Premier Tim Houston and Health Minister Michelle Thompson visited the Dalhousie Family Medicine Clinic in Halifax on Wednesday to announce new initiatives designed to help recruit more family doctors and to help more people access health care.
There are currently close to 110,000 Nova Scotians registered on the Need a Family Practice Registry, a number that has grown by 40,000 in the past 14 months since the Conservatives were elected on a promise to fix health care.
The result is that across the province it’s not unusual to see lineups of 30 people or more waiting for walk-in clinics to open so they can be seen by a health care professional. Or people paying a monthly fee of $25 to a new private medical clinic called Algomed just to ensure they can get an appointment to see a nurse if they happen to get sick or need a prescription refill.
“Improving health care is the most pressing issue for Nova Scotians,” Houston said on Wednesday. “And I assure you it is one of the most pressing issues for me and my government.”
Houston and Thompson said recent changes made at the Dalhousie Family Medicine Clinics located in the West End Mall and in Spryfield have resulted in 780 patients coming off the Need a Family Practice Registry. By the end of June 2023, Thompson expects approximately 3,500 people will no longer be without a health care provider.
Changes being trialed by the Dalhousie clinic where student doctors are trained include hiring a licensed practical nurse, a physiotherapist, and a social worker to form a collaborative team that can provide ongoing care to people with chronic health issues such as diabetes and COPD. Teamwork means more patients can be seen without necessarily involving a medical doctor or a nurse practitioner. If consults are required, the visits will be shorter.
The licensed practical nurse or “rapid onboarding team” is another idea targeted to reduce some of the paperwork associated with taking patient histories and dealing with patient referrals that consume a lot of time. According to Dr. Joanna Zed, the medical director of Dalhousie’s Family Medicine program, that one change has increased the capacity of the Dal clinics to see about 30% more patients.
Over the next four years, these changes being tested at the Dalhousie Family Medicine Clinics will be offered across the province to other community clinics and family medicine practices.
“We are hopeful Nova Scotians will experience faster access to care once these new projects are scaled up and out across the province,” said Gail Tomblin Murphy, vice-president of research, innovation, and discovery at Nova Scotia Health.
Changes to the composition of family practices along with reducing the paper burden should help nurse practitioners and doctors see more patients.
A third change is aimed at encouraging more medical students to consider family medicine as a career and to retain even more graduates of Dalhousie University’s Family Medicine program.
About 44 family medicine doctors graduated from Dalhousie last year. According to Jane Gaffney, media relations for Dalhousie Medical School, over the past five years, about three-quarters of the family medicine graduates have chosen to stay in Nova Scotia.
Starting this summer, when the next cohort is due to graduate, newly minted family doctors will be offered free office space and an experienced mentor if they sign on to work at Dalhousie Family Medicine clinics before establishing their own practice. And they may take their Dal clinic patients with them.
“This offers new doctors an optimal training environment,” said Zed.
This same offer may be available sooner than next summer to doctors who are new or moving to Nova Scotia, according to Grayson Fulmer, senior director medical affairs with Nova Scotia Health.
The premier announced the province has budgeted $6.3 million over four years to test these new models and “scale them up” at community clinics across the province.
Liberal leader Zach Churchill said he hopes that it will work.
“We want to see less people who need a family doctor,” Churchill said in an interview with the Examiner. “So, time will tell whether this is an effective model or not. We have to evaluate it based on how many new family doctors are being brought into the system and how many patients are being attached.”
“Another real important question is whether we are going to be able to keep up with the pace of retirements. We know, for example, there are more than 100 family doctors practicing who are over the age of 65.”
NDP MLA Gary Burrill said Wednesday’s announcement were “good baby steps” at a time when “bold steps” are required to improve access to health care.
“At this time, when we have 110,000 people on the list waiting for a family practice, I think it is true this is not a moment for baby steps. It’s a moment for the kind of bold and comprehensive steps that were promised by the Conservatives and the government 14 months ago and I think we are not seeing those today.”
Burrill said it’s a question of magnitude. “We are talking about acquiring better access to health care for 3,500 people in a situation where we have 110,000.”
Meanwhile, the emergency rooms remain overcrowded when people have no other option.
The legislature goes back in session on Thursday. The premier declined to respond to a question from reporters about why he asked Conservative MLA Keith Bain to consider resigning as Speaker of the House. Houston said he didn’t want to “taint” the good news around health care by responding to “rumours” and a “manufactured story.”
Bain has not offered his resignation.
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(That the nearest Well Woman Clinic for those without a family doctor occurs once a month, but on a regular schedule approximately every four weeks, is a separate scheduling issue, but also contributes to the effective lack of health care access for folks without a family doctor.)
In the Annapolis Valley, for Kings and Annapolis Counties, there are no walk-in clinics. There are after-hours clinics M-F (excluding holidays) at the hospitals in Wolfville and Berwick. To get an appointment with these, you have to call in the morning on the same day. If the folks who take the bookings are on the phone, you get sent to voicemail and told to call back (that is, there is no phone queue). Spaces are filled within the first hour that booking is open usually. So when the doctor in Toronto who answered my request on the TeleHealth app on Monday told me I had to see someone in person to get a referral to a specialist for a non-emergency, ongoing medical issue that I’ve had for years and have seen a specialist for before, it was too late in the day, plus Monday was a holiday so the two after-hours clinics were closed.
So I tried to get an appointment on Tuesday. Turns out the Berwick clinic phone line opens an hour earlier than the Wolfville clinic phone line, that I was more familiar with. So they were already booked up when I reached them. It took me 36 calls over an hour and a half to finally reach a person for the Wolfville clinic, and by then spaces for that day were also filled, so that was an hour and a half wasted. I had to work yesterday so the after hours clinic wasn’t an option. I was able to get an appointment today by basically spamming the phone line: calling 130 times in 35 minutes. That’s at the clinic that is farther away from me, but I figured to actually get an appointment I couldn’t be choosy and needed to start with the one whose phone line opened first. (Fortunately I have a car, so it will only involve an hour extra travel time rather than 2 hours on the bus or an expensive cab ride if I ended up with an appointment that ran later than the last bus.)
There’s apparently a primary care clinic at the hospital in Kentville, too, that is not the emergency room? I just learned this accidentally by stumbling on the exact right web page today after finally getting an appointment, and have no idea how their bookings are managed (the info I found says that they also do not take walk-ins, however; the only walk-in option in this region is the emergency room).
Between waiting around for a TeleHealth reply (which does function similar to a walk-in clinic, and doesn’t take bookings) and repeatedly dialing my phone for an after-hours clinic appointment, I’ve spent half a work day this week just to book an appointment. My success rate at actually accessing care through TeleHealth is at about 25%, with an average wait time of 2-3 hours, and my success rate at actually accessing care through the in-person clinics is about the same, though I guess technically with half the wait time since space gets booked up so quickly each day those clinics are open. All in all, each medical consultation I’ve had in the past 2-3 years while I’ve been on the family doctor wait list has taken about two work days of cumulative time out of my schedule – for what is usually a 15 minute, very straightforward consultation, in my case.
Even apart from the lack of doctors and nurse practitioners in the province, the systems for people without a family doctor to be able to actually access medical care are horribly broken. There’s no reason that the TeleHealth app couldn’t allow for pre-booked, non-same-day appointments, or have an option where patients could roll over their spot in a queue to another day if their consultation request times out for that day (’cause the TeleHealth app also only takes appointments during business hours M-F, and times out after some number of hours). And while it is important for access to care that people without computers can book appointments at the in-person primary care clinics over the phone, there’s no reason why some space couldn’t be held for phone appointments and other space be bookable online, or why the hospitals that the clinics are at couldn’t get a basic phone queue system. Or a more centralized system could schedule people to triage patient needs and, if patient transport between clinics was provided for those without transport, to distribute the workload between clinics some (though my impression is that all of the primary care clinics across the province have insufficient capacity to meet patient need).
It might be useful to know how many calls the primary care clinics throughout the province get each day to request appointments versus how many appointments are available. That seems like it might be obtainable through a freedom of information request, if such data is collected at all? (Certainly with the current phone system, there is no way to know how many patients just never get through and give up, so there seem to be no direct measurements of unmet need. When I’m in a more cynical mood, I tend to suspect that’s by design on the part of the province.)
We have been with Dalhousie Family Medicine since 1974, a year after the practice was formed. Two of our children were delivered by staff. Just a few blips along the way but excellent care and excellent staff. I had an appointment on Tuesday and the usual level of care could not be better. Well worth the drive from Dartmouth and we have no intention of leaving the practice.