Nova Scotia’s health care shortages are almost biblical: no room at the inn, or hospital, clinic or doctor’s office.
Common-sense, backed up by research, says that having a family physician improves health. The physician-patient relationship means illnesses are caught earlier, when it is faster and cheaper to treat, thereby improving health and reducing emergencies. Hospital over-crowding comes from sicker patients who don’t have a family physician as well as a shortage of long-term care beds (some of which might be unnecessary with better access to doctors).
The whole system seems bogged down a type of creative accountancy seemingly designed to spare us from the hellish truth and cover years of inaction by health care executives.
A front-page article (Doctor shortage takes toll on Nova Scotia specialists) focused on the problems faced by specialists and ER doctors at Valley Regional Hospital in Kentville.
The most succinct summary of the situation in Kings County is a sign posted on the door of the walk-in clinic in New Minas. In a classic Catch-22 situation the walk-in clinic is so overwhelmed it can no longer accept walk-in patients.
Kentville is a bell-weather community for the state Nova Scotia health care. First, the Valley Regional Hospital was built as a medical hub where the bulk of specialists in SW Nova are located. Secondly, for the 10 years before she became CEO of the Nova Scotia Health Authority, Janet Knox was president and CEO of the Annapolis Valley District Health Authority. Former NSHA VP of Medicine Dr. Lynn Harrigan was also with the AVDHA, as was Tim Guest, NSHA vice president of integrated health services. They know this hospital and this community intimately, and should know its problems at Valley Regional better than anyone.
The article said 4,752 doctorless patients visited Valley Regional ER in 2018, up from 1,302 in 2013. It’s going to get a lot worse. There’s an easy parallel for understanding this.
Officially, the NSHA’s family physician waitlist has 51,119 people on it. Since November 2016 the NSHA says 75,645 people found a physician. Perhaps they have, but focusing on the official NSHA figures is like jogging on quicksand.
Adding up those waiting for a doctor with those who found a doctor equals 126,764 people. However, an October 2016 Freedom of Information request revealed that 155,415 Nova Scotians didn’t have access to a family physician. The FOI numbers said 20 percent of HRM (78,019) and 14 percent of rural residents (77,396) didn’t have a family physician. Subtracting the official NSHA figures from the FOI number shows 28,651 unaccounted for potential patients.
The population of Kings County in 2016 was 60,600. Fourteen percent of 60,600 is 8,484 people without a family physician. Between June 2017 and February 2018, seven family physicians in Kentville, Kingston, New Minas and Berwick closed their practices. Two other GPs closed their practices and relocated out of the county. One of the departing physicians also held clinics two days a week in Berwick, so his loss was both to his patients (I was one) and the Berwick walk-in clinics. We also lost an eye-ear-and-nose specialist. A common, conservative figure used for average patient loads for established family physicians is 2,000. However, two of the seven had long-time practices which had in excess of 7,000 patients. If you can keep up with the math that means in nine months 21,000 Kings County residents lost their family physician. Add on the 8,484 FOI number and we see that 48 percent of the population of Kings County (29,484) are without a doctor.
A Nurse Practitioner has been found for Kentville and two GPs and a psychiatrist have announced plans to open a New Minas clinic in November. Using NSHA new guidelines for patient loads this gives 3,200 people access to a primary care professional, leaving 24,284 without.
It’s been over a year and up to a year-and-a-half since these seven doctors left their practices. They would have given several months’ notice of closure and yet, the NSHA has failed to hire replacements. The “employment opportunities” listed on NSHealth.ca on March 16, 2019 shows openings for family physicians in Berwick, Kingston, New Minas, Kentville, Canning (full- and part-time), as well as a pediatrician and two anesthesiologists in Kentville, and a Family Practice Department Head – Western Zone.
On top of the physician openings, the Western Zone – Valley, South Shore, Yarmouth – doesn’t have a Zone Medical Executive Director. The job description says, “The Zone Medical Executive Director is accountable for developing physician leaders as well as utilizing resources in an efficient and sustainable manner. Working with a provincial set of policies and standards, the position has zone-level responsibility for the following areas: physician engagement, integration and performance management; privileging and credentialing; appointment and oversight of physician leaders in compliance with the medical bylaws; physician resource planning; coordination of residents and medical students, and physician professional development. In addition, the Zone Medical Executive Director is responsible for integrating provincial programs in the Zone.”
Many doctors question the levels of bureaucracy in the health care system, but this posting shows that no one is in charge in SW Nova. If we are to believe all the layers of executives serve a purpose, then the situation in the Valley can be likened to an orchestra without a conductor. The fact that the NSHA has trouble filling executive posts – Cape Breton is also short a Zone Medical Executive Director as well as 15 other vacant management positions – suggests no one wants to work for this organization. Or at least not under the current executive.
With nearly half of Kings County without a doctor, the walk-in clinic and Valley Regional are bound to be swamped by people seeking medical attention. How serious their need is relative because just getting a prescription refill requires authorization by someone with a medical degree. (BTW, doctors aren’t paid for renewing prescriptions.) If you don’t have a family doctor, if the walk-in clinics no longer accept walk-in patients, the only option is the ER. That is a situation foisted on people by the NSHA’s cavalier physician recruitment plans.
Kentville and Kings County are a health care bell weather situation because they are such highly attractive places to live and work that the NSHA prominently features their position as the heart of Nova Scotia wine country in recruitment marketing. If the poster place for recruiting struggles with a net loss of physicians and ever-growing numbers of orphaned patients, how bad is it the further from Halifax you live and work?
We have heard of the dissatisfaction in Cape Breton. We have heard of the problems in Kentville. A physician in Yarmouth tells me they’re next. By June Yarmouth General will be down to one anaesthetist, which he says makes surgeries almost impossible. The NSHA is looking at a replacement from South Africa but that anaesthetist is still in South Africa and not here. The majority of the residents who were trained in Yarmouth either left the province or became hospitalists elsewhere. And another town doctor is moving his practice to Kelowna. In 2011, six local doctors closed their practices, so the problems aren’t new, they just haven’t been fixed.
In a rebuttal piece about the Kentville situation (Valley patients not in peril while waiting for surgery) Guest said they have teams working hard to address operating room resources, bed flow and human resources. “Our multi-year hip and knee action plan included approval to recruit four additional anesthesiologists for the province.” That’s confirmation of approval to start recruitment, which isn’t the same as having hired someone. The need is not new.
In response to Guest, local resident Bob Levy, who is a former NDP MLA for Kings South and retired judge, wrote this: https://www.thechronicleherald.ca/opinion/letter-to-the-editor/counterpoint-nsha-blame-shifting-292255/
The NSHA attitude towards doctor recruitment is casual in the extreme. We have been bleeding doctors long before the NSHA was formed. The Physician Resource Plan published in 2012, and which family physicians complained was outdated when it was published, said we needed 100 new physicians a year to maintain a status quo which was already stretched to breaking. The PRP predicted that by 2021 our medical needs will equal those of 1.1 million people. That need is based on age, not an actual growth in provincial population. The increased needs of our aging population is a popular excuse for NSHA problems, but not something they or their predecessor authorities seem to have addressed.
Nova Scotia’s Auditor General, Michael Pickup, highlighted the NSHA inaction on November 27, 2017 when he revealed that a physician recruitment plan for the province wasn’t put in place until the spring of 2017! That was two years after the NSHA was officially created. Further, he said that the recruitment efforts of the Nova Scotia Health Authority and Department of Health weren’t coordinated. Which perhaps explains by the NSHA skipped medical recruitment fairs.
After these revelations, NSHA CEO Janet Knox was interviewed on CBC Information Morning. Then-host Don Connelly said to Knox, “I suppose that every conversation you have or hear is about doctor recruitment.” Knox responded, “No, it’s only been in the last year that has been a topic.”
This is a surprise because physician recruitment, retention and loss has been a long-running, hot topic in Nova Scotia. It was the key issue the 2013 provincial election was fought on. Politicians, professional associations and the Physician Resource Plan have long urged action. More and more doctors have been speaking publicly about the declining conditions in our health care system. It boggles the mind that NSHA executives can claim to be surprised by the complaints.
This is not a system failure, it is a management failure. We don’t need more studies, we need to find executives who will act on existing studies, recommendations and needs rather than talk about them.