Carr acknowledges “deep problems” but says good work being done
The Nova Scotia Health Authority’s new boss acknowledges there are “deep problems” in the province’s health-care system but he said there’s good work being done that should be talked about as well.
“There's a lot to be proud of here," Dr. Brendan Carr told reporters last week in Halifax at his first news conference as CEO.
"This organization has been through a tremendous amount of change in the last five years and they've actually done a very good job of... putting some of the building blocks in place. We've got the right direction, there's been a lot of good work done and we've made actually significant progress in a lot of areas, and despite that... the prevailing narrative here tends to be a very critical narrative of the healthcare system...
“I'm certainly not suggesting that all of these issues are not real issues,” said Carr, who grew up in Nova Scotia and took over the NSHA helm after holding health leadership positions in Ontario and Vancouver Island. “In fact, they're very important issues and they're very real issues. My point is that to only focus on the challenges is actually not going to help us as a system to improve.”
Carr served as vice-president of medicine with the former Capital district health authority and as an assistant professor in emergency medicine at Dalhousie University from 2007 to 2012, when he left to pursue a career opportunity in British Columbia. in Brampton and Etobicoke, Ont.
As of Dec. 1, 48,790 Nova Scotians didn’t have a doctor. That’s down slightly from 49,340 in November.
Carr said the authority's “very vigorous” recruitment program has seen 438 new doctors hired since 2016, including 130 hired last year. Another 94 have been hired since April 1.
As for Nova Scotia's overstressed emergency departments – frontline doctors are calling it a crisis – Carr said he will be touring health facilities across the province, including emergency departments, to get feedback from staff on making improvements.
“You know the emergency system in the province has to do a number of things. It has to be accessible, it has to be high quality and it has to be reliable. And today, I don't think we're meeting all three of those things and we could have a high-quality system that is accessible, but if it's not reliable then that's not good enough.”
The number of unscheduled emergency department closures more than doubled in 2018-19 from the year before. Twentyone of the province’s 38 emergency departments experienced temporary closures from April 1, 2018, to March 31, 2019.
“We've just recently signed a contract or a master agreement with physicians which may offer some assistance in terms of that (problem),” Carr said. ” I think the point is there's always a number of factors working together that create these conditions and so I think what we need to do is stand back and understand this better.”
The new contract gave physicians a two per cent pay bump each year for the next four years.
In 2017-18, Nova Scotia family doctors and specialists earned the lowest pay in the country with an average gross clinical payment of $267,000, according to the Canadian Institute of Health Information. The national average is $345,000.
Carr also addressed the question of when the province expects its overhaul of the electronic health record system will be complete. Two companies have been shortlisted to implement a “one patient, one record” system in what turned out to be a controversial process. A company that didn't make the shortlist said the process was biased toward Cerner and Allscripts. The province has denied this.
“There is a lot of work that needs to be done to ensure that when you turn on the technology that the people that are using the technology are really ready to use it in their day-to-day practice and in their workflows,” Carr said. “And so I have no idea how close to that we are here in Nova Scotia - just because I haven't had the opportunity to really, you know, get a sense of that - but there's a lot of work that needs to be done to prepare.”
As the health authority’s new leader, replacing Janet Knox, Carr said he’s not looking to make dramatic changes to address the health-care challenges. He said the collaborative family practice model that has been put in place in many communities is working well with over 80 collaborative practices now established.
“On the national scene or perspective, we're actually better than most other provinces in terms of the availability of family doctors,” he said, referring to Nova Scotia ratio of about 260 doctors per 100,000 people.
“We've invested heavily, as I said, in these care teams, we've learned a lot about collaborative emergency centers, about our pre-hospital care system. There's been a lot of innovation in Nova Scotia in terms of the way that we deliver services that is actually being modelled in other parts of the country and so I see a system that has the right fundamentals.”
“….the prevailing narrative here tends to be a very critical narrative of the health-care system...”