In late November, Dr. Marilyn Crabtree wrote a letter to Ontario Minister of Health Dr. Eric Hoskins on behalf of the Medical Staff Association of Winchester and District Memorial Hospital. Dr. Crabtree is the Secretary Treasurer of the hospital Medical Staff Organization. The letter was to outline the doctors’ concerns about a program designed by the government to allow new family medicine graduates to practice in groups with other family doctors. The program is the New Graduate Entry Program (NGEP) and the details are outlined here:

This is the text of Dr. Crabtree’s letter:

“Dear Minister Hoskins,

I am writing on behalf of the Medical Staff Organization of Winchester and District Memorial Hospital to advise you of the serious concerns this Hospital and its Medical Staff have regarding your Ministry’s “New Graduate Entry Program”. In its current form, this policy will devastate and possibly close the Winchester and District Memorial Hospital within the 3 year time frame of the current proposal.

Our Hospital is a vibrant and active facility. We have won provincial awards for our Maternity Care, for our eConsult program development and our small rural community raised millions of dollars just 10 years ago to fund the construction of our new facility. Our community is committed to its hospital and the services it provides to the entire Stormont, Dundas and Glengarry region. We also provide care to many patients from South Ottawa and to those from the severely underserviced areas around Cornwall as well. Unfortunately, we cannot function without full scope family practice physicians as over 65% of the physicians with admitting privileges are just that – Family Physicians.

In order to continue to provide the high quality care to patients that our communities have come to expect, we need to continue to recruit new Family Physicians who will do Emergency Room shifts, care for inpatients and provide OR assists and Obstetrical services. We have an aging physician demographic with 3 retirements in the last year and an expected 3 – 5 more in the coming 3 years. We must be able to recruit new physicians to take over the care of patients when our colleagues retire. These physicians may choose not to practice in a designated “underserviced area” and therefore would not be able to provide care in our hospital while working for 3 years in their community of choice.

To add to this issue, the number of patients each of our Family Physicians cares for is very large (1800-2400 patients per physician for those in practice for 5 years or more). We provide full scope office care in addition to our hospital work. Most of the physicians who do not plan to retire in the coming 3 years would like to be able to transfer part of their patient load to a new physician but again, without new graduates being able to take some of the load, our patients will continue to suffer from inadequate access due to supply-demand imbalances that can never be rectified.

We are writing to you and forwarding a copy of this letter of concern to our local media to raise awareness about the impact the “New Graduate Entry Program” will have on rural hospitals like Winchester and District Memorial Hospital and communities like those in Eastern Ontario. We hope to see this program eliminated as we see it as a poorly thought out plan to restrict practice and payments for new physicians who only want to contribute to the care and treatment of the ill and infirm of Ontario.


Marilyn Crabtree, MD, CCFP”

Dr. Crabtree’s letter caused quite a stir in her corner of Eastern Ontario because it foretold a loss of medical services. There was a view by some that she was fearmongering but, in fact, every word she wrote is true and thank goodness the Medical Staff of the Winchester and District Memorial Hospital was concerned enough to call out the Minister on a plan that was clearly not designed with smaller hospitals in mind. (The NGEP has many other flaws but, in this case, I wanted to focus on one particular problem.)

When I spoke with Dr. Crabtree, she did not seem entirely comfortable that she had upset people. It is only natural that a good doctor, used to helping people stay calm, balks at upsetting the community. It takes a lot of courage for her, and the Medical Staff she represents, to say very publicly, “This is wrong and we don’t support it.” The task of a good Medical Staff Organization is to raise awareness when the health of patients or a community might be affected. This is exactly what happened and the Winchester community now understands the impact some of the Liberal government’s plan for health care might have in their hospital and for their primary care.

Let’s hope the other community leaders are doing as good a job as the doctors to preserve the community health system they have all worked hard to build.

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