The good news is that 4,369 Nova Scotians found a primary care provider last month.
The bad news is that 5,511 other Nova Scotians added their names to the province’s we-need-a-family-doctor list during that same period.
Welcome to the dark cloud inside every health care silver lining.
The worst news is that, after you do all the adding, subtracting, carrying the ones and crunching the numbers, the distressing end result is that, as of December 1, 82,088 Nova Scotians — 8.3% of the population — still have their names on the “Need a Family Practice Registry.”
That is the highest number we’ve recorded since the province began keeping score in 2018, eclipsing even last month’s previous record high of 81,267.
To put that into bleaker perspective, consider this:
- nearly 30,000 more Nova Scotians are looking for a family doctor now than at the same time last year.
- in the almost five months since Premier Tim Houston’s Progressive Conservatives came to power, 12,000 more Nova Scotians have added their names to the official ranks of the doctor-less than the number of Nova Scotians who reported they’d found one.
Oh, and did we mention that we’re on the cusp of another unrelated-but-related, should-be-good-news-but-maybe-not milestone: welcoming Nova Scotia’s one-millionth resident?
On Thursday, Houston — whose own long-term goal is to double the province’s population by 2060 — hinted to reporters his government may have to re-think plans for the $2-billion-and-growing Halifax Infirmary expansion project just to make sure it can respond to the health care needs of what he predicts/expects/hopes will be our exponentially growing population.
“We know as a province we have set ambitious population growth goals,” he explained after his weekly cabinet meeting, “so we should be building health care infrastructure with that in mind.”
Yes, but… why can’t I find a family doctor?
Houston isn’t responsible for creating the firehose of health care crises currently washing over us and threatening to wash us away, of course, but he campaigned last summer almost exclusively on the promise that he could — and would — fix it.
That pledge explains why we not only handed him the keys to the premier’s office but also gave him a majority government of a limo and told him to get on with it.
So, now he will be judged on how well he does.
While Houston has quite rightly piled on the caveats — there will be no easy or quick fixes to a health care system that was decades in the breaking — Nova Scotians will want to see real progress on an almost impossible panoply of problems in 2022.
- How will we find enough family doctors to care for our current population?
- How will we train — and retain — enough new family physicians to catch up — and keep up — with our expected population growth?
- How can we add more health professionals to the system — physician assistants, nurse practitioners, etc. — to reduce some of the pressures on the family doctors we do have?
- How will we reduce the ever-escalating number of “temporary” emergency room closures in rural Nova Scotia?
- How will we — in the alternative, or as a supplement, develop community-based alternatives for hard-to-staff rural ERs?
- How will we reduce ambulance wait times?
- How will we decrease ambulance off-loading times at already overwhelmed urban emergency rooms?
- How will we attract enough nurses, nurse practitioners and licenced practical nurses to fill nearly 1,500 current vacancies?
- How will we increase core nurse staffing levels that haven’t changed in the last 20 years?
- How will we change the minds of the 60% of currently working but over-stressed, under-resourced nurses who say they intend to change careers in the next year?
- How will we make Tim Houston’s promise to create 2,500 new long-term care beds in his first three years in office come true?
- How will we match our mental health needs to fiscal and human resources?
That, of course, is just a sampler of the multitude and multiplicity of problems we face.
Many of the issues are interrelated and our failure to solve one dominoes over into another. Because there aren’t enough family doctors, for example, patients have no choice but to take what ails them to their local emergency room, creating overcrowding and longer wait times. Because there aren’t enough nurses, the nurses we do have end up over-worked, stressed and discouraged out of the profession, creating even more shortages. And even more stress for those who remain.
And so it goes.
Tim Houston has already put his own health care Fixit team in place.
The day after he was sworn in as premier, Houston fired the CEO and entire board of the health authority, replacing the full board with only its former chair, Janet Davidson, to serve as a new super-administrator for the system.
At the same time, the authority’s only recently hired CEO, Dr. Brendan Carr, was out the door, replaced as interim CEO by trusted Houston confidant Karen Oldfield, the longtime head of the Halifax Port Authority and one-time chief of staff to former Tory premier John Hamm.
Houston shuffled the deputy minister of health, Dr. Kevin Orrell, into the job as CEO of a newly created office of health care professionals recruitment.
And he named MLAs Barbara Adams, a physiotherapist, as the minister of a new department of seniors and long-term care, and Brian Comer as the minister responsible for addictions and mental health.
Since then, Houston has made some small but significant announcements.
In September after a whirlwind health care tour of the province, for example, he announced plans to expand virtual care options for the then-75,000 Nova Scotians (now 82,000) without a family doctor. That is supposed to be in place in December. Will it be? How will it work as a stopgap measure?
And last week, his government announced $57 million in new spending to add staff and beds to long-term care. He even encouraged unions in that sector to see his government as “a willing partner” in their struggle for higher wages and benefits to attract needed staff. How will the rubber of his words meet the road of collective bargaining?
Houston, of course, is still learning what it means to govern.
The morning after his party was elected in July, for example, he learned — thanks to the violent eviction of homeless encampments in Halifax — that Nova Scotians expect their political leaders to be more than uni-dimensional, and capable of solving our health care woes and creating affordable housing at the same time.
Housing hijacked much of what he thought would be his agenda for the fall session of the legislature. Now he must make sure he keeps his eye on the health care ball while not losing sight of all the other policy and issue balls also flying in his direction.
At this point, he still has goodwill and good wishes.
But that won’t last forever.
My guess is that 2022 will be the year when we really begin to take the measure of our new premier.
An important reminder about electoral promises and toes-to-the-fire journalism. Thanks
How will we — in the alternative, or as a supplement, develop community-based alternatives for hard-to-staff rural ERs?
Whatever happened to Collaborative Emergency Centres the Dexter government introduced after their rash 2009 promises to keep all rural ERs open met reality?
I understood this idea was widely regarded in health care circles for quite some time. Are we creating more of them or have they somehow become victim to health care turf wars?
…as of December 1, 82,088 Nova Scotians — 8.3% of the population — still have their names on the “Need a Family Practice Registry.”
As we attract more people here, as more doctors retire and we are unable to replace them with new graduates, should we not be looking to re-think how we manage basic medical service provision?
Should we continue restricting our Medical Home – where blood tests and imaging for example must be sent to one specific family doctor? Yes, medical continuity may be desirable (even essential in some cases) but what happens if after years of trying, you simply can’t find a family doctor, like the other 80,000 or so Nova Scotians?
Could our Medical Home instead be our Electronic Patient Records and imaging history which could be viewed by any doctor we designate at any given time? Surely if a drop-in clinic doctor tells me need imaging, and it is interpreted by a diagnostic radiologist, they or any other doctor at any drop-in clinic could make sense of what it means it in view of my health history arrayed before them and make suitable recommendations?
This could free up overloaded ERs to focus on genuine emergencies and offer medical services to people who currently cannot locate a family doctor and who are currently condemned to wait 8 hours to obtain the basic medical care for which they paid in their taxes?
True, this is not just a public health management issue.
It needs to be devised in consultation with the medical profession so the quality of medical care is not compromised, but increasingly the current arrangements are just not working for 80,000 people and counting.
“How will we attract enough nurses, nurse practitioners and licenced practical nurses to fill nearly 1,500 current vacancies?”
Should we re-think the way we train nurses?
My youngest girl graduated from Dal nursing school with distinction, passed her NCLEX and is now a practising RN.
Sure, COVID-19 complicated her studies but from what I could see, too much of the time in her compressed 3 year course was taken up with arcane theory (ask any practising RN what hermenuetic phenomenology means to them) and with considerable study time devoted to research techniques. These might be fine post-grad topics but they seemed to me not the most fundamental skills for an extremely hands-on profession like nursing.
She was unable to insert a urinary catheter, give a hypodermic shot or insert a suppository with any confidence although she could administer medications. When she arrived on the wards her lack of practical experience meant she became a burden on already stressed out senior nurses who were understandably reluctant to let her do much without close supervision and really didn’t have time to teach her the practical topics she should have learned during clinical studies.
Maybe we could look at teaching the more practical stuff so these junior nurses could be clinically useful to some extent earlier on to overloaded RNs and much of the theory be culled and delayed until later or even post-grad.
Perhaps all nurses should be initially trained as LPNs then after a certain time in clinical practice be allowed to upgrade to RNs, if they desire and show aptitude.
I wonder if we might be better off training nurses in teaching hospitals rather than in costly university courses, as used to be done?
Bingo, my husband (a recently retired doctor) and myself an ER nurse had that very conversation..
Start with people who are interested in the nursing field and begin with a couple of months of training, put them in the nursing homes and hospitals as CCA’s. After a few months back for more training to bridge to a LPN. Those who want to continue go on to their RN’s with lots of training in hospitals. Then those who want to leave the bedside and go to managerial roles take more university.
I cannot tell you the number of new grads who come to work unprepared for what is demanded of them. StFX grads are worse that Dalhousie.
Also CCA’s need to be paid a living wage. We cannot retain workers there with wages that are below $20/hour. It is hard, back breaking work…
HRM offers the best and most expensive pension plan in Canada and a service award of 6 months salary upon retirement. Nova Scotia nurses and all other health care employees, and other provincial employees, have a much less generous pension plan and no long service award.
And HRM goes begging to the province and Ottawa for money for frills.