The president of Doctors Nova Scotia, Dr. Tim Holland is optimistic for the future of health care in Nova Scotia.

Raissa Tetanish

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HALIFAX: With almost 150 vacancies for family physicians and specialists in the province, the senior director in charge at the Nova Scotia Health Authority (NSHA) is concerned.

But Grayson Fulmer said recruitment efforts are coming together to try and fill those vacancies, and the health authority is working with other agencies, such as the Department of Health and Wellness, Doctors Nova Scotia, the College of Physicians and Surgeons of Nova Scotia, and the Office of Immigration.

“We’re starting to see real success,” said Fulmer. “We’re leaving no stone unturned when it comes to our recruitment efforts.”

He said there are three areas of major concern when it comes to shortages – psychiatry, as it’s a competitive market, has shortages in Cape Breton and the Northern Zone; anesthesiology, which is a high needs specialty; and emergency medicine, as it’s also highly competitive, and emergency department doctors are more agile and more apt to move from site to site.

Fulmer said the health authority has been taking a number of different approaches when it comes to recruitment. Fifty collaborative practice teams have been added recently, increasing access to primary care.

Since April 2017, 68 new family physicians have come on board.

“And since October 1, we have 21 that are in various stages of offerings,” said Fulmer.

Each month, the NSHA compiles a report for the public titled “Finding a Primary Care Provider in Nova Scotia.” It keeps track of those residents in the province who sign up to the NSHA’s “Need a Family Practice” registry. It was launched November 1, 2016.

The October 2018 report notes 58,046 registrants not yet placed with a family practice. That makes up 6.3 per cent of the province’s population.

Fulmer said the health authority has a robust strategy in play, which consists of a variety of efforts.

Working with Dalhousie University’s Family Medicine Residency Training Program, 10 new residency spots were created throughout the province – six in the Northern Zone with the creation of a new site, two added to the existing site in Cape Breton, with one added in South West Nova. One position will be used for family medicine residents to gain additional clinical experience in an area that would enhance services in the community, such as mental health and addictions, or oncology.

The health authority is attending job fairs and conferences, and reaching out to medical schools across Canada. There’s also a recruitment team working now in the U.K. and London.

A new recruitment Web site: https://recruitment.nshealth.ca was recently launched, which provides on-line visitors to check out what’s available in terms of positions, and gives them a chance to find out more about the province.

“We’ve seen 35 applicants or inquiries through the website already, but don’t have our full reporting back yet,” said Fulmer. “I can say it’s been very well received. All indications are very positive and many say it’s the right step forward.”

He said one of the challenges when it comes to family physicians is the health authority doesn’t always get notice when a doctor plans on retiring. Some do, he said, and they try to work with the doctor to have a plan in place.

That’s why the authority, he said, is focusing on the number of vacancies, which sits around 145.

“This is a very fluid number and changes on a day-to-day basis, as some doctors are stepping up to fill some of those holes,” Fulmer said.

Specialty-focused

In terms of recruiting specialists, the senior director in charge said it’s more focused work because of the nature of the profession.

“We’re attending more focused conferences. Take psychiatry for example. We’ve attended conferences in the U.K. and nationally, and have attended sub-specialty conferences as well. We’re focusing a lot on our conference presence to make sure we’re talking to as many people as possible,” he said.

They’re also in contact with residency programs across Canada, and working on a delegation to go to Alberta after making contact at a conference in Toronto. Targeted advertising in academic journals is also being done.

Additional support

A key factor to the recruitment effort, according to Fulmer, is “community connectedness.”

Some communities have seen the creation of a local recruitment group, which features local physicians, community and business leaders, and the health authority.

“As we bring people into the province, the best people to positively highlight the communities are those people who live in the communities,” said Fulmer, calling their support ‘invaluable.’ “We really want to reinforce the community roles in recruiting.”

Not yet placed

In the Eastern Zone, which covers all of Cape Breton, as well as Antigonish and Guysborough counties, the percentage of without a family doctor has gone from 6.4 per cent in 2015-2016 to 7.52 per cent in 2018-2019.

As of September, 2018, 4,260 patients were not placed with a family doctor, but 6,171 patients found a primary provider.

Between April 1 and August 31, four family doctors and five specialists were recruited in the Eastern Zone.

The Eastern Zone is currently recruiting: 4 full-time psychiatrists; 3 full-time ophthalmologists; 15 full-time family physicians; 2 full-time emergency physicians; 1 full-time pathologist; 1 full-time oncologist; 1 full-time dermatologist; 1 full-time gastroenterologist; 1 full-time head and neck surgeon; 2 full-time pediatricians; 1 full-time obstetrician/gynaecologist; 1 full-time anaestheliogist; 2 full-time respirologists; 1 full-time radiologist; 1 full-time child and adolescent psychiatrist; and 1 full-time geriatrician.

Doctors Nova Scotia optimistic

More than 58,000 people are without a primary care provider in the province.

And while that number is a concern to the president of Doctors Nova Scotia, Dr. Tim Holland says there’s hope for the future.

Holland says the agency has been collaborating with others, including the Nova Scotia Health Authority, to address doctor shortages, and six recommendations have been made to the province.

“We’re definitely feeling those shortages across the specialties,” said Holland, who runs a family practice in Indian Brook and fulfills emergency department shifts at the Colchester-East Hants Health Centre in Truro. “Family medicine is in a big crunch, as well as anesthesia.”

Holland says the health authority has made strides since first forming into one provincial authority from nine district authorities.

“They’ve since done a severe pivot toward more effective strategies,” Holland said.

With many communities across the province in dire need of family physicians and specialists, Holland said there are good things happening, such as financial investments, but more needs to be done.

“The health authority is talking more and engaging more with local physicians,” he said. “Compensation is one of the biggest areas of concern.”

Holland said the loss of doctors in the province has been multi-factorial, with critical work environment issues close to the top. He said one of the biggest losses has been the decision-making capabilities of physicians.

“Physicians are incredibly frustrated about that,” he said. “We’ve dedicated our lives to fostering health and making our patient lives better. It’s frustrating to look at different jurisdictions and see that happening.”

Holland says Nova Scotia physicians have been the lowest paid across the country for years, but it was the relationship with their district health authorities – and ability to make decisions – that was a positive. Now, he said, physicians such as himself are spending more and more time daily – two to four hours himself – on paperwork.

“Without that paperwork, it would make the work life better, allowing us to do what we want to do, which is work with our patients,” said Holland.

With practicing physicians aging, more and more are retiring, with many leaving their patients without a primary care provider. Holland said Doctors Nova Scotia is recommending an investment into succession planning, to work with doctors transitioning out of the field and those coming in. Doing so, he said, would see more mileage out of the retiring doctors and oncoming physicians, leading to a safer transition.

“As the work environment improves, the compensation isn’t as critical,” he admitted.

In the Nova Scotia Health Authority’s ‘Finding a Primary Care Provider in Nova Scotia’ October 2018 report, more than 58,000 residents in the province have registered as not having a primary care provider. Holland said the average family practice has a patient load of about 1,350, meaning the province needs more than 40 family physicians, not including specialists.

“It’s alarming we need so many,” said Holland. “When it comes to retiring physicians, we can sort of predict when they’re leaving. But it’s those that get up and leave with only a few months’ notice that are hard to plan for.”

Holland has seen first-hand the need in rural communities where residents have no family doctor and there is no walk-in clinic available. Many emergency departments in rural areas are seeing closures due to lack of physician availability. Locums in the province can choose the shifts they want to fill, often leaving a void in rural settings. Holland said an enhanced locum fee for those areas is good, but it could be better.

“There is some collaboration happening. Emergency doctors are the lowest paid in the country and it gets to be frustrating. Physicians are feeling frustrated, but I do think there is reason to be optimistic. We have the right people in government who understand the problems and we’re working on how to deliver on those,” said Holland.

“We want to help physicians thrive, which will benefit our patients. I think people are coming to see that there’s hope we’re taking the right steps. There is promise here if we keep our feet down and continue collaboration.”