Immediate Action Needed to Strengthen Nova Scotia’s Physician Workforce

Nova Scotians rely on health-care services being available when and where they need them. But with more than 56,000 people sitting on the province’s waitlist for a family doctor and over 100,000 people lacking primary care, health care is on unsteady ground across the province.

With the province struggling to attract and retain both family doctors and specialists, there simply aren’t enough doctors to provide the care Nova Scotians need.

“With more than half of practising physicians over the age of 50, with increasing numbers of people without a family doctor, and with many specialty services hanging on by a thread, it’s clear that short- and long-term solutions are needed to ensure Nova Scotians have access to the care they need,” said Dr. Tim Holland, President of Doctors Nova Scotia (DNS).

Without enough physicians to meet the needs of patients, practising physicians are bearing the burden, working long hours to fill gaps in services and taking on excessive patient loads. This difficult work environment is not sustainable and makes it even harder to attract doctors to Nova Scotia.

Doctors Nova Scotia, Maritime Resident Doctors (MarDocs) and the Dalhousie Medical Students’ Society (DMSS) represent physicians at every stage of their career in Nova Scotia. All three organizations worry about how their members can deliver high-quality patient care in a strained health-care system.

The three groups teamed up to release a new position paper, titled “Road Map to a Stable Physician Workforce,” which calls on the provincial government to take immediate action to stabilize the physician workforce in Nova Scotia.

Click here to read the full report

The paper lists six recommendations to create a stable physician workforce.

1. Pay physicians competitively
Nova Scotia’s physicians are among the lowest paid in Atlantic Canada and among the lowest paid in the country. The province must become a leader in physician compensation in Atlantic Canada, with a path to becoming nationally competitive. Not only would this help recruit new physicians to Nova Scotia but it would also help retain the physician talent we current have.

2. Introduce a new blended payment model
Adding a blended payment model for family physicians to support comprehensive and collaborative care, similar to what’s now offered in New Brunswick (Nova Scotia’s main competitor for physicians) would make working in Nova Scotia more enticing to physicians. This would support the province’s recruitment efforts for family doctors and specialists, and halt the tide of physicians leaving Nova Scotia to work in neighbouring provinces.

3. Invest in succession planning
Implementing a Transition into Practice/Transition out of Practice model would improve the work environment for both new-to-practice doctors and retiring doctors. The retiring physician mentors the incoming physician, who learns the ins and outs of the practice before being on their own with a full roster of patients. Providing this peer-to-peer support will lead to successful long-term physician recruitment, particularly for rural communities.

4. Improve physician engagement
Physicians need a say in health system decisions that involve their patients. The Nova Scotia Health Authority and the Department of Health and Wellness must seek the input of the right mix of physicians when making decisions about the delivery of health services. That means involving the organizations that represent physicians, including DNS, MarDocs and the DMSS, as needed.

5. Change the focus of billing audits
Physician audits are meant to be educational and focus on how doctors can improve their billing processes. But in Nova Scotia, aggressive audits contribute to low morale and a national reputation as an unattractive province to practice medicine. The first time a physician is audited, the audit should be for education purposes only, with a commitment to discuss the audit details with the physician. Disciplinary action should only be taken in the rare circumstance of fraud or intentional abuse, or if a physician keeps repeating the error after attempts to educate.

6. Create a “Red Tape Reduction Task Force” for physicians
Nova Scotia physicians are burdened by an incredible amount of paperwork that takes them away from caring for their patients. The mandate of this task force would be to remove unnecessary administrative work and to ensure that physicians are paid for the work they do, which will increase physician capacity and build trust between physicians and the government.

Have your say
Ultimately, we need to make Nova Scotia a better place to practise medicine, which will mean more doctors working here and deciding to put down roots, which will strengthen patient care and access across the province. Immediate action is needed for this to happen.

But we can’t do this on our own. It’s up to all health-care stakeholders to come together and take action on these recommendations. If you believe the government should take action and improve health care for all Nova Scotians, contact your MLA today and share your concerns.

Comments

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Submitted By: PGY2 In exile

If they are not already, I would like to see residency programs in NS prioritize local medical graduates over those from other provinces. We should not be subsidizing other province’s failure to appropriately allocate residency positions, and inso doing train people who have no substantive connection to our province.

Submitted By: Maria Patriquin

http://www.livingwellihc.ca
“Collaboration is reliant on healthy relationships. Compassion is the currency of relationships. We are social beings and our brains are social organs. We have the capacity to learn and grow together. Because of our social nature, our success will be defined by our ability to honor the role of relationships and the importance of regard for our deep seated need to connect and belong. By virtue of these qualities and values, the collaborative model of care holds the potential and promise of being able to establish the healthiest forms of working relationships if the process of forming them is itself compassionate and considers our humanity”. We will strengthen when the process transforms into one that is compassionate, communicative and collaborative. As it stands it is lacking these qualities consistently and is dehumanizing, making our workforce weaker and creating a less desirable lens through which others see working here in our beautiful province.
Dr. Maria Patriquin, founder of Living Well IHC a “not for profit” PMH/Collaborative Care clinic/Family Practice Team est 2012.’
http://www.livingwellihc.ca/
https://patientsmedicalhome.ca/news/pmh-success-story-dr-maria-patriquin/
Association for Positive Psychiatry of Canada, founding & board member. http://www.appc.ca
Physician Lead: Group Medical Visits CHTeams/NSHA
Mental Health Committee Atlantic Canada Representative, CFPC
2016 PMH Care and Compassion Grant CFPC: Submit your story to kindonpurpose@gmail.com
Assistant professor Dalhousie University Department of Family Medicine
Collaborative Working Group on Shared Metal Health Care, CFPC
Editorial Advisory Board, Canadian Family Physician
Canadian Pediatric Society Strategic Mental Health Task Force
Promoting compassion, communication and collaboration in health care

Submitted By: Doctors Nova Scotia

Thanks for your comment. Dalhousie does prioritize Nova Scotia medical graduates; they get first choice of family medicine and specialty residency seats. Once they’ve chosen, then medical students from other provinces and out of country are able to apply for the remaining seats. What Dalhousie can’t do is set the conditions (competitive compensation and work environment) that will cause our medical graduates to choose family medicine; that falls to the Nova Scotia Health Authority and the provincial government.

Submitted By: PGY3 who had to move

Dr’s NS: you wrote below “Dalhousie does prioritize Nova Scotia medical graduates; they get first choice of family medicine and specialty residency seats”. This is false. As someone who went through the match in the past three years I can tell you that no such provisions for prioritizing NS medical graduates to local residency positions exists. If you think it does, please post your source.

Submitted By: Patricia Woodall

ER’s need nurse practitioners in a triage position to relieve the Dr.’s load. People should not be waiting for a doctor when they have a common cold, or a child has a skinned knee etc. No one should have to wait in the ER for prescription refills and thereby waste time in an almost non existent ‘health care’ system. A five hour wait or more for simple things that a Nurse Practitioner could handle is not necessary. Helping to pay tuition/books for last year med students with a contract to stay in NS for 2 years in return would probably help also. For every problem there is a solution that doesn’t have to be complex or expensive !

Submitted By: Anne Knowlton

Maybe doctors should treat patients medical problems, falsifying medical records and forging signatures, that probably make audits unnecessary.

Submitted By: Doctors Nova Scotia

We looked into this topic and you’re right; there is no preference to match Dalhousie medical graduates to residency positions at Dal. Medical graduates at Dalhousie use the Canadian Residency Matching Services (CaRMS) to match with a residency program. This is how it’s done at all med schools in Canada. As you most likely know, the CaRMS process seeks to match students to their specialty and location, based on an algorithm that balances students choices with the choices of specific programs. So if a Dalhousie graduate chose to enter the match and identified Family Medicine at Dalhousie as a top preference, and Dalhousie Family Medicine ranked the student as one of its choices, there would be a match. While we don’t know of any explicit recognition of Dal graduates through the match, (again the CaRMS process is followed) if a student studied at Dal and would be known by its program directors, that would potentially provide opportunity for a greater likelihood of matching at Dalhousie.

On the undergraduate level (for new medical students), there are a total of 108 first year positions at Dalhousie, funded by Nova Scotia, P.E.I. and New Brunswick; generally there are 63 positions reserved for students from Nova Scotia, 30 for New Brunswick (who study at DMNB), 6 for PEI and 9 for non-maritime residents.

In a future blog, we’ll be exploring the issues surrounding medical students and learners in Nova Scotia, and what needs to change to keep more new-to-practice physicians in the province.

Submitted By: Jim Muckle

Small administrative suggestion: I’m going to send a copy of this article to my MLA and ask for a community discussion on these points. If you made it easy for your readers to print copies or to save .pdf versions, it would help make next steps easier. Happy to cut and paste until then. Thanks for your good work!

Submitted By: Barbara Markovits

Although I don’t work in health care I grew up with 2 parents who were doctors. I remember medicine before medicare, and I watched my parents’ practice change afterward. I also recall the issues that they correctly predicted 50+ years ago. I largely agree with your analysis, the proposals and many of the comments. However, your link : https://doctorsns.com/sites/default/files/2018-09/next-steps/Road-Map-to-a-Stable-Physician-Workforce_0.pdf is apparently not secure. Could you please post a secure link?

Submitted By: Mary Moran

An excellent article with practical suggestions. One more: figure out which refugee-status countries have the best medical training programs, encourage medical professionals to immigrate, and offer a short paid-for course (1 year intensive?) to achieve equivalent status in Canada. A requirement would be to practice in a (sponsoring?) rural community for ten years.

Submitted By: Craig Jansen

Thanks for the good work you are doing to try and improve this situation. After reading the report, I am surprised at the apparent lack of direct engagement by our municipalities in marketing their towns, cities and healthcare facilities to prospective doctors. There are many incentives that could be offered to doctors from a local level that would help address the current state of affairs. Indeed, it seems that several towns in Ontario are playing a key role in physician recruitment (https://blackburnnews.com/midwestern-ontario/2018/04/26/goderich-welcomes-new-group-doctors/) . We need to demand more from our local councils in supporting provincial efforts and indeed leading on physician recruitment for their ratepayers.