Baby boomer phase-out fuels doc drought

Nearly 70,000 Nova Scotians can’t find a family doctor

Another month, another record number of Nova Scotians who can’t find a family doctor.

As of the first of this month, it’s up to 66,404.

The reason the family physician shortage is getting worse is, on one level, simple. More family docs are exiting the profession in this province — retiring, moving away or switching to another speciality — than entering it, either as recent graduates or recruits from elsewhere.

Add to that the fact retiring family doctors saw, on average, more patients than the physicians who replaced them.

The Nova Scotia Health Authority’s website lists 88 vacancies for family physicians across the province (to March 31 of this year). That’s the highest number I recall seeing, though I don’t look every month.

Given family doctors are expected to manage average caseloads of at least 1,350 patients — though many established, older physicians see far more — that suggests well over 100,000 Nova Scotians may actually be without a primary care physician.

INCENTIVES LACKING

Two major factors are at play here.

The first isn’t new. It’s demographics.

The population bulge known as the baby boom (in Canada, those born between 1946 and 1965) includes family doctors, and that large cohort is nearing or past retirement age.

So, it’s no surprise a significant number of older family doctors have been hanging up their stethoscopes in recent years.

Here’s what’s concerning, though.

We’re only about halfway through baby boomers hitting standard retirement age. People born in 1956 turn 65 sometime this year.

The peak years of the baby boom were the late ‘50s, so even bigger numbers of retirements are looming.

According to Doctors Nova Scotia, 295 practising family doctors here are nearing or past age 65. That includes 155 already 66 and older.

Almost 500 are 56 and older. A surprising number of physicians do work into their 70s. But there’s no question many Nova Scotia family physicians will be retiring over the next decade and beyond.

Thousands of Nova Scotians lost their family doctor to retirement with no replacement physician available to take them on as patients. If that keeps happening, orphan patient numbers will continue rising.

Second, I’ve heard from a number of young doctors about a lack of incentives to practise family medicine in Nova Scotia.

Medical graduates carry a lot of student debt, usually over $100,000. So new doctors are often understandably keenly interested in positions that pay well.

But they’re also mindful of having a healthy life-work balance.

PAYMENT MODELS

Many older family doctors work on a fee-for-service (FFS) payment model, paid per procedure per patient. It’s a system that rewards volume.

But the FFS approach isn’t appealing to a lot of young doctors. They prefer contracts (alternative payment plans, or APPs) that guarantee a defined minimum level of income.

(Young family doctors also take a lot of specialized shifts, as hospitalists or in ERs, which pay better than a straight family practice.)

According to sources, in recent years the Department of Health and Wellness seemed reluctant to do APPs. With a family doctor shortage, and fee-for-service incentivizing volume, APPs became less favoured.

It’s been suggested to me the sharp rise in doctorless patients in the Halifax area over the last year may have been at least partly due to new family medicine grads being pushed toward, but rejecting, FFS practices in central zone, while at the same time APPs were hard to get.

I asked the government about any moratorium on APPs with family doctors. A health department spokeswoman said government continues to support APPs, including in central zone.

Meanwhile, the drought goes on.