The Chronicle Herald (Provincial)
A dearth of doctors
Those without family physician at disadvantage during pandemic
Since Nova Scotia declared a state of emergency in March, accessing health care has significantly changed: healthcare providers have switched to virtual care and walk-in clinics have closed or reduced their hours.
Being without a family doctor can be especially stressful during these times, according to Maria Patriquin, a 22-year family physician who provides collaborative health care at her clinic in Halifax.
“Our concern is that there's a significant number of people who do not have a family doctor who have less options (to seek care),” she says.
Patriquin says doctors are worried people's health would deteriorate if they can't secure health care for themselves.
“The shortage of family physicians or primary care access is not a new issue, but it's one that's fallen into the bottom of the care ladder right now,” she says.
People most affected by this problem are children, the elderly, people with physical disabilities and people living with mental illness, according to Patriquin.
As of April 1, about 46,000 Nova Scotians were on the Need a Family Practice Registry. People without a family doctor or nurse practitioner can sign up to the waitlist so the Nova Scotia Health Authority (NSHA) can find them a family practice.
Trish Fulton signed up in January but has yet to hear back.
Fulton's family doctor retired in late December. She had been his patient since she was born. He was also looking after her almost three-yearold daughter.
Fulton's happiness for her doctor's retirement was tainted with concern for her family.
“I was instantly panicking because my daughter gets frequent ear infections,” she says.
Fulton had to go to a walkin clinic three times this year for her daughter's ear infection. It was an inconvenience because the closest clinic is 30 minutes away from her home. Long wait times with a toddler were also “never fun.”
Getting medical care became more difficult for Fulton as COVID-19 spread.
“A lot of clinics and doctors’ offices are closed or won’t see anyone with COVID symptoms. My daughter gets a higher fever with her ear infections, so she couldn’t be seen anyways.”
More than anything, Fulton is worried her toddler would contract COVID-19 if she went to a walk-in clinic or the emergency room.
“My worst fear is her getting (an infection) during this pandemic,” she says. “Every time she touches her ear or feels a little warm, I’m terrified.”
When her daughter “shoved” a Q-tip in her ear, Fulton didn’t know what to do.
“She had blood coming out of her ear,” she says. “My husband ended up calling his family doctor to ask for advice and they said definitely take her to the IWK.”
Fulton says the IWK emergency department is “on top of their game." They had a screening process for COVID-19 where they asked people questions and measured their temperature and blood pressure.
When it was clear that Fulton’s husband and daughter were free of COVID-19 symptoms, they were taken to a “temporary” emergency room for NON-COVID health issues. Fulton says, “there was barely any wait.”
Fulton wants people to stay at home and wash their hands.
“The longer we are social distancing, the longer it will take to find a family doctor and the more chance my daughter will end up with an ear infection or two.”
While Fulton is grateful to the IWK and all health-care workers, she wishes there were more family doctors so her daughter would always have reliable care.
Patriquin says family doctors are at risk of closing their practice due to the pandemic. Being a fee-for-visit doctor means Patriquin can’t sustain her clinic for long without patient visits.
In early April, Doctors Nova Scotia and the Nova Scotia Health Department announced the Income Stability Program to compensate feefor-visit physicians.
Doctors who participate in the program need to agree to be redeployed by the health authority as needed to respond to COVID-19.
Patriquin says virtual group medical consultations could be a solution to help people without primary care access. Some people have privacy concerns about such an approach, but it can be a way for patients with similar conditions to feel connected to a larger community.
While navigating care provision during COVID-19 is a challenge, it can also be an opportunity for health care providers to collaborate.
For example, collaboration can be a solution to improve the long wait times people experience when calling 811
“(As it stands,) it’s not a very sustainable option, nor is it reasonable,” she says. “If you’re having an acute issue, then that’s not something you want to wait three hours for.”
Patriquin suggests a system where family doctors can help take some of the calls to ensure continuity of patient care. This can also provide physicians with an alternative source of income. Having separate lines for COVID-19 symptoms and general medical concerns is another possible solution.
Positive change requires continuously evolving and evaluating approaches to health care provision, says Patriquin. This means healthcare providers at all levels of expertise and scopes of practice need to work together to help people get the care they need during and after the pandemic.