Docs lack of trust stems from dismal NSHA record

In the final analysis, it’s all about control.

Family doctors are the main entrance into the health system.

The province is convinced it can’t manage that system without control over the entry point.

The preferred method of control has become a thinly-disguised employer-employee relationship, and the model that will be used to get there is collaborative family practice teams — formerly Collaborative Care Clinics.

On the surface, this may not appear like a radical change. Doctors are already paid out of the public purse, so a case — albeit a weak one — can be made that they are provincial employees now.

Except, within defined parameters, employers tell employees what to do, where, when, and even how to do it. That’s what family doctors worry about most.

For Premier Stephen McNeil and his government, the goal is simply to provide the best possible care at a price the province can pay, and it entrusts the health bureaucrats to get that done.

A little history may help shed some light on why doctors are disinclined to share the government’s trust.

Almost two years ago, officials of the then-nascent Nova Scotia Health Authority were telling meetings of family doctors around the province that there were more than enough of them.

“Don’t sign any long-term leases,” doctors quote NSHA officials saying at that time. The warning was clear. Doctors might not continue to practice where and how they were.

At the same time, no new practices could be established without the health authority’s approval, and family medicine residents were told that jobs they had lined up were not going to happen. There were reports of young residents leaving the meetings in tears.

Other Nova Scotians, doctors who had left the province when things looked bleak back in the 1990s, who wanted to return in 2015 or ‘16, were turned away unless they were willing to locate to specific, “under-serviced” areas.

The current province-wide shortage in family doctors, likely to deteriorate further, is part of the dismal record of the same health bureaucracy that doctors are now being asked to trust as their “partners” in collaborative family practice units.

Managing the numbers of family practitioners was the first attempt by the NSHA to control the entry point to the health system.

Amid the chaos that created, the same bureaucracy is holding tight to the levels that will control collaborative practices.

But the history doesn’t answer the question: “Why shouldn’t family doctors be employees of the province?”

For starters, most of them don’t want to report to or be directed by the province, the NSHA or any other bureaucracy, and if they are forced, many will simply leave.

The province knows that, so won’t position doctors as employees of collaborative practices, but the two sides are unable to agree on funding mechanisms for the new collaborative model. That’s not surprising, given there’s no common understanding of who will be in charge.

The province has contracted individual doctors to work in collaborative practices. Those deals are the basis of a court challenge by Doctor Nova Scotia, which represents the province’s 2,200 physicians in all financial dealings with the government, except those contracts.

Like cattle for the brand, the NSHA is trying to herd doctors into corrals, where the NSHA controls the funding.

Many doctors make a strong case that the NSHA’s collaborative model has a higher per patient cost than people treated in a traditional family practice, and the difference is wider when applied in rural parts of the province.

With the NSHA controlling the purse strings, doctors worry that high-cost collaborative practices will result in rationing of primary health care, like long term care, home care and other services are now.

Are family doctors just being prima donnas? Most other working Nova Scotians have bosses. Why can’t family doctors?

While a question shouldn’t be answered with another question, here goes. Can your boss tell you what to do, and what not to do? Here’s another one. Who do you want to make the decisions about your medical treatment?

He who pays the piper, calls the tune.

Jim Vibert, a journalist and writer for longer than he cares to admit, consulted or worked for five Nova Scotia governments. He now keeps a close and critical eye on provincial and regional powers.