Nova Scotia has a doctor problem. Perhaps lack-of-doctor might be more accurate. And “crisis” is certainly a more apt description than the mundane problem.
According to the province’s one-year-old “Need A Family Practice” list, 42,198 Nova Scotians — 4.6 per cent of the province’s population — are currently officially listed as looking for a doctor. That number is up from 25,000 in March, and 33,000 in July.
As apocalyptic as those numbers may seem, Statistics Canada’s stats are even more appalling. They show more than 100,000 Nova Scotians actually need — but can’t find — family doctors. (Why the discrepancy? One possible explanation: a Dartmouth senior told the Chronicle Herald “he’d made over 20 attempts over a few days [in November] and kept receiving a ‘system overload’ message from the provincial service.”)
And it is only getting worse. In November, 4,314 names were added to the need-a-doctor list, while just 2,018 were listed as having found one, meaning twice as many were added as subtracted during the month, meaning…
The Nova Scotia health authority’s physician resource plan officially estimates it needs to recruit 51 family doctors a year just to keep up with demand. Last year it fell short, and while officials claim they’re on track for 2017-18, even deputy health minister Denise Perret concedes: “We think we need [the target] to be higher.”
No kidding. Other figures show 55 per cent of the province’s doctors are over 50, and 40 per cent of doctors in Dartmouth have indicated they plan to retire within five years.
To make all that senselessness make even less sense, Nova Scotia’s College of Physicians and Surgeons in 2015 shuttered a program designed to help immigrant doctors qualify to practise in the province. During its 10-year existence, the Clinician Assessment for Practice Program (CAPP) allowed over 100 physicians to work in under-serviced areas, 99 per cent of whom then qualified for their medical licences.
When it capped the CAPP program permanently, the college claimed it “no longer represent[ed] best practises.” But Dalhousie University’s medical school says it won’t even be ready to roll out a replacement program until next year — three years after the closure of CAPP. And that program, when it launches, won’t allow specialists to qualify.
Which means that Dr. Layla Abouellail, a Kuwaiti-trained obstetrician-gynecologist and a fellow of the Royal College of the United Kingdom, will continue helping out in “an entertainment ultrasound clinic for women who want to see 3D images of their babies” instead of doing what she was trained to do. Her husband, Dr. Amr Nassrat, another obstetrician-gynecologist, has become a real estate investor and landlord after he wasn’t allowed to practise in Nova Scotia.
Meanwhile, German anesthesiologist Dr. Erik Steffen, who wants to move to the province with his Nova Scotia-born wife, won’t be able to — even though the health authority itself lists vacancies for anesthesiologists in Halifax, Truro, Amherst, and Bridgewater. While other provinces allow specialists like him to at least practise under provisional licences while they work toward certification, Nova Scotia’s college of physicians says no.
“What I worry about most is public safety,” the college’s registrar, Dr. Gus Grant, told the CBC.
What I worry about most is how public safety will be protected if a trained anesthesiologist isn’t available for a critical operation.
It’s not that most officials don’t recognize we have at least a problem. And maybe a crisis. As health authority president Janet Knox conceded to reporters last week, “we have a major problem [with doctor recruitment] that we are saying is job one for the health system of Nova Scotia.”
The larger issue is the lack of political leadership to tackle the crisis.
Where’s Stephen McNeil when we need him?
After a vote-shifting public healthcare debate almost derailed McNeil’s march to a second straight majority government during last spring’s provincial election campaign, our premier did have a brief, nano-second, Saul-on-the-road-to-Damascus conversion. “We heard about health care,” he acknowledged after the votes were counted and promised new health-related initiatives in his fall budget.
Instead, he added just $6.2 million more to the $4-billion-a-year healthcare allotment in his September budget, bringing what NDP leader Gary Burrill called “a garden house to a house fire.”
It hasn’t gotten better since. Last month, McNeil responded to Auditor-General Michael Pickup’s report criticizing his government’s handling of the need-a-family-practice list, not by acknowledging the concern and promising to do better, but by telling the auditor general his government’s handling of the list was none of his business (even though it clearly is).
With his government’s popularity tumbling to its lowest level since it was first elected in 2013 in the latest poll numbers released last week, you’d like to believe Stephen McNeil would take a few moments between the turkey and the rum pudding this holiday season to reflect on what voters are telling him.
You’d like to believe… But then, you used to believe in Santa Claus.
Thanks Parker for the link. I don’t know that this fully explains the question that Parker raised but Sask. has 14.9% of its pop. over 65; N. S. has 19.9%. In addition, N. S. appears to have about 48 % of the doc. complement working in a specialty. Sask. 41.5%. PEI has very few doctors working in a specialty and patients from PEI likely come to NS to access specialists; maybe NB and Nfld also make use of specialist services in NS, so that would explain the busy- ness and the need for a greater % of specialists in NS.
But here’s another problem- doctors in NS do not appear to feel that their concerns are being addressed. There is a significant gulf between Doctors NS and the NSHA (add the sitting government). This is significant for this reason at least: Doctors NS ,one would think, would like to be meaningfully engaged by the NS Health Authority and the sitting government. I don’t believe that they feel this way. This creates the problem/mindset of,’ to hell with all of this, I only have three more years to go and it’s someone else’s problem.’ This is more than just a sour taste. Maybe doctors are making the decision to cut back as soon as they can so as to avoid the ravages of so much sustained stress.
To illustrate, two years ago a specialist in northern NS told me that he worked 70 plus hours per week and had five years to go to retirement. He had said that he had asked the Minister of Health to have two prospective specialists (in his specialty) come to the hospital to work with him so that they could take over down the road. It’s coming on four years from that request , and he has heard nothing. Why two to replace this one doctor?
In 2015 this specialist had enough current patients and referrals “on the desk” to last him through to retirement; that’s without having to accept one single new patient.
Enjoyed the article and the comments.
Here’s a good article from JAMA that El might enjoy.
https://jamanetwork.com/journals/jama/fullarticle/2665004
It’s also worth remembering that when we recruit physicians from medical schools in the developing world, we are depriving that country of a physician it badly needs, and which it paid dearly to educate.
I think there is a Halifax centric element to this issue as well. The city historically rarely struggled to recruit qualified applicants. Not so for CB/Yarmouth. The deciders in the city are ok with the poles filling gaps with anyone they can get or perhaps no one at all. They’re less comfortable when it starts to become an issue closer to HRM.
The Canadian Medical Association website (https://www.cma.ca/En/Pages/canadian-physician-statistics.aspx) has extensive data on the number of physicians per province, broken down by age, sex, location of practice, and national origin.
The data shows that Nova Scotia has by far the largest number of physicians per population: 261 per 100,000, compared to the national average of 228 per 100K. Manitoba has only 204; Saskatchewan 196.
Can Stephen, or anyone else, shed any light on how a province with the most doctors per capita in the province somehow has a doctor shortage crisis? Could this be a problem of allocation, or work load, rather than numbers?
(It’s a complicated problem, and I have no idea what’s behind this. But the numbers are odd, to say the least.)
It is complicated. I don’t know if this is the entire answer but Halifax acts as a referral centre for all of Atlantic Canada. A significant amount of time and care is given to NB and PEI patients which necessitates the increased number of physicians. There is much debate around the topic but salaried physicians tend to see are far fewer patients than their fee for service counterparts. The tendency in this province seems to be to salary more physicians going forward which requires more bodies to look after the same number of people. I would argue electronic charting is also a drain on efficiency but that depends on your specialty. I don’t how that compares to other provinces. We have an aged demographic which also requires far more physicians as I believe 40% of healthcare is for those over 60. I don’t believe the per capita distributions are controlled for age.
A few reasons I’ve heard. 1. More specialists: the Maritime provinces all refer cases here when they get unusual or complicated. 2. The IWK gets all the tough cases from the Maritimes. 3. Research & teaching: some doctors would treat patients, but would also spend a substantial portion of their time teaching medical students and conducting research. Because NS is smaller, this inflates our numbers more noticeably than the various medical schools in Ontario do theirs.
I have mixed feelings about the IMG process. 25% of doctors in Canada are effectively CFAs. Obviously there should be a process to verify and license qualified candidates. Often really desirable candidates are recruited internationally to work in our academic institutions. I do feel bad for all the Nova Scotian youth (and their families) who would have loved to study medicine but didn’t make the cut at dal. They move on to other jobs or fields but lose that chance to practice medicine. In Canada the real barrier is getting accepted to medical school. If you bypass that barrier by having wealthy enough parents that can send you to the Caribbean or come from a different country and are fast tracked via a certification process it seems unjust to the local that nearly made the cut. Dal also produces enough graduates to sustain most of our needs but the province has been unable and unwilling to recruit or retain them.