For Kentville anesthesiologist Dr. Rob Doyle, healthier people mean better surgical outcomes and less pressure on an already strained health-care system

Anesthesiologists like Dr. Rob Doyle may not be the doctor most patients remember after surgery, but they are essential to keeping operating rooms and intensive care units (ICUs) open at hospitals across Nova Scotia.

Magicians of medicine, anesthesiologists are the doctors who put you under for surgery, suspending you for a time in the grey area between life and death. They monitor your vital signs and keep you breathing during the operation, administering medications and watching the machines.

“We induce a coma that’s one step above death,” said Dr. Doyle, who is head of the department of anesthesiology at Valley Regional Hospital in Kentville, in the Nova Scotia Health Authority’s (NSHA) western zone.

The unique role that anesthesiologists play in the hospital, and its direct link to patient care, is not well understood.

“The interaction I have with patients is brief, but fairly intense,” said Dr. Doyle. “They have to trust you that you’ll be the person who will help them get through that process.”

He finds the work incredibly rewarding. “There’s something very satisfying about having a patient wake up calm and comfortable after a long operation,” he said. “It almost doesn’t matter what happened in the interim.”

Born and raised in Kentville, he attended medical school at Saba University School of Medicine in the Caribbean. Completing his medical training outside of Canada meant he was considered an international medical graduate (IMG) when he returned to work in Nova Scotia.

Many IMGs struggle to secure a residency and find long-term work. However, building a connection early on with doctors at Valley Regional gave Dr. Doyle an edge. In medical school, he did a rotation with the anaesthesia department. He went on to do his residency at Dalhousie, partly funded by the district. He and his wife, and their two young children, now call Port Williams their home.

Consulting patients is a key part of the care Dr. Doyle provides. Before surgery, he meets patients to discuss their medical history, pre-existing conditions and concerns.

It’s not just about ensuring each person makes it through surgery – it’s about making sure it won’t make them sicker. Following any surgery, patients are at a higher risk of heart attack or stroke for several weeks, even if they’ve had no complications. “If you’re not well enough to recover from the surgery, we may consider not doing it,” said Dr. Doyle.

Because he’s based in a regional hospital, Dr. Doyle said his job takes him to every department: pediatrics, obstetrics/gynecology, orthopedics, oncology, urology and more. “Everything but heads and hearts, which are done in Halifax.”

Valley Regional serves people from communities in the Annapolis Valley, so it’s important to provide a range of surgeries – everything from tonsillectomies to bunion removals.

However, in recent years the hospital has been focusing on providing arthroplasties – hip and knee replacements – for patients from across Nova Scotia. It currently does more joint replacements per year than the Moncton Hospital in New Brunswick. While this benefits patients who need a new joint, it’s not such good news for local patients who need other surgical care.

The high demand for joint replacements means Valley Regional’s five operating rooms are always booked. “We can’t always accept patients who need semi-urgent care from a peripheral hospital. Our patient flow, OR capacity and in-patient beds are far below what’s needed to service our zone.”

For Dr. Doyle, it comes down to providing timely patient care. “If you don’t have access to the OR in 30 days for a cancer patient, you fall outside of recommended guidelines for care. For something like an elective C-section, you can’t go beyond one week.”

He worries that people in his community may face long commutes to other hospitals for surgery, which may become a barrier. “A lot of our patients have trouble coming across town to get their hernia repaired. Asking them to go to Yarmouth for the surgery is prohibitive for them.”

And it’s not just OR space that’s in demand at Valley Regional – it’s also anesthesiologists. There are currently nine anesthesiologists at the hospital (eight full-time and one part-time). The department needs two more to make up a full complement. “With our shortage, we’ve had to close an OR, which is 20% of our output,” Dr. Doyle said. “Everyone is working harder to pick up the slack.”

For him, that meant working 38 days in a row over September and October 2018 to cover his department and the ICU. “It’s very taxing on the body and on your family life. You want to be available, but after 25 days in a row, you feel like you’re being pushed down. It’s not a good work-life balance.

He’d like to recruit an anesthesiologist who can work in the ICU, which is also facing a physician shortage. “If we lose one more ICU physician, that ends our 24-hour coverage, which would be a major issue for the patients we serve.”

A nation-wide shortage of anesthesiologists makes recruiting to rural areas difficult. “Across Nova Scotia, physicians are often paid less than in the rest of the country,” Dr. Doyle said. “Saying this province is lovely only gets you so far. There are a lot of provinces that will pay you more.”

He’d like to see physicians playing a bigger role in recruitment, in order to ensure patients – and communities – get the services they need. “We can identify easily what’s needed for the job. Having someone recruiting for anesthesia, and me not being involved, it’s not as effective as it could be.”

In the meantime, he thinks a province-wide, pre-operative plan for all patients awaiting joint replacement could make better use of limited hospital resources (the average wait time is about two years for this surgery). “If patients are healthier coming to the surgery, they’ll have better outcomes. Hopefully the Nova Scotia Health Authority will push this initiative forward.”

Boosting patient access to family doctors is also important. “Our family doctors are overworked, and this carries over into my work,” Dr. Doyle said. “We’re dealing with the end stages of a lot of health issues. If a person is intervened upon at age 25, rather than at 60, they won’t need a foot amputation.”

For Dr. Doyle, it’s all about confronting the issues that make people sick in the first place. “What keeps me up at night is feeling like we’re in a hamster wheel – that we’re just putting a Band-Aid on a bigger wound. Maybe there’s a way we could help patients out in the long run. I feel privileged to have the colleagues and patients I have, but I know there are spaces where things can be improved in the system.”