The state of neurology services in Manitoba, particularly for multiple sclerosis, has been “a slow-moving train wreck” due to poor government management for years, but those services are now on the edge of collapse, says the acting head of neurology at the University of Manitoba.
For years, specialized neurologists have been leaving for opportunities in other provinces, but “despite endless briefing notes, letters and solicitations up to and including the deputy minister of health, there has been little meaningful response to address the problem,” Dr. Dan Roberts said at a Thursday news conference.
“We are now at a point where, because it’s been very difficult to recruit replacement physicians … we face the closure of [the U of M’s multiple sclerosis] clinic within as little as 90 days.”
He said he called the news conference “out of a sense of desperation.”
Just prior to the pandemic, Roberts said he was asked by the head of the U of M’s department of medicine to take the lead in helping to advance neurology in the province. That was precipitated by a number of neurologists leaving the city for better opportunities elsewhere, he said.
Just over the past two-and-a-half years, the province has lost two physicians who were providing much of the volume of care in the MS clinic, with another departure impending, he said.
“Allowing the closure of the MS clinic would be disastrous and would have repercussions in neurology for other disciplines, including stroke neurology,” affecting the lives of thousands of Manitobans, Roberts said.
“This fiasco was entirely predicted and was easily avoidable.”
Immediate support is needed from Shared Health and the government to prevent that from happening, Roberts said.
“Over the next year or so, we have a need for the recruitment of somewhere between eight and 10 neurologists, mostly with subspecialty skills in MS and in acute stroke.”
There are nearly 3,000 patients with multiple sclerosis who rely on the MS clinic and scores of acute stroke patients every week who depend on rapid assessment and timely intervention, said Roberts.
In order to deliver care to the number of patients who rely on the MS clinic, about 23 half-day clinics need to operate every week. Right now, only 13 can be done, he said.
With the impending departure of another physician, that number will fall to eight half-day clinics a week.
“That becomes just unsustainable,” Roberts said, adding wait times for MS patients will soon exceed a year.
READ | Dr. Dan Roberts’s announcement of Thursday news conference on ‘desperate situation’ for neurology:
Speaking at a separate Thursday news conference, Dr. David Matear, the director of Manitoba’s surgery and diagnostic backlog task force, deferred concerns about increasing wait times to Manitoba Shared Health.
In an email to CBC News, a Shared Health spokesperson acknowledged the challenges at the MS clinic.
The province is in the midst of “bolstering staffing,” with recruitment for an additional MS neurologist in its final stages and recent approval to create an additional nurse practitioner position, the spokesperson said, adding an increase in the clinical stipend for MS physicians has been approved, which should help with retention.
But Roberts said the nurse practitioner position took six months to approve, and that only happened after the existing one left on maternity leave.
And while the stipend for MS physicians is welcome and essential, they are also sorely needed for stroke neurologists, he added.
Desperate for stroke neurologists
Over the past 25 years, therapeutic advances in neurology have improved the treatments for epilepsy, multiple sclerosis, cerebrovascular disease and acute stroke, Roberts said.
That has also led to the need for specialist neurologists in those disciplines.
The situation facing the MS clinic also occurred with epilepsy management, Roberts said.
“We now are in a situation where the waiting lists for EEGs [electroencephalograms, tests that detect abnormalities in the brain’s electrical activity] will continue to grow over the next two years, and we have no recourse but to wait.”
The province recently signed an agreement with the British Columbia Institute of Technology to open two EEG seats for Manitoba students, but it takes two years to train EEG technologists.
Meanwhile, the waiting lists are doubling every 15-20 weeks because EEG requests can only be accommodated at this point for intensive care units and emergency departments, not for someone who might need a diagnostic assessment for epilepsy, he said.
As a result, some epilepsy and MS patients are seeking care at emergency departments, said Roberts.
“Those are the inevitable consequences of denied access to diagnostic and therapeutic services.”
Although the government has nearly completed construction on a new epilepsy monitoring unit and a 28-bed stroke in-patient unit, it has yet to approve operating budgets to recruit more neurologists to staff those facilities, he said.
Right now, Manitoba has just four stroke neurologists and one of those is required to be on call every night, to be available within 15 minutes of a patient arriving in the emergency department, according to Roberts.
“We are now looking at the prospect of having to man a new 28-bed stroke unit, and that will increase call responsibilities by a factor of two,” he said.
That means the number of stroke physicians needs to double, he says.
“We also need to retain the ones who are here. So what was initially a recruitment problem has now become a desperate situation requiring urgent intervention.”
In its email, Shared Health said it has recruited two epileptologists — neurologists who specialize in caring for people with epilepsy — two stroke neurologists and a cognitive neurologist in the past 18 months.
“Additionally, physicians have been recruited to support in-patient work in neurology and stroke care, providing important patient care while freeing up some specialist care for more services,” the email said, and efforts to recruit are ongoing.
“We acknowledge this will take time due to the very specialized nature of many of the open neurology positions but we remain very much committed to the process.”
Roberts challenged those Shared Health claims, noting he accounted for the new recruits when he said there eight to 10 more are needed.
As for the support for in-patient work, that is one medical officer — and it only came after the neurologists unilaterally withdrew service from half their designated in-patient beds “out of safety concerns and sheer exhaustion.”
The moves by Shared Health came two years after the initial request, “and too late to avert disaster which was predicted well in advance,” Roberts said.