Nunavut

Nunavut has a population of 39,000, spanning 2 million square kilometres across 25 fly-in communities in 3 time-zones. Healthcare provision is overseen by the Department of Health in Iqaluit (the capital) but is split into 3 health regions: Qikiqtaaluk (Baffin/east), Kivalliq (central), and Kitikmeot (west). The population in Nunavut is primarily Inuit, with the exception of Iqaluit (60%).

Qikiqtaaluk region

The Qikiqtaaluk region has the territory’s only hospital—the 35-bed Qikiqtani General Hospital in Iqaluit. The hospital serves approximately 16,000 people in the Baffin region. It has a 24-hour ER, GP-obstetrics (low to moderate risk), midwifery, inpatient/hospitalist service, general surgery, colposcopy, pediatrics, tuberculosis specialists, and clinics. Various other specialists visit regularly from Ottawa.  QGH has a laboratory, inpatient pharmacy, x-ray, ultrasound, and a CT scanner (as of 2014). It has over 20 full-time physicians, in addition to senior family medicine residents from Memorial University of Newfoundland’s NunaFAM program (6 month rotations) and University of Ottawa (2 month rotations), and senior pediatric residents from University of Ottawa (1 month rotations).  Furthermore, QGH has allied rehabilitation professionals on site to serve both the community and inpatients.  Across the street from QGH is the Akausisarvik Mental Health Treatment Centre, which has visiting psychiatrists from Ottawa and provides regular counselling services. Public Health for Nunavut is also based in Iqaluit.

Other communities in the Qikiqtaaluk region include: Arctic Bay, Cape Dorset, Clyde River, Grise Fiord (northernmost civilian settlement in Canada, on Ellesmere Island), Hall Beach, Igloolik, Kimmirut, Pangnirtung, Pond Inlet, Qikiqtarjuaq (Broughton Island), and Resolute. These communities do not have a full-time physician living in the community. They do have visiting physicians, generally from the group at QGH, who visit for approximately a week at a time. When there is no physician in the community, the nurses in the health centres receive phone support by an on-call physician at QGH.

The main referral centre for this health region is Ottawa, if too complex to be managed in Iqaluit.

Kivalliq region

The Kivalliq region has no hospital, but the Rankin Inlet Health Centre does have a few inpatient beds with 24-hour nursing for uncomplicated or respite patients. Rankin Inlet has 2-3 full-time doctors who work on a consult basis. Nurses see patients first, and physicians are consulted as needed. Rankin Inlet has 1 physician working 24 hours for Emergency, with a second physician as backup. When not doing ER, physicians will be in clinic. The Rankin Inlet Health Centre has a laboratory (for many common labs), intermittent ultrasound service, x-ray, and a midwifery service for low-risk obstetrics for the entire Kivalliq region. It also has a regular schedule of visiting specialists.

Other communities include: Arviat, Baker Lake (geographic centre of Canada!), Chesterfield Inlet, Coral Harbour, Naujaat (Repulse Bay), Whale Cove, and Sanikiluaq (in Hudson Bay, off the coast of Quebec and Northern Ontario, the southernmost community in Nunavut).  Arviat has a population of approximately 3100 which has recently surpassed the population of Rankin Inlet, due to the high birthrate. For most weeks of the year, there is a solo physician in Arviat working together with the health centre nurses. Baker Lake has a solo physician working with the health centre nurses approximately 75% of the year. The other communities have visiting physicians approximately 1 week at a time, every 6-8 weeks. When there is no physician in the community, there is a regional on-call physician who assists the nurses by phone.

The main referral centre for this region is Winnipeg. However, given frequent bed shortages in Winnipeg, sometimes patients will have MedEvacs to hospitals in other cities, such as Thompson, Churchill, and Selkirk.

Rankin Inlet, Baker Lake, and Arviat have community pharmacies, but the other communities do not. In these communities, medications need to be flown in when prescribed.

Kitikmeot region

This is Nunavut’s least populous region, which also does not have a hospital. Cambridge Bay is the hub (has its own low-risk midwifery service), with the other communities being Gjoa Haven, Kugaaruk, Kugluktuk, and Taloyoak. All of these communities rely on visiting doctors (no full-time). On-call physicians are available by phone to assist the nurses when there is no doctor in the community.

The main referral centre for this region is Yellowknife. However, more complex patients will be sent further to Edmonton.

Billing

If working as a solo physician in a community, the rate is $1500/weekday plus after-hour callbacks ($150/hr). Weekends are $600/day plus all callbacks ($150/hr). Housing and travel is provided for locums. Some of the communities have a physician house for locums, others rely on hotel rooms. If staying in a hotel, food is provided. Travel days up to 3 days per locum period are paid at $600/day. Per diem expenses during travel are also paid as per government employee rates.  A medical license costs $200/year, which is not reimbursed. One must be eligible for FULL unrestricted licensure in other provinces in order to qualify for working in Nunavut. There are no provisional licenses here.

If working in a community with more than 1 doctor, the rate is $1200/day for clinics. Rankin Inlet pays $1500/24 hours to be on-call, with callbacks billed after 17:30 at $150/hour. Backup in Rankin Inlet pays $600/24 hours plus all callbacks at $150/hour. ER in Iqaluit pays $175/hour. OBS in Iqaluit pays $2500/24 hours. Hospitalist pays $1400/day. Anesthesia pays $2000/day. There is no fee-for-service pay structure.

There are no overhead expenses, beyond your medical license and CMPA.

If working full-time (220 days per year), the government will pay for moving expenses to/from Nunavut and they will subsidize rental housing. This would also qualify you for a Northern Allowance of $60-80,000 per year in addition to retention bonuses. They also pay for some CME every year, including travel. Keep in mind that taxes are also the lowest in the country.

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