Profile: Dr. Nicole Ebert, GP Obstetrician, Vanderhoof, BC

Dr. Nicole Ebert, GP Obstetrician

Dr. Nicole Ebert serves the town of Vanderhoof, BC, population 4,600, and the surrounding community. She owns a share in the Omineca Clinic, along with 14 other family physicians, and is one of the community’s seven GP Obstetricians (GP OBs). In addition to her obstetrical skills, Ebert is one of four physicians with the skills and hospital privileges to perform Caesarian sections. Her practice, though unusual, is one of the mainstays of rural maternal healthcare in Vanderhoof and the surrounding region.

Obstetrical service in Vanderhoof is exclusively provided by Ebert and her colleagues. Vanderhoof is well set up for surgery so medical evacuations only occur if the situation is extremely complex or if the baby is earlier than 36 weeks. “We’ve delivered twins here and had breech deliveries, and we do VBACs (Vaginal Births After C-section),” says Ebert. “We’ve got great back up in Prince George. You can call the specialist and say ‘this is what we’ve got – what do you think?’ We usually do the procedure with their blessing, depending on what’s going on.”

Ebert and her colleagues also support the communities of Burns Lake, Fraser Lake, and Fort St. James, along with local First Nation communities. Pregnant women travel from their communities at 28 weeks for their first pre-natal consult. Those who need to be monitored more closely continue to travel to or are lodged in Vanderhoof; otherwise, women will return home and come into Vanderhoof when it is time to deliver, and then again for their six-week post-partum exam. Omineca’s GP OBs work with local public health nurses, and nurse practitioners in the smaller communities to ensure patients and their babies are cared for between check-ups. “Vanderhoof is lucky to have GP Surgeons and GP Anaesthetists on 24 hour backup so there is always someone to turn to in a difficult situation,” says Ebert. “This team approach is a direct outcome of Northern Health’s MoreOB program. This phenomenal program trains all nurses and physicians involved in obstetrics work,  and has provided consistency and stability for rural obstetrics service.”

Ebert received her C-section surgical training in a roundabout fashion. After finishing her residency, she traveled to Tasmania for a year, where she trained in obstetrics for six months and learned C-sections. When Ebert first moved to Vanderhoof 15 years ago, she continued to perform the procedure under supervision, eventually posting the requisite number of procedures to operate on her own and earning hospital privileges.

With only one program in Canada currently offering C-section training to GPs, Ebert admits “there’s worry for the future of rural GP obstetrics because there isn’t an easy pathway to gain enhanced skills.” Additional pressure has been brought to bear now that the pool of trained GP OBs from South Africa is no longer available. “Lots of people have been interested in doing C-sections, but haven’t been able to get training. It’s hard – you have to find a specialist who’s willing to train you.”

One of the biggest challenges in recruiting GPs to obstetrics, Ebert observes, is the reluctance of many new graduates to enter into obstetrics.  Some feel they need more training in obstetrics than current family medicine programs provide and others are concerned about the lifestyle demands of an obstetrics practice. Her advice for aspiring GP OBs just beginning their practice is to find a community with enough volume and experienced backup to develop skills and knowledge. As for balancing the demands of obstetrics and family life, Ebert admits that the process can be tricky and that GP OBs need to be accepting of their unpredictable work. “Inevitably, you’re going to have a delivery during your son’s birthday party or at Christmas, and you might be gone eight hours if you have a C-section to perform. You need to be okay with that.”

Ebert notes that a GP OB practice can be heavy, especially in years where there are a large number of deliveries. “Nothing else stops. The births are just added on top of your normal workload.” However, because of the large number of physicians in the Omineca Clinic, the members of the practice are able to cover for each other, allowing every doctor to take a recommended 10 weeks of time off. “Luckily we don’t usually have to go outside of the clinic to find holiday coverage as locum availability as can be a problem. We’re very supportive of each other and Northern Health is very supportive of us. We try to see as many patients as possible so that people aren’t waiting a long time for care, but in a way that’s sustainable, so that everybody benefits.”

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