Dr. Sarah Newbery, Marathon, ON (dgphoto.com) from:https://dialogue.cpso.on.ca/articles/small-town-practices
Dr. Sarah Newbery is a family physician who has worked in Marathon for the past 30 years. She has been involved with Northern Ontario School of Medicine (NOSM) in various capacities since its inception in 2002
She is currently Associate Dean of Physician Workforce Capacity. In this role she works to create connections across the health care system in Northern Ontario to support efforts to recruit and retain Northern Ontario’s future workforce. Part of her role includes supporting the development of the Rural Generalist Pathway at NOSM U.
She is a past president of the Ontario College of Family Physicians, was VP Clinical of the Northwest LHIN for several years before starting her associate dean role with NOSM U, has been involved in numerous Ontario and national committees and has been active with both the CFPC and Society of Rural Physicians of Canada. She has served NOSH as chief of staff for 16 of the past 30 years, handing over the reins to her very skilled colleagues a in 2020. Passionate about community-engaged health care, she works to advance equitable access to care for the people Northern Ontario, with a focus on rural and remote communities.
Sarah is the mother of two adult sons who are her heart’s delight and partner to Dr. Eliseo Orrantia, who is also a rural generalist family physician.
Martina Kelly is a professor in the Department of Family Medicine at the University of Calgary. She qualified in Ireland, later completed her Master’s on reflective practice in clinical placement learning in 2007, earned an ASME travelling grant to the University of Alberta in 2010, and she moved to Calgary in 2012. Her PhD comprised a series of qualitative studies, using a phenomenological lens, on the meaning of touch in clinical practice. In 2022 she received the AFMC–Gold Humanism Award as a leading investigator in the nuances of human connection.
“…my experience of rural family physicians at the time was that they were deeply connected to the community, that they made a difference not only in individual lives but in the life of the whole community, and that appealed to me.”
Martina Kelly : Hello and welcome to Medics Voices, where we talk to key opinion leaders in medicine and health. Today I’m taking with Dr. Sarah Newbery. Thank you very much for joining us.
I was really keen to talk to you because of your leadership and experience in generalism, and particularly rural family medicine. Let me begin by asking, what drew you to rural family medicine?
Sarah Newbery: What drew me to family medicine was my experience growing up. I grew up in this small community called Hazelton, which is the most northern point on the Yellowhead Highway in British Columbia. It’s mile zero to the Gold Rush in the Yukon, and my father was a family doctor there. We lived on the hospital grounds with a group of other family doctors and the local dentist and the local maintenance guy, and there was this whole community around the hospital, and a thriving community in the hospital context.. So, my experience of rural family physicians at the time was that they were deeply connected to each other and to the community…that they made a difference not only in individual lives but in the life of the whole community, and that appealed to me. I will say, though, that having grown up in this small place in the late 70s through the 80s, there were very few other professions that were visible to me. I knew teachers, I knew nurses, I knew a couple of dentists. At one point, I met a lawyer. I didn’t actually know what engineers did! So, when I thought about my options for work I saw few, but of the options that were visible to me at the time, being a family doctor really appealed to me and I’m so grateful that that’s the path that I chose.
MK: One of the things that really struck me most when I moved to Canada was how full scope general practice is here. For the international audience, would you mind explaining what that actually means or looks like in your day to day clinical practice?
SN: I’ve have spent 30 years of practice in the community of Marathon, it’ll be 30 years this summer. We are a small group of family physicians providing all the medical care. At the most we’ve had nine, and as a group of family physicians we have provided primary care services at the top of our scope. We do have a primary care team, but within the physician scope, we provide as much as we can. We provide all of the inpatient care locally. We cover the emergency department 24/7 all year long. We provide obstetrical services, chemotherapy under the supervision of an oncologist who works remotely. We provide all of the palliative care and addiction services collectively. And this is the reality of the majority of rural communities. Some physicians have an interest in one area more than others, so they might do more emergency work than obstetrical work, or they might do more addictions work than emergency work. There is a collective generalism in the context of the group of physicians, but really it does span the breadth of that work.
One of the things that also can feel a bit difficult to wrap one’s mind around when we think about the Northern Ontario context, and much of rural northern Canada, is just what it means to be rural. Marathon is on the North Shore of Lake Superior. It’s about halfway between Sault Ste. Marie and Thunder Bay. Sault Marie’s population is about 75,000, Thunder Bay is about 150,000, and Marathon with a population of 5000 is the largest community on the 700 kilometer stretch of road between Sault Ste. Marie and Thunder Bay, so when we are sending a patient out, it’s typically by air. The nearest larger center is just over 300 km away, and that degree of remoteness in Canada, when we’re talking about rural contexts, can sometimes feel quite unfamiliar to an international audience.
MK: For me that’s quite mind blowing, the distances are so vast. When I talk to students is they say they love the idea of rural practice, just like you mentioned at the beginning, because there’s that community where everyone gets to know each other, but they’re also scared of the thought of being the responsible physician, so far from what we think traditionally of as specialist care, although telemedicine has changed it a bit. So I was wondering if you could reflect a little about what’s that looked like that in your career…
SN: I trained in Northern Ontario so I trained for rural practice and had a handful of experiences during training where I realized how big that responsibility was, and how infrequent the big events were. In some ways maybe the lack of frequency is a bit reassuring because the likelihood that something big is going to happen today is small, but the challenge of managing that big thing when you’re not doing it every day can feel quite overwhelming.
I will share with you my first emergency shift as an independent clinician in Marathon. My first patient on that first shift was a child who had died in the night. They came in with absent vital signs, and I was completely overwhelmed. In some ways, mercifully for me, the child was already starting into a rigor mortis and had probably died a few hours earlier, so there was very little for me to do, except to console an intensely grieving family and support the paramedics. But, in that moment, it was the realization to me that, had that child come into come in two or three hours earlier, would I have known what to do? Could I have managed that? Who would I have called? What if I hadn’t been able to successfully resuscitate them? And that feeling was so overwhelming. I remember having a conversation with my one senior colleague at the time. There was a group of six of us who were new to practice, and we joined one guy, the only senior colleague in town. I remember physically crying on his shoulder. I don’t remember if he did this literally, or if it was just a feeling that he created, but I feel like he took me by the shoulders, stood me up a little straighter, and said “it will never be as hard again as it is in this moment, because it’s your first day and you’re new, and now this very hard moment is behind you and I will, and we will, always have each other’s back” It still makes me feel a bit weepy. So the experience of deep mentorship and collective community was very powerful and I feel like that is a thread that has woven through my career. That is interesting to me because, I think when we get into medicine, we often have had to compete to do that…we pursue it quite individually.. We have to pass those exams on our own as individuals. We compete for residency spots. There is this very individual approach to acceptance into medicine, and the pathway through medicine, and it can be really easy to forget that once you enter practice, it is very much a collective endeavor, and we need to be doing this work together. We need to support one another, and we need to have one another’s back, both in the community, but also in our current era, with real-time virtual support. We need to ask for help when we need it. We need to trust that people will pick up the phone when we call, and that we can support one another. It is actually far less lonely, I think, now in the age of virtual tools than it was even 30 years ago, but it was important that I reaslised that providing care in difficult circumstances is a responsibility that I’ve accepted as an individual, but that we can implement and deliver together. That was a really profound first day moment. I don’t think I could have put that into words on that day, but my reflection now after 30 years in practice, is the importance of feeling afraid and feeling committed together.
“I’ve been thinking a lot about rural generalism, and what I increasingly feel is a three stranded braid of continuity, comprehensiveness, and context, because what we do in primary care, but more broadly, as rural generalists in our hospital, in patients’ homes, wherever we find ourselves providing care, that context is so important…”
MK: There is a very strong spirit when I go to Canadian rural meetings, and I feel that sense of shared identity is very powerful. It’s a very powerful thing to experience, even as somebody who is not working in a rural context, but you really feel that sense of shared feeling that, we’ve got each other.
SN: Where it becomes hard for new graduates in particular, I think, is when they’re entering into a practice that maybe has been under-resourced for a period of time, and the clinicians still there may be feeling a bit burned out, or maybe feel like “Oh, thank goodness you’re here, I can step back.” but what we really need to do as seasoned clinicians with new clinicians in the community is to really lean in and support them well, even when we feel like it’s a deep dig to find the energy to do that. But, if we don’t, we won’t be able to retain them. They need to experience the support that many of us experienced when we entered rural practice and, when we can welcome new clinicians well and lean into supporting them and building community around them, helping them to feel like they too belong both in rural medicine and in our community in our group of colleagues, then we will have done something good in supporting them in their career, the way that I felt supported in mine,
MK: And I think you have done that through your work with NOSM. Do you feel that?
SN: I do. Let me come back to the geography for a moment. NOSM covers 850,000 square kilometers. We could fit four times the land mass of the UK into Northern Ontario, and if with the UK population, we’d have 240 million people in Northern Ontario, but we actually have less than a million. We have less than the population of the city of Ottawa or the city of Calgary. There’s one person per square kilometer in Northern Ontario, and the two campuses of NOSM University in Thunder Bay and Sudbury are 1000 kilometers apart, and so it can feel hard to have the sense of community and connection across the breadth of that geography, but I think I think that’s getting better, and at NOSM too, as we continue to use virtual tools well. And addressing the conversation about professional identity and how we support professional identity for our undergraduate learners and our residents in training who are finding a way to see themselves as clinicians of service to rural communities or indigenous communities or francophone communities in Northern Ontario, I think that conversation is becoming increasingly rich in ways that I hope will leave our learners feeling supported in whatever path they’ve chosen for Northern Ontario.
MK: It sounds like in the school in Northern Ontario, there’s a lot of attention to contextualizing the learner experience and saying that that variety and context is actually part of the joy of generalism. It’s like you’re reframing as a positive component , the type of doctor you can be,
SN: Its really interesting that you say that. I’ve been thinking a lot about rural generalism, and what I increasingly feel is a three stranded braid of continuity, comprehensiveness, and context, because what we do in primary care, but more broadly, as rural generalists in our hospital, in patients’ homes, wherever we find ourselves providing care, that context is so important for how we are able to maintain continuity for the expectation of comprehensiveness of scope and setting. I think NOSM is working hard to make sure that what we offer students is culturally safe and contextually relevant. I think , I hope, those two pieces will support our learners to feel like they can step out into practice in Northern Ontario, particularly in our rural and remote communities, and take their medical knowledge and their clinical skills and their collaborative and advocacy skills and leadership skills and apply them in a meaningful way in whatever context they choose in Northern Ontario, and really breathe life into how they serve and are of use to communities in the North, which feels exciting to me.
“…sometimes I think we do lose perspective, especially when we experience joy in our work. It was a rare day that work was something that I felt I had to escape and go and do my life. Work absolutely felt like an important part of my life, and something that brought me joy and satisfaction.”
Dr. Sarah Newbery, Marathon family doctor and Associate Dean, Physician Workforce Strategy, on being honoured with the Society of Rural Physicians of Canada’s 2024 Rural Mentorship Award.
MK: You’ve done a lot of leadership throughout your career, particularly more laterally, and this idea that as family doctors we often are leaders in our community. Is there something about being a leader in a smaller community that you might be able to share with the listeners.
SN: if I think about the local experience of my leadership experience in Marathon, I would say that there were two elements that really shaped how I see leadership in that context; one was in restarting obstetrical services. When we went to Marathon in 1996 the obstetrical program had closed and my colleague Rupa Patel and I took on restarting the obstetrical program, and that was maybe small “L” leadership but not a formal role. We dug in and rewrote policies and worked at training nurses and creating the environment with our other colleagues in which they would feel able to commit to providing obstetrical care. It was a really interesting process of trying to deeply understand what mattered to women and what mattered to the community and what we could be capable of as a group and as a clinical team. Th e obstetrical program continues now 30 years later. I think it’s one of the only obstetrical programs to reopen after being closed and be successfully sustained, and huge kudos to my colleagues who are still providing obstetrical care.
For me, when I was chief of staff, that was really important… finding ways of taking what mattered locally from the standpoint of quality of care, but understanding the value of collaborating across the region. So I worked with the tertiary center Chief of Staff, who was an orthopedic surgeon, Gord Porter, and we created something called the Northwest Chiefs of Staff Council, which brought together 12 hospitals across the 1000 kilometer geography, and brought together the 12 chiefs of staff of these small rural hospitals, together with the tertiary chief of staff, to talk about issues that mattered to each of our settings, and particularly how we access care in the tertiary setting; how we transport people in, how we repatriate patients back, what should the expectations of quality of care be, how do we manage critical incidents when they happen in between facilities, like somebody who’s transferred back inappropriately, or somebody who decompensates on the way, and that experience of taking a leadership role and trying to use it to make things better for other people in leadership roles was a really valuable one.
I think it really shaped how I understand leadership as service and leadership as trying to be of use to colleagues and of use to patients and communities, and so those two examples, the less formal leadership role that had impact on community service, and then a more formal leadership role that I think supported the region, feel like points of leadership that I feel really grateful for, and really glad to have been able to learn through,
MK: With such a busy life, on call, delivering babies, covering the emergency department, I’m pretty sure some people are freaking out and wondering, do you actually have a life? Do you have fun? What do you do? Could you tell us a little bit about a life outside medicine?
SN: So that is a question that I have asked my sons, who were raised in Marathon. Do you feel like we had an ok life? Was I too busy? I asked because sometimes I think we do lose perspective, especially when we experience joy in our work. It was a rare day that work was something that I felt I had to escape and go and do my life. Work absolutely felt like an important part of my life, and something that brought me joy and satisfaction. If anybody looked at hours spent, they would say, “Wow, your life was not very well balanced, because the number of hours you spent at work compared to hours at home feels quite skewed.” But when I think about what gave me energy, I often felt that the time that I spent at work was energizing and allowed me to come home and be a good mom, be a good citizen, be involved in the community and so ,from an “energy in and energy out” standpoint, it was a rare day that I felt that work took more than it gave back, and so I feel good about that. I do look back and think, wow, the reading list, the pile of books beside my bed, doesn’t go down very quickly. I’d love to spend more time reading. There are hobbies I’d like to pursue more as well, but I feel really rich in friendships. I feel like I’ve had lovely opportunities in our community, and I feel like work has not typically been something that I felt like I needed to escape, and I’m grateful for that. Maybe, you should interview my husband and my boys, they might tell a slightly different story about where they wish I had spent more time. But, I truly don’t look back with regret about how I have spent my time and I would say that one of the things about being a rural physician is that there is something about the role that weaves you so well into the community, and continues to feel really rewarding.
“…when the conversation is about access and rural practice- that we need to keep thinking about the boots on the ground, that need to be here to provide the hands on care that people need and will always need, and in a way that ensures that people understand the territory of patients’ lives…”
MK: And, I was wondering, does nature play a role in your career?
SN: Absolutely, and I’m grateful to my partner, Eli, who’s also a rural family doctor, who has ensured that we’ve gone out on a wilderness paddling trip every summer, so we’re unplugged and out in the bush somewhere. That has been wonderful. We have a small camp on the shore of Lake Superior where I probably haven’t spent as much time as I should have, but lots of paddling on the lake, lots of hiking, lots of time outside, and I do feel really grateful for the opportunity to live and to work in a rural setting that is surrounded by the wilderness, as opposed to an agricultural rural setting. Marathon is on the remote shore of Lake Superior, and is surrounded by a wilderness of water to the south and a wilderness of boreal forest to the north. I’m joining you today from Hazelton, where I’ve done a bit of locum work, and it is also surrounded by beautiful wilderness, and I think that there’s something really blessed about being able to look out the window and see trees and mountains and water, and I’m really grateful for that. It is a specific phenomenon of rural practice that is really wonderful,
MK: I’ve noticed in my colleagues that they have a real appreciation of nature- a connection, a spirit…
SN: Yes, it is good for our minds, it’s good for our souls, being able to connect with nature, I think helps keep us healthier, and that’s a wonderful thing. And, related to that, something that I think about a lot these days is about the combination of high tech and high touch, and in a world that feels like it’s moving quite quickly towards high tech and AI and virtual tools, which can be useful tools if we harness them well, we can actually provide more of the high touch care that I think benefits patients most, and which benefits communities most.
And I worry an emerging conversation about access when we don’t actually finish the sentence, which is “access to whom, for what, with what expectation of care in your community?” We can think about how we can use digital tools, not to create more virtual providers who live remotely from the community, but to better support the clinicians who live in the community, better support from specialists, to be able to reach out to colleagues more easily, and maybe to be able to provide some remote care when they’re not in the community. But I do think a lot about the importance of the clinicians who, to use Ian McWhinney’s term, both hold the map and are in the territory [of their patients lives], and I think one of the things that we risk in a conversation about access and virtual tools is that we risk pulling clinicians out of the territory when a big part of what makes us as individuals part of healing for people and communities is our ability to be walking in the territory with our patients.. I think about that a lot. I don’t have an answer but it is a point that I try and raise when the conversation is about access and rural practice- that we need to keep thinking about the boots on the ground that need to be here to provide the hands on care that people need and will always need, and in a way that ensures that people understand the territory of patients’ lives, and maybe that’s the last thing that I’ll share.
MK: Such a powerful note to end on. Thank you so much for chatting with me.
SN: Thank you so much for the opportunity.
