For more than two centuries, residents of a remote Canadian island in the north Atlantic knew they could count on a nearby doctor for relief of most ailments.

But this June, Fogo Island will lose the community’s only full-time physician, a trend mirrored in many of Newfoundland’s towns and villages as the region battles economic decline and a looming demographic crisis. The closest doctor will be a six-hour round-trip by ferry, subject to the vagaries of powerful maritime storms.

“When you consider it’s the first time since 1792 that they’ve been without a resident doctor, it leaves you gobsmacked and really hits home that there’s something bigger happening,” said Paddy Daly, host of the popular Newfoundland-based radio show Open Line. “This is something that’s been a long time coming. This didn’t happen overnight.”

Ever since its cod fishery collapsed in the early 1990s, the province of Newfoundland and Labrador has struggled to regain economic momentum.

But the province is also battling a demographic crisis, with deaths outnumbering births and an exodus of residents. In the recent national census, Newfoundland and Labrador was the only province in the country to see its population drop since 2016 and has struggled to retain the immigrants that arrive in the region. Among the hardest hit by the exodus were the smallest settlements, known as outport communities.

The lack of doctors has become emblematic of this plight, even inspiring the 2013 Canadian comedy The Grand Seduction. In a the film, the villagers of Tickle Head work hard to lure a doctor to settle in the community by putting on fake games of cricket and leaving money at the wharf.

After their physician left in 2021, residents of another outpost, Bell Island, tried to take matters into their own hands, launching the Bell Island Grand Seduction Facebook page, pleading with the region’s health authority to send Dr Firas Ayar back to the community.

“We do not want to trick, charm or hoodwink Dr Ayar into returning to Bell Island. We want this platform to be used to show him our love and respect and our desire to have him back in our community,” wrote resident Kenneth Kavanagh.

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The group eked out a small victory when Ayar returned on a short-term contract. But the broader trajectory of the region suggests these small wins will be rare – especially in communities with dwindling economic prospects.

“In a lot of these places, likely gone are the days when you had a family doctor who knew you and your children and their children,” said Daly. “And so people will have to think about whether they move to be closer to care, or whether they stay.”

Nearly 100,000 Newfoundlanders lack access to a family physician and Fogo Island’s recent loss of a doctor highlights the complicated realities of managing a shortage of healthcare professionals.

Island resident Sabrina Payne recently decided to sell her home and leave the islandafter long ferry trips to the mainland became too much when she was receiving cancer treatment.

“It took me a long time to make the decision, because I really loved the place,” she told CBC. “But ultimately my mental health was declining because it was – everything was a chore.”

The community, is home to one of Canada’s most expensive and famous hotels, whose guests have included the prime minister, Justin Trudeau, and Gwyneth Paltrow.

The Fogo Island Inn, where the cheapest stay exceeds US$6,000 – is also one of the biggest employers in the community. Shorefast, the company that runs the hotel, is a registered charity that says it invests all of its profits back into the community.

Daly suggested Fogo might be one of the few places with the resources and influence to successfully lobby the region’s health authority.

“In Fogo’s case, it might be that Shorefast plays a role in helping the community secure a doctor,” said Daly. “Because increasingly it looks as though the places will try to take matters into their own hands.”