Up along the Cabot Trail, nestled within the forests and mountains of Cape Breton Highlands National Park, three physicians are working together to provide comprehensive family medicine for their community.

Drs. Nicola Smith, Rebecca Hoffer and Carly Crewe work in the small fishing village of Neil’s Harbour, about 2.5 hours from Sydney, Cape Breton, and about 5.5 hours from Halifax.

Along with providing outpatient care at Highlands Medical Clinic, the physicians also staff a 24/7 emergency department (ED) and 10-bed inpatient facility at Buchanan Memorial Hospital, and provide medical care at the local long-term care facility.

Serving the communities from Cape Smokey to Meat Cove, they care for between 3,000 and 3,500 patients through the clinic, as well as tourists that visit the ED. It’s an older population with a high burden of chronic disease, and the remote location means that teamwork is vitally important.

“We have incredible clinic support from Shelby Burton (NP) and Makayla Buchanan (FPN), who just so happen to be sisters,” said Dr. Hoffer. “as well as Margaret (Hawley) Rideout and Debbie Buchanan, our administrative staff. We recently had one of our nurses, Janice Hayden, train to be a nurse prescriber, and a new NP, Afton Jette, started in September.”

“While the current physicians are from away, most of the nurses were born and raised here,” said Dr. Hoffer.

That local connection is vital. “The nurses often fill us in on who is related to whom, what their connection is with other patients, and entertaining anecdotes that would be well known to those from the area. It’s not unusual to have people who are related to each other both admitted to hospital or in the ED at the same time – which can sometimes make for lovely family gatherings, and other times, family feuds!”

Knowing the community depends on the hospital also empowers everyone working there to keep the emergency department open every day of the year.

Bad weather is always a wild card in this remote community. In 2021, the road between Ingonish and Neil’s Harbour was swept away in a flood, which meant that many hospital personnel had to either commute the long way (a three-hour drive) or go by boat or helicopter. They persevered and kept the hospital open. The physicians also credit recurrent locums (notably Drs. Tim Woodford, Luke Harnish and Tom Currie), for helping keep the ED open year-round.

Despite the challenges, the physicians say that working together in a small community has definite perks. They value the long-term relationships they’ve developed with their patients and fellow community members.

“Our patients might also be our neighbour, our mailman, or our kid’s bus driver or teacher,” said Dr. Hoffer. “Several of my patients are in the book club that I’m part of.”

Providing care in the clinic, ED and the inpatient unit allows the doctors to truly follow patients throughout their life journeys. “We might see a patient in clinic for a routine prenatal appointment, in the ED if they go into labour, and then months later when that baby develops a rash. We might see that same woman when she brings her husband to the ED with a fishing injury, and then a few days later, visiting a grandparent receiving palliative care on our inpatient ward.”

All three physicians say they chose rural family practice because they are generalists at heart, deriving great satisfaction from the diversity of their work. But working on a collaborative team also allows them to explore their own interests.

Dr. Crewe has a special interest in mental health and provides dedicated appointments for psychotherapy, while Dr. Hoffer enjoys complex chronic disease management. Dr. Smith, who loves teaching, regularly takes on medical students and residents; as a result, Neil’s Harbour is now a popular destination for trainees.

Their remote location means they aim to provide as much care as they can in the community. “This often means going outside our comfort zone in terms of procedures or management of conditions,” says Dr. Hoffer.

Dr. Smith, originally from Dartmouth, has worked in Neil’s Harbour for nine years; she joined the practice for the opportunity to work with the legendary family physician Dr. Ken Murray. He also recruited Dr. Hoffer, who is from Montreal and had spent time working as a locum in communities across Canada before settling in Cape Breton. Dr. Crewe, who is from Ontario and trained in Alberta, joined the practice in 2022.

The make-up of this practice has made it particularly supportive. “For the last few years, following the retirement of Drs. Murray and Buffett, all our physicians have been women with young families,” said Dr. Hoffer. “We strive for work/life balance, as much as is possible with a busy call schedule, with a mutual understanding of the difficulties that can come from being both a parent and a physician.”

Their collaboration applies at home, too. Dr. Hoffer and Dr. Smith live next to each other and share the joys and difficulties of rural life. “My husband might go out with the chainsaw if a tree falls down and blocks our shared driveway,” said Dr. Hoffer, “while Dr. Smith’s partner often comes by with gifts of eggs from their free-range chickens.”

Looking ahead, Dr. Crewe will be leaving the practice in late 2024, which means Highlands Medical Clinic is seeking two more physicians to complete their team. They encourage family physicians interested in joining their dynamic practice to get in touch: manager@highlandsmedicalclinic.ca.

Note: This story was originally published in the October 2024 issue of doctorsNS magazine

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