Doctors have serious concerns about how they can practise medicine effectively in the current health-care environment. Physicians in nearly every community, specialty and practice type across the province share similar concerns.
Many doctors enter medicine because they are called to help people. For them, being a doctor is a vocation, not just a career. They spend years pursuing the education and skills they need to care for the people in their communities.
But there aren’t enough doctors to meet the needs of patients in Nova Scotia, and the doctors that are working in the province are under stress. Since the province moved from nine local district health authorities to the centralized Nova Scotia Health Authority in 2015, physicians have felt increasingly removed from local decision-making – like they don’t have a say in important community matters. The majority of doctors on the job say they are feeling disconnected, disrespected and burnt out.
Many physicians are deciding to leave the province, reduce their workloads or retire early. The number of Nova Scotians without a family doctor is now 13 percent, more than double the figure six years ago.
To truly understand the challenges facing Nova Scotia’s physicians, last spring Doctors Nova Scotia (DNS) crisscrossed the province, meeting face-to-face with doctors in 24 communities. Their lived experiences – and, by extension, the experiences of their patients – are the basis of a new report by DNS, titled “Healing Nova Scotia: Recommendations for a thriving physician workforce.”
In the report, Nova Scotia’s doctors give five recommendations for strengthening the physician workforce and improving patient care. These include:
Improve and restore local decision-making and physician engagement
Improve the decision-making process between government and the Nova Scotia Health Authority (NSHA). Include physicians on the board of directors of the NSHA or let them give advice to the board (Note: in March 2018, two physicians were appointed to the NSHA board).
Health care doesn’t have a one-size-fits all solution. When physicians lose professional autonomy and satisfaction, they feel disconnected – from their work and their patients. Patients suffer when health care decisions don’t take into account the needs of their community.
Integrate recruitment initiatives to boost physician supply in Nova Scotia
Start a physician recruitment task force to develop new recruitment strategies. Resurrect community-based recruitment teams and give flexibility in privileging, so doctors can choose their location, schedule and payment model.
Tens of thousands of Nova Scotians are on a waiting list for a family doctor while the province struggles to fill 60 open family medicine positions. And that’s just the tip of the iceberg – the province’s Physician Resource Plan identifies the need to recruit 1,000 physicians over the next 10 years. Recruiting strategies need to be deliberate, considered and community-based – so that each community in the province gets the health-care providers it needs.
Decrease the burden of unsustainable workloads
The physician recruitment task force must focus on filling existing vacancies, determining gaps and developing solutions for succession planning. Working together, all stakeholders must help physicians leverage technology to increase access to care for patients.
The current system requires too much work of too few doctors – and that means that everyone suffers. Patients struggle to get health care, while physicians work overtime to provide as much care as possible to as many people as they can. It’s a recipe for burnout. It’s time to ensure there are enough doctors for the patients who need them, and that physicians can use all the technology available to them (including phone calls and email) to provide care.
Revive full-scope comprehensive family medicine
Create a new primary care payment model that supports physicians collaborating with other health-care providers and ensure privileging doesn’t restrict physicians’ practice opportunities.
Primary care medicine is the keystone of a functioning health-care system – but many primary care physicians, burdened by outdated payment structures and rising business costs, struggle to spend the time they need with their patients. It’s time to ensure that all physicians have access to a payment model that works, so that all Nova Scotians have access to the care they need.
Maintain rural specialty services
Start mandatory rural rotations for specialty residents (including general surgeons, psychiatrists, obstetricians/gynecologists and urologists), integrate defined-license physicians into communities and have a strong locum program for short-term leaves.
Half of the province’s population live in rural communities. That often means that accessing specialist care requires long drives, time off work, paying for meals and parking, and other costs. Reviving rural specialty services by bringing in more medical learners and international graduates would help bring specialist care closer to home.
But a report alone is not enough. All of the province’s health-care players must work together to create a thriving physician workforce and to ensure that health care is available to everyone.
“Most of the issues facing the physician workforce are broad, complex and systemic – beyond the capacity of any individual health-system partner to resolve independently,” says Dr. Manoj Vohra, President of DNS and a family doctor in Truro, N.S.
“Ultimately, doctors and stakeholders all want a health-care system that provides quality health care to the people of Nova Scotia. There are tremendous opportunities for us all to work together for the well-being of Nova Scotians,” says Dr. Vohra.