As the new chair of the Discipline of Family Medicine, Dr. Bob Miller wants the discipline to maintain its focus on people. "I have problems with primary healthcare reform concepts because they are looking at management strategies that are more like corporate strategies and are not focussed enough on the individual. I don't want to see family medicine go that way."
Dr. Miller grew up in northern Ontario, and earned his medical degree from the University of Western Ontario in 1972. He did a one-year rotating internship at the Royal Columbia Hospital in New Westminster, B.C., then returned to Ontario to join a practice in Cambridge. During that time he was involved in teaching medical students and family medicine residents. He continued this academic interest when he moved five years later to Sharbot Lake, a small community north of Kingston, Ontario. As a part-time faculty member at Queen's University, he became increasingly interested in an academic career, and in 1983 he joined the Discipline of Family Medicine at Memorial University.
Before moving to Newfoundland permanently, Dr. Miller enjoyed one memorable three-month locum at Baie Verte in the summer of 1975. "It was the summer of the century people were actually coming to hospital with sunburn! Then, when I was looking for an academic career, I knew that Memorial had developed a reputation as a good rural family medicine place, which is where I always saw myself. And when I came here and met (Drs.) John Ross and John Lewis, it was a natural fit."
When he first came to Memorial, Dr. Miller thought that if anywhere in the country could teach Canada how to change primary care practice it would be Newfoundland. "Then the province got into regionalization and shut down a lot of hospitals. The way in which it was done didn't leave anything for many communities. We need more places like the Whitbourne Clinic, where there is a sense of a community health centre that provides a certain level of service. If you downscale it too much, everyone leaves."
Dr. Miller uses the analogy of the Mom-and-Pop store to describe his value system, as opposed to the "big box" system represented by large stores like Canadian Tire and WalMart. "In terms of primary health care reform, the talk is more and more about the 'big box' but when people are sick and need individual help, they are looking for Mom-and-Pop stuff. If we go too far one way we won't be able to go back maybe that's why I feel I need to get involved in administration, in what's going on across the country, to have an impact on where this whole primary health care reform is going."
Along with colleagues from family medicine, psychiatry, and the University Counselling Centre, Dr. Miller is involved in the Rural Mental Health Education and Consultation Project, a pilot project designed to enhance the educational opportunities in mental health care for professionals in the Twillingate area of the province. The project uses the technology of video-conferencing, Web page resources and a self-help library.
"The rural nature of this province is an advantage to us educationally. We're masters at distance education technology and there are lots of areas in which we can grow. We need to be involved in preparing our students to work in health care teams, and we need to do research to know how to do this effectively both in urban and rural settings. Memorial can do the research because we have the identified small communities to see how these teams work in isolated communities. We need a groundswell of support to get the funding to research this."
Another issue that Dr. Miller is passionate about is that medical students should choose or should not choose family medicine as a career for the right reasons. "They might be turned off because of media attention to negative aspects such as remuneration packages or call schedule. But I truly believe the positives outweigh the negatives and family medicine can be a phenomenal career choice. It's not a 9-to-5 job, it's a major commitment that doesn't stop at 5 p.m. People are born and people die, that's what it's all about. You have to be willing to be there."
Doctors do burn out, and Dr. Miller said it may be that the age of the family doctor being everything to everybody has gone by. "We're now talking about groupings of family doctors in practice so the patient can get to know someone over period of months. At the very least we have to have a way of practice where the patient sees service is being provided by a recognizable entity. I have no problem with team approach that is neighbourhood based and I prefer the concept of salaried medicine to fee-for-service."