More doctor losses

Four months ago the walk-in clinic in New Minas posted a notice that they were no longer accepting walk-in patients. A month ago they announced the impending closure of the walk-in clinic. The clinic has closed. These signs are in the entrance of what was that clinic.

This illustrates the absolute desperation in the delivery of health care in Nova Scotia.

Further to this are the unfathomable actions of the Nova Scotia Health Authority under the leadership of president and CEO Janet Knox. On Thursday, June 27, a Valley physician told me he knew of four physicians who were interested in establishing family practices in the Kings-Hants County area (Kentville to Windsor). Three of those physicians were only offered half-time practices by the NSHA and the limitations on the fourth were such that none of these doctors could make a living here!

These four doctors have moved their search for host communities for their medical practices outside of Nova Scotia.

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A new low in the politicalization of health care

On the morning of June 28, 2019 the Province of Nova Scotia sank to a new low in the politicalization of health care.

The Minister of Health announced that as of July 1st the government will cover breast augmentation surgery for transgender women in Nova Scotia.

No doubt using notes carefully prepared for him and vetted among public relations officers the Minister said and is quoted in press releases saying, “I can appreciate the distress transgender people can experience during their transition, and I thank those who have advocated for this change. We are now providing more support and more equitable coverage for transgender women.”

There was no mention of how many years people have advocated for this service. Nor an explanation for “why now?” The simple answer is: tokenism.

This is Pride Month, so jump on the inclusivity bandwagon to look caring and like you’re doing something for the LBGTQ community.

This is offensive.

People who have medical needs deserve to have those needs addressed asap. Decisions about and delivery of medical care should not be dependent on political opportunism and advantage. It cheapens government, governance and our trust in those who hold public office.

This type of opportunism and demeaning of trust in decision-making leaves a bad taste. What happens to people with other medical issues? Do they need a month and photo opportunity for government to consider them?

Legitimate medical needs should be addressed on the basis of that need and urgency for those afflicted, NOT for the political agenda of a government and the Nova Scotia Health Authority.

I have no position on the need or urgency of this. I am offended by the political manipulation. This is a disingenuous initiative which should offend everyone.

For those who many benefit, information is here:

https://novascotia.ca/dhw/gender-affirming-surgery/?utm_source=halifaxtoday.ca&utm_campaign=halifaxtoday.ca&utm_medium=referral

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Why is the NSHA recruiting for positions in Kenya?

Why, I wonder, is the Nova Scotia Health Authority hiring people to work in Nairobi, Kenya?

The NSHA can’t find people to work in Nova Scotia, so why would they be staffing overseas? And this is not hiring staff overseas, but for overseas. Below is an ad the NSHA has run on-line.

Sure, it’s a mistake. At least one hopes it’s a mistake, but how has no one at the NSHA discovered it? Why haven’t they corrected it or taken it down?

How many other simple things do they screw up? How do they get Nairobi out of any Nova Scotia destination?

The NSHA add: 

Family Practice Department Head – Nairobi

Company Name: Nova Scotia Health Authority

Company Location: Nairobi, KE 

This job is no longer accepting applications

Job applicants: 
Entry level

Company: 10,001 employees
Hospital & Health Care

Job description

Expression of Interest

Context 

The Nova Scotia Government has outlined a vision for health care called Putting Patients First – Developing solutions so all Nova Scotians get the care they need when they need it. Overall goals are to improve the health and wellness of Nova Scotians, provide safe and quality person centered care, and to create a sustainable, effective and affordable provincial health system.

A critical step in enabling this vision was the consolidation of the nine existing district health authorities into one provincial authority, the Nova Scotia Health Authority (NSHA), with the IWK remaining as a separate authority. A streamlined health system provides many opportunities to put resources where most effective to meet population needs, build a system that focuses on people and patients, ensure a provincial approach to planning and integration of services, and reduce duplication.

The NSHA was created by legislation on April 1, 2015. A new zone leadership team was recruited for this organization including a Head, Department of Family Practice for each of the four administrative zones.

The Department Of Family Practice

  • Represents more than 1000 family physicians in Nova Scotia
  • Focuses on topics that are relevant to family physicians and family practice
  • Supports a collaborative approach to primary health care
  • Strengthens communication and relationships between family physicians and specialist colleagues at NSHA to improve patient care and access
  • Provides a learning and social network for the family practice community

Mandate

Reporting to the Zone Medical Executive Director and working within a co-leadership model with an Administrative Co-lead (Director Primary Health Care, Western Zone) the Zone Department Head of Family Practice provides strategic and operational planning and service leadership in collaboration with health system stakeholders for the Eastern Zone Department of Family Practice.

Accountabilities

Department Administration

  • In collaboration with the Medical Executive Director ensures that the Department medical staff activities are consistent with the overall strategic and operational direction of the Department and aligned with NSHA strategic imperatives;
  • In partnership with the Department leaders, ensures the effective, efficient utilization of Department resources – human, financial, space, physical and clinical;
  • Participates in the development, oversight and reporting of Zone Department’s objectives, planning, budgeting, resource allocation and utilization;
  • Develops a schedule of physicians to ensure coverage of the unit and appropriate medical administration;
  • Makes recommendations regarding physician resource needs for the Zone Department, in collaboration with the Zone Medical Executive Director, the Vice President of Medicine and Integrated Health Services, the Medical Site lead(s) and, where applicable, the Zone Division Heads; Quality and Utilization Management
  • Working with appropriate representation from the geographic location of the health care facilities, sets the standards/guidelines for health services for the assigned Department; develops systems for monitoring performance to these standards; develops and executes mitigation and improvement plans in the areas of non-performance and develops action plans for issues.
  • In collaboration with the Zone Medical Executive Director, addresses any standards of medical practice including issues regarding performance and behaviors of department members aligned to the Department and works to resolve complaints regarding care/services provided by medical staff within the Department.
  • The Zone Medical Department Head coordinates regular utilization reviews and assists with bed management issues as required.

Leadership 

In collaboration with other physician leaders, leads the planning and development of policies that support the integration and standardization of the Department.

  • Must be a member of Zone Medical Advisory Committee (ZMAC) and as such, advise ZMAC on the quality of care and treatment provided to patients and the fulfillment of teaching and research responsibilities within the Zone Department. If the Zone Medical Department Head and the University Department Head are not the same individual, the Zone Medical Department Head is responsible for the organization and implementation of clinical activities and works with the University Department Head for the academic review within the Department.
  • Serves as the Academic Lead for medical students and residents for the Zone Department.
  • Identifies potential liability issues and legal problems within the Department and provides advice to Zone Medical Executive Director and legal counsel for specific cases/files, as required.
  • Participates in performance appraisals as directed by the Zone Medical Executive Director and implements the NSHA’s process for continuing professional development and evaluation related to the Zone Department.
  • Undertakes professional development in management and leadership as agreed with the Medical Executive Director.
  • Holds regular meetings with members of the Zone Department, Zone Division heads within the Department, Zone Network Leads, and medical site leaders and ensures consultation and compliance with the current Health Authority and departmental objectives, policies and rules and regulations.

As the organization matures, areas of responsibility may change to create needed alignment of Departments and networks.

Eligibility

MD (with or without specialty) with evidence of past and ongoing leadership training.

Application Deadline:Posted until filled.

Compensation: Range $125,000 – $175,000 – individual compensation will be set based on previous leadership experience.

Seniority Level: Entry level

Industry: Hospital & Health Care

Employment Type: Full-time

Job Functions: Other

 

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Absent policy cruel for seniors

A front page article, “Keeping couples apart ‘cruel’” is sad for the family and an unnecessary situation.

https://www.thechronicleherald.ca/news/local/keeping-couples-apart-cruel-halifax-veteran-separated-from-wife-in-her-last-days-319112/

The desire for Mr. and Mrs. McCabe to spend their last years together is not unique. Nor is it the first time that the spouse of a veteran placed in the Camp Hill Veterans Memorial Hospital been denied the right to be together.

In June 2018 Bryce and Hazel Gibson from Halifax, who had been married for75 years, were separated when he went to Camp Hill and she to another long-term care facility.

Forceful breakups of long-standing marriages is such an epidemic in that October 2016 the Progressive Conservative Party of Nova Scotia introduced a bill guaranteeing couples could stay together in long-term care homes. Former party leader Jamie Baillie told the CBC he had been approached by a family about a situation where only one spouse could stay in a federal facility. Sound familiar?

At the time former Health Minister Leo Glavine, who had dealt with five similar cases, said, “When the day comes for [the couple] to go into a nursing home in Nova Scotia, they will go as a couple.”

A spokesperson for the Department of Health said the issue would be addressed in a continuing care strategy. That was 33 months ago. Where’s the strategy?

What is so confusing is the federal government, through Veterans Affairs, allows the Nova Scotia Health Authority to use discretion to fill the empty beds at Camp Hill. Year-after-year Camp Hill consistently has empty beds. So the impediment to keeping elderly couples together is the NSHA.

Over and over again, Nova Scotia’s aging population is highlighted as the root cause of the problems faced by government and health care. For all those excuses we don’t hear solutions. Government and the NSHA have had time to factor that aging population into all their decisions. They haven’t.

Separating elderly couples is not a new or unique issue. This has been an on-going issue since 2015. How long does it take the NSHA and Department of Health to address a problem?

This is the failure of health bureaucrats and executives to anticipate and act.

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Physician recruitment doesn’t add up

Nova Scotia’s family physician recruitment plans don’t add up. The Government and Nova Scotia Health Authority don’t seem on the same page.

The Nova Scotia Health Authority’s list of “career opportunities” suggest it seeks to hire family physicians on a one-for-one basis. A physician retires or moves, the NSHA posts an opening. Hiring on a one-for-one basis only exacerbates the province’s doctor shortage. The rule of thumb in Nova Scotia is that most family physicians care for 2,000 patients. Longer-practicing doctors have almost double that number of patients. My personal physician, in his early 40s, has 3,800 patients.

New doctors are being recruited with work-life balance in mind. To that end, new recruits are expected to handle a patient load of 1,350 people. That’s one third fewer patients than the bulk of family physicians in Nova Scotia see.

On April 6, at a community event I mentioned this to an MLA and suggested we should be hiring 1.5 doctors for every opening. He responded by saying, “We should be hiring TWO doctors for every one that leaves.”

On April 27th, in responding to a television reporter’s questions about the provincial doctor shortage and Inez Rudderham’s video about her journey with cancer in Nova Scotia, Premier McNeil said his Annapolis riding was losing six doctors and “we should be hiring twice that number” of doctors.

What the Government is advocating is not what the NSHA is doing.

The Premier’s comment means the NSHA should be hiring 12 family doctors for Annapolis County. The NSHA is only advertising for three physicians. In Kings County, which lost nine family physicians between June 2017 and February 2018, but is getting three doctors in November, the NSHA is looking for five full-time and one part-time family physician.

The net loss of family doctors in those two counties is 12, but the NSHA only sees the need for 8.5 physicians.

That part-time physician opening is one of 19 part-time positions across the province. This is curious because Doctors Nova Scotia says they haven’t a definition for a part-time physician. The best guess is that this would be half of a full-time physician’s patient load, so 675 people. Whatever a part-time physician’s duties are, the NSHA appears not to have transmitted them to DoctorsNS.

Adding up the patient loads of the 12 Annapolis and Kings County doctors who have left or announced their departure means 33,000 patients are seeking a family physician. However, the NSHA recruitment goals would only provide a full-time family physician for 11,475 people. That leaves 21,525 “orphaned patients”. This doesn’t include those residents who didn’t have a family doctor before these departures.

The question remains: if new doctors are expected to see one-third fewer patients than those they replace, why aren’t we advertising more open positions? And why are the Government and NSHA so far apart on our needs?

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Gabrielle Horne speaks

Finally, Dr. Gabrielle Horne is speaking up about the hell Nova Scotia health care put her through. Her story is a warning to potential medical professionals thinking of working here as well as to Nova Scotians, about who to trust, and to those politicians who continue to shield the guilty.

This is an important read:

https://www.theglobeandmail.com/opinion/article-physician-heal-thyself-the-potential-crisis-of-conscience-in/?fbclid=IwAR0bVqSyyl_S6KRYmJDZUK1gYfmoZzYsEoxUqYIg01uUWiESmv2I4gdfKmY#comments

In the reader comments two writers wrote:

MG59 said, “In the interest of fairness, I would be curious to hear the other side of this story.

“I’m not saying that she is necessarily misrepresenting things, but anyone with life experience dealing with powerful people in high level organizations knows that there are two (or more) sides to these internal conflicts, and she seems to be alleging conspiracies and dark dealings among a large number of people.

“Count me a bit skeptical.”

AceMcFool added, “I guess I’ve been around too long to reaily (sic) believe in such one-sided perspectives, especially when so many people are involved.”

This article is Dr. Horne finally speaking after a decade of persecution and litigation in which that unheard ‘other side’ spent in excess of $10 million taxpayer dollars to try to silence her and protect the vanity and professional reputations of those who were in the wrong.

In Nova Scotia we reward resumes, not results.

While the original complainant may have been a male physician, the harm was carried out – and funds approved to do so – by women. Specifically, former CEO of the Capital District Health Authority, Chris Power, who is now CEO of the Canadian Patient Safety Institute. Power was in charge when the spurious accusations were made against Dr. Horne. Then, when the Nova Scotia Health Authority was formed, CEO Janet Knox, a long-time friend and colleague of Power, approved a multi-million appeal against the initial court ruling for Dr. Horne.

In the interest of public health, better health and fairness, the public needs to remember that the courts TWICE found in favour of Dr. Horne.

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The acute doctor deficit in Kings County should concern all Nova Scotia

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.

https://www.thechronicleherald.ca/news/local/doctor-shortage-takes-toll-on-nova-scotia-specialists-291329/-

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.

DSCN1299

This notice is on the door to the walk-in clinic in New Minas, Kings County. (Allan Lynch Photo)

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.

Guest’s rebuttal is here: https://www.thechronicleherald.ca/opinion/counterpoint-valley-patients-not-in-peril-while-waiting-for-surgery-291599/

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.

 

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