The Houston government is introducing legislation today to streamline what it calls administrative hurdles to health care delivery.
In particular, the legislation:
• makes it illegal for employers to require a doctor’s note from employees for sicknesses of five days or fewer. But should an employee take two sick leaves of five days or fewer in any given 12-month period, the employer can require a doctor’s note for the third sick leave of any duration. The change, said Health Minister Michelle Thompson, will save 50,000 hours of physician time annually.
• removes all application fees for any health care provider seeking to relocate from other Canadian jurisdiction to Nova Scotia. Such fees can be up to $200 annually, depending on profession. The legislation also says all applications must be processed within five business days. Additionally the government says (no legislative change was required for this) it will now pay for the first year licensing fee of any health care provider relocating to Nova Scotia. Depending on the profession, licensing fees can range from $1,000 to $2,000 annually. The provider will be responsible for paying their own licensing fees after the first year.
• allows the colleges overseeing the 21 regulated health professions to recognize the credentials and licences of health care providers trained outside of Canada.
• allows the Governor in Council (the lieutenant governor, so in effect, the premier and cabinet ministers) to expand the scope of practice for the various regulated professions without the approval of the full legislature
• takes the authority to create forms required of employers away from the Workers Compensation Board and gives it to the Governor in Council instead.
“No longer will employers in Nova Scotia be permitted to require a doctor’s note when an employee can’t come into work because they are sick or hurt,” said Thompson. “This has been a waste of valuable time for our physicians — time that they cannot afford to lose. It is also a waste of time for Nova Scotians whose time would be better spent staying home, getting better. There are some parameters in place, of course, to protect employers from abuse.”
I asked Thompson how the government settled on five days as the doctor’s note requirement, and not six or 10, or the recommended seven-day COVID isolation period. She said that the five-day figure was arrived at after conducting a “jurisdictional scan” of other provinces’s legislation.
“I think we need to believe in people that those days are going to happen — we all have them — and then we used our discretion to move forward,” said Thompson. “So five days seems like a reasonable number to choose.”
The 21 regulated professions covered by the new legislation are:
• Audiologists and Speech-Language Pathologists
• Chiropractors
• Counselling Therapists
• Dentists
• Dental Hygienists
• Dental Technicians
• Denturists
• Dieticians
• Dispensing Opticians
• All Doctors covered by the Medical Act
• Medical Imagers and Radiation Therapists
• Laboratory Technicians
• Midwifes
• Nurses
• Occupational Therapists
• Optometrists
• Paramedics
• Pharmacists
• Physiotherapists
• Psychologists
• Respiratory Therapists
Nova Scotia is the first province to eliminate application fees for health professionals and to cover the first year license fees.
“If you are a doctor or nurse or other regulated health care professional who is licensed or practice in Canada, this new legislation says can now be licensed to practice here in Nova Scotia,” said Thompson. “Our doors are open.”
Asked if the changes might allow under-qualified health care professionals to move to Nova Scotia, Thompson said it wouldn’t.
“We do it with the colleges,” said Thompson. “And the College of Nurses is a very good example of us looking at cross-jurisdiction understanding of who’s training and what is the registration process. So, you know, this isn’t about lowering the bar. It’s really about opening the door… we want to bring people here. If I were to seek care in Alberta, I wouldn’t look for a Nova Scotia-trained nurse in order to deliver that care there. So I know that the day care is regulated there by the colleges and that’s enough for us.”
In terms defining the scope of work for health professions, the legislation takes away a bit of democratic oversight — cabinet can make changes to the scope of work unilaterally, without a vote of the house.
Thompson said the intent was to speed up the process for what are usually minor or non-controversial changes, such as those brought in with the expansion of virtual care. She insisted that all changes would be made in consultation with and usually at the request of the colleges, but admitted that in theory cabinet could make a change not requested or even opposed by the colleges.
This legislation was designed to protect employers, not workers. Employers can require sick notes from employees who have taken 2 different sick days in the last 12 months. That’s virtually everybody. The legislation has actually made it *easier* for employers to require sick notes, by codifying it and removing any doubt that they are permitted to do so.
Every year I sit in a waiting room full of sick people and get a new prescription for an uncontrolled substance. A nurse is allowed to write a prescription for me, but then my employer drug plan won’t pay for it. I save $200, so it is well worth my time, but how much is even a one minute long appointment with a doctor worth?