After working almost every day for 13 years, Dr. Christopher Giede does not really know what to do with all of his free time. He plays guitar and feeds his pet sheep, but can not stop worrying about his cancer patients.
These worries seep into his dreams: "Are your patients being taken care of in their absence? Do they think he's abandoned them?"
In September, the 55-year-old gynecological oncologist was licensed.
"I'm physically sick and I can not carry the load," Giede said during an interview at his home near Saskatoon. "There has been a lot of psychological stress in the past couple of years, and that did not help with physical stress."
The only other gynecological oncologist in Saskatoon, Dr. Anita Agrawal, quit her job in December. She told CBC News that she was "exhausted" and tired of asking for support. She took a job in Ontario.
The situation in Saskatoon is being replicated in other smaller cities across Canada.
Kingston, Ont., And Sherbrooke, who, for example, have had difficulty recruiting and retaining gynecological oncologists, especially in the midst of a national shortage due to retirements, disability licenses, international competition, and increasing demand for a according to the Society of Gynecological Oncologists of Canada.
Specialists are often drawn to departments in large centers with larger teams and more resources. In both Calgary and Winnipeg, for example, there are five gynecological oncologists on staff, and each of them stays on duty every five weekends. In Toronto, 21 specialists share the workload.
Do you feel in danger?
Saskatchewan is losing three of its four gynecological oncologists by June of next year; two in Saskatoon and one in Regina.
A gynecological oncologist is a highly trained specialist who treats ovarian, cervical, uterine and vulvar cancers.
It is a unique specialty in which gynecological oncologists not only perform complex surgeries, they also herd women through the entire process of treatment with chemotherapy and post-operative care.
"We become very attached to our patients, and vice versa, they cling to us," Giede said.
Kimberly MacKinnon, an ovarian cancer patient, received treatment from both experts and is not comfortable with the arrival of loops in Saskatoon, Ottawa, to take care of her case.
"How do they know my case? It's devastating and scary. You feel in danger," she said.
In October, the Saskatchewan Cancer Agency sent patients a letter informing them that Saskatoon was losing its two specialists; Dr. Giede was on indefinite leave and Dr. Agrawal was leaving the practice in early December.
A subsequent statement from the Saskatchewan Health Authority said that the specialists were leaving for "personal reasons."
This is misleading, say the two physicians, because their reasons are work-related.
Giede said he is asking the health region to hire a third gynecological oncologist and add other clinical support for at least six years. He warns that the province's promise to "aggressively recruit" replacements is ill-fated, unless workload issues are resolved.
Each year, another 240 women are diagnosed with reproductive cancer in Saskatchewan. The waiting time for a cancer hysterectomy is approximately four weeks, along with Ontario, according to data from the Ministry of Health of both provinces.
The prairie province is in a chronic dilemma about the staff of experts enough to avoid burning. Its small population of 1.12 million people only guarantees – in theory – a number of experts in any field.
However, patients are spread over large distances, and timely access usually requires care in Saskatoon and Regina. Experts need a certain critical mass to maintain a balance between personal and professional life.
When Giede took a job in 2005 as the only gynecological oncologist in Saskatoon, he was on call 24 hours a day, seven days a week. The arrival of a second gynecological oncologist, Dr. Anita Agrawal, in 2008 provided some relief.
Still, the two doctors shared what they called a "one-by-two" workload – that is, each had to stay on duty half of each month in addition to their normal clinical practice. If one took a vacation, the other covered 24/7.
It was not unusual for Giede to be called out of bed in the middle of the night to see a patient on febrile chemotherapy in the emergency room, to sleep a few hours in the hospital, and to have a radical four-hour hysterectomy that day.
"I knew when we were getting tired when we were discussing who was working the most, and it was a silly argument because we were working more than a full-time position," Giede said. "We needed each other and we need to work well or we would have collapsed a long time ago."
As academic physicians, they should also do research, teaching, and administrative work.
"You're giving bad news all the time"
Doctors began sending out e-mails and letters requesting a third gynecological oncologist in 2012. Their frustrations intensified when, in the same year, the health region did not hire an anxious young doctor who had been born and raised in Saskatoon and was looking for a job in the city.
"I love Saskatoon, and it drew me there," said Dr. Sarah Glaze to CBC News. She confirms that she has had several meetings with the university and health region, but without any job offers, she has finally found work in Calgary.
Giede was particularly disappointed that health officials did not create a position for her when it is proven that local doctors are more loyal.
Health officials have argued that the number of patients does not justify the addition of a third specialist.
Magic number of 3
A recently published report on national best practices, called the Pan-Canadian Standards for Gynecological Oncology, states that the magic number at any center is at least three gynecological oncologists. This reduces the surgeon's fatigue and improves patient care.
"The doctor's exhaustion is a huge problem," said James Bentley, president of the Society of Gynecological Oncologists Canada. "If you've been with two people for a long time, it's very tiring, we're dealing with people who are sick, you're giving bad news all the time, long surgeries, complicated chemotherapy regimens.
In Ontario, a hospital must meet this referral from three gynecological oncologists on the team to be designated a Gynecologic Oncology Center by Cancer Care Ontario.
Moncton, Halifax and St. John, all from the team of three gynecological oncologists, but have often proved challenging for these smaller centers, and others in Canada, to maintain that number of specialists.
There are 101 gynecological oncologists operating in Canada, with about 85 clinical positions, as reported by the National Society. Many of them only see part-time patients and also work in research, teaching or administration.
In Giede's case, he should supervise resident physicians over a full load of patients.
By 2015, the health region has finally given permission to hire a third specialist. However, Giede said that for three consecutive years, a potential candidate rejected his job offer because of the work environment.
Saskatchewan Health Minister Jim Reiter has ordered the health authority "to do whatever it takes to aggressively recruit" new gynecological oncologists.
A job advertisement promises $ 467,000 – $ 587,000 per year, plus a signature bonus of $ 30,000 with a three-year commitment to return service.
The health authority is also sponsoring two gynecological oncology fellowships, with about $ 200,000 each, in exchange for services in Saskatchewan – just as Giede did for nearly two decades.
"When you have a home doctor, there's a strong likelihood they're around," Reiter told CBC News. "In the long run, we think this will help with retention."
Giede said he is proof that fellowship encouragement is not enough, "if you let the person you trained burn."
In a face-to-face meeting with Reiter, Giede gave a speech to a minimum of three gynecological oncologists in Saskatoon and Regina, as well as clinical associates, locum filling, and first aid support from within the cancer agency.
The Health Minister has confirmed that there are no plans to centralize services in just one city and that a formal review of the program will occur soon. Recommendations can lead to changes in program structure and number of employees.
& # 39; We're holding on to us & # 39;
Last summer, the pain in Giede's neck reached the point where he was taking anti-inflammatory pills, lying down at work and going straight to bed when he got home.
Both Giede and Agrawal said they held out as much as they could, and did not plan their matches together.
"Our goal was to provide the best care we could with everything we had in spite of the environment," Agrawal said.
Giede will only return to the operating room if his health and work environment improves.
"No one wants a temporary solution. I'm confident the message has gotten there."