Family doc shortage in Nova Scotia worsens

Nova Scotia has 40 fewer family physicians than it did at the end of last year, despite recruitment efforts and contrary to government assurances the doctor shortage is manageable.

Family doctors are leaving much faster than the province can find new ones. The reasons vary, but are not limited to normal retirement. Some doctors are taking down their shingles because they are burned out, or disturbed by the state and direction of health care in Nova Scotia. Others are leaving for greener pastures.

Recruitment isn’t likely to get any easier. Nova Scotia has joined an exclusive club. It’s listed by the Canadian College of Family Physicians as among the worst provinces in Canada for a family practice, sharing the dubious distinction with Quebec and Ontario.

That’s not the kind of publicity that helps recruiting efforts, as the Nova Scotia Health Authority beats the bushes in places where doctors are “even more miserable than they are (in Nova Scotia),” according to a source familiar with the NSHA.

Practising family doctors must register with the Nova Scotia College of Family Physicians, a chapter of the CCFP, and they revoke their registration when they stop practising in the province. NSCFP executive director Cathie Carroll said the college recorded a net decline of 40 registered family doctors between December 2016 and June 2017.

That is the largest seven-month decline in memory, and it occurred while an estimated one in 10 Nova Scotians was already without a family doctor.

Family doctors are the foundation of the health-care system, and in Nova Scotia that foundation is cracked, if not crumbling.

“Our province has one of the sickest populations in the country, with the second-highest rate of diabetes, some of the highest rates of obesity, and the highest death rates in Canada from cancer and respiratory disease.

“That’s just a partial list. We also have one of the oldest populations in the country — a demographic that will only keep growing, and with it, their need for healthcare services.” That diagnosis is from a Health Department paper called Nova Scotia’s New Collaborative Care Model.

The government denies that the province is in, or headed for, a health crisis, but that seems disingenuous or fanciful, given the decrease in family physicians combined with poor population health and aging.

Family doctors say the health authority’s estimate that about 30,000 Nova Scotians are without a family doctor is a fantasy.

The number is much closer to, and probably greater than, 100,000.

As the province and the authority move to collaborative care clinics or centres, some doctors are concerned there will not be enough doctors to staff them.

Collaborative centres bring together various medical and health professionals, such as nurse practitioners, physiotherapists and psychologists, but family doctors are essential.

Doctors say estimates that nurse practitioners could relieve the burden on family doctors by up to 70 per cent is unrealistic. That number, or one close to it, is trotted out by health administrators who claim collaborative care is the answer to patients’ inability to find family doctors.

A doctor working in a collaborative clinic estimates he sees 75 to 80 per cent of the patients after they have seen the nurse practitioner. If that ratio is consistent, collaborative centres will not improve access nor will they have a positive impact on healthcare costs.

The Canadian Medical Association supports collaborative care, but not for cost containment. The CMA says patient-centred health care demands that each patient is treated by the appropriate caregiver or team.

Unresolved issues around collaborative care include ambiguity over accountability for patient care and liability issues, remuneration, and reconciling various professional routines and terms for effective team communication.

There are 1,323 registered family doctors in the province. That would be roughly one for every 735 Nova Scotians, but when doctors’ downtime is factored in the patient load increases.

The health and age of patients also determine the number a family practitioner can treat, in either a traditional or collaborative setting.

One thing is certain. If the province continues to suffer a net loss of family doctors, no primary care model will work.

And the health authority exaggerating its recruitment success, as it did recently in Cape Breton, is not helpful.