gaps in them," he said.

He says patients can end up travelling from health cabins, to health centres and to the hospital. He says building better infrastructure and technology in the smaller communities will reduce dependency on travelling to Stanton. 

"If we could avoid the crisis that created the conditions where people need to travel to Stanton, where they need to visit the emergency department, that's key," he said.