Epic failure leaves family docs demoralized

You’re working more and making less. Your boss is dissing you, even occasionally if inadvertently taking that disrespect public. You love the work, but is it worth it?

Your kid’s teacher stops you in the grocery store to ask if you can take on one more patient. You hear the question daily, sometimes many times a day. She isn’t asking for herself. Her mother just got out of the hospital. How do you say “no?”

This account, or a variation, can be heard from family doctors in villages, towns and cities across Nova Scotia. Many add that if it wasn’t for their patients, they’d be gone. They stay and continue in family practice out of loyalty and concern for the people they care for, who would join the long line of doctorless Nova Scotians without them.

The average Joe or Jane has little financial sympathy for doctors, but Nova Scotians are not proud that family physicians here are the lowest paid in Canada. Most are earning the same money as seven years ago, and some are earning less. Their last contract took some incentives away and the new billing opportunities that were added came with so much bureaucratic hassle they’re hardly worth the effort. Telephone consultations became billable but doing so seems guaranteed to draw an audit from MSI. The doctor has to log the time the call begins and ends, and everything that goes on in-between and after. If you’re going to get paid, your notes are more important than the quality of medicine you practice. Why bother?

How did Nova Scotia manage to get to a point where family doctors are, at once, the most highly prized human capital and the province’s most discouraged workforce? That is a feat of epic leadership and organizational failure.

It’s easy to blame the provincial government, it’s ham-handed reorganization of health administration and the resulting and ongoing ineffective system management by the Nova Scotia Health Authority. It’s easy because much of the fault lies with Stephen McNeil’s Liberal government and the NSHA that family doctors describe as autocratic and unresponsive.

But some physicians also wonder what Doctors Nova Scotia (DNS) has been doing to earn their annual dues of more than $1,600.

DNS is located on a cul-de-sac in Dartmouth’s Burnside Industrial Park, in a stand-alone building described by one doc as “swanky digs.” The building seems more than adequate for the rodent I hoped was not a hungry rat when it greeted me in the basement john.

Pest-control notwithstanding, doctors may have some legitimate complaints about DNS, which has the unenviable task of trying to satisfy 3,500 members — 2,500 practising — who bring a wide range of complex issues.

Those complaints run the gamut. Some docs say DNS is too big, or out-of-touch with rural docs; that it exhibits poor governance practices and bad financial management; that it has been ineffective against the McNeil government’s agenda, which family physicians see as falling just short of all-out war on them.

Despite all that, when Premier McNeil said his government’s problems aren’t with Nova Scotian doctors but with Doctors Nova Scotia, the profession rallied around their society-cum-union like hawks protecting the nest.

Divide and conquer seems like a flawed strategy, but the province will need to come up with something because a new deal with doctors stands between the Liberal government and the next provincial election.

With 32 staff and an operating budget north of $6 million, DNS does seem large. And, like virtually everything else in Nova Scotia, it’s metro headquarters makes it removed, even remote, from physicians in far away, rural practices.

But, unlike the health bureaucracies that are exclusively funded by taxpayers, when asked DNS opens like a book, gives a fumbling scribe free access, acknowledges its flaws and answers questions openly. Direct access to decision-makers and executive members is automatic, with no pre-screening by public relations or communications gatekeepers.

Members may take issue with how DNS spends their money, but there’s no effort to obscure the trail.

The one thing DNS officials keep close to their vest is the negotiating strategy they are planning to take to the table when they sit down with the government to get a new deal for doctors. The current agreement expires in 2019.

Primary health care in Nova Scotia — already virtually nonexistent for thousands of Nova Scotians looking for a family doc — is unsustainable under the current conditions.

It’s the government’s job to fix that, and it’s going to need the doctors’ help. A little respect would go a long way.