New health care models take off
Virtual care pilot programs easing doctor shortage
The growing number of Nova Scotians who do not have a family doctor weren't prescribed any magic pills at Thursday's standing committee on health.
But the burgeoning virtual care and collaborative care health models were touted as ways forward to alleviate the province's doctor pinch.
“One of the opportunities that we have right now is around virtual care,” Dr. Nicole Boutilier, vice-president of medicine with the Nova Scotia Health Authority, told the committee.
“Consults are happening regularly across the province with virtual care providers.”
She said virtual care pilot programs are being concurrently rolled out in the western and northern health zones. The western zone consists of Annapolis Valley, South Shore and southwest Nova and the northern zone encompasses Colchester, Cumberland and Pictou counties and East Hants.
Boutilier said the pilots, which began in mid-may, are intaking about 2,000 people every week.
“It will give the opportunity for almost 30,000 that are on the list (waiting for a family physician) to have access to care that will initially be provided by Nova Scotia physicians virtually,” Boutilier said.
“We are very excited about the possibilities of providing primary care access to multiple people who are waiting on the list,” she said.
Boutilier said patient responses show satisfaction with the virtual service.
“They are getting seen in a timely way, after they’ve requested a consult with a physician, and if they need to see someone in person, that is being facilitated as well,” she said.
Dr. Aaron Smith, executive medical director in the northern zone, pointed to impressive data from that area on how quickly the team is involving and engaging patients.
“This isn’t just a question of using a Zoom platform or a (Microsoft) Teams platform to connect the patients, this is using an entirely new platform to really streamline that process,” Smith said. “We are really learning as we go and learning from that experience.”
Smith said patients are pleased with the ability to convert from virtual to inperson care close to the communities from where they are accessing virtual health care.
The need for virtual health care is greatest in the northern and western zones, because they lead the way in numbers of people on the Health Department registry waiting list for a doctor. Statistics show that more than 69,000 Nova Scotians were on a wait list for a family doctor as of July 1, an all-time high and up from 66,404 in June.
More than 24,000 of those waiting for a doctor in June live in the western zone and nearly 19,000 more live in the northern zone.
To try to meet the doctor shortage challenge, the Dalhousie University medical school in Halifax trains 124 students per year and 67 per cent of practising physicians in Nova Scotia have trained at Dal, said Dr. David Anderson, dean of the medical faculty.
“Access for family physicians for Nova Scotians, particularly in rural settings, is an issue the medical school is acutely aware of,” Anderson said, so much so that it precipitated two strategic shifts in medical training at Dalhousie over the past several years.
“First, we are providing a much greater emphasis in our undergraduate program in training in family medicine,” Anderson said. The school has set a goal of having 50 per cent of medical graduates trained in family medicine.
Anderson said the school has also recognized the need for physicians outside the Halifax area and now provides students and residents more educational opportunities throughout the province.
Dr. Katherine Stringer, head of the family medicine department at Dalhousie, told the committee that the old model of one family physician serving the community entirely on their own no longer serves the population well.
“It’s changing to be more of a team-based approach as is evident with our collaborative clinics,” Stringer said.
Stringer said the medical school trains physicians to focus on teamwork, with the family physician as the team lead, to promote the continuity of care and communication across settings that can include a clinic, a hospital and an outpatient care unit.
“Our graduates are indicating to us that this is how they want to practise as well,” Stringer said.
Dr. Heather Johnson, the new president of Doctors Nova Scotia, has practised family medicine in Bridgewater for 20 years, and currently works in a collaborative practice with three other physicians and a nurse practitioner.
Johnson told The Chronicle Herald that collaborative practice and virtual care are essential to the future of rural medicine.
“It’s not just recruiting, we have to think about retention as well,” Johnson said of increasing the rural doctor numbers. “To recruit them, we have to be open and inviting, we have to have competitive salary packages. New graduates want to go to communities that have things ready for them to hop into interdisciplinary teams that are up and running and ready to go.”
Johnson said graduates want to be doctors, not business owners.
“We have to help them integrate into the communities, we can’t just bring somebody in, drop them off and say, ‘well, enjoy your career.’ We need to think about how we are going to mentor them, how we are going to support them, how we are going to integrate them into the community.”