We are constantly told there is a doctor shortage in Nova Scotia. Yet, statistically we are about where we should be in terms of patient-doctor ratios. The problem with statistics is they get skewered by geography, since most of our doctors are concentrated in HRM, which leaves the rest of the province under-serviced.
Provincially, the hottest information in any community is not a scandal, but about a new doctor accepting patients.
On the surface the province’s just-announced $200,000 contract with Emergency Medical Care to reduce ER closures by tapping a floating supply of provincial doctors seems a good idea. Anything that reduces closures and wait times is a good, right? In reality this contract is a shining example of the failure of Nova Scotia Health Care as it is currently organized.
How is it that Nova Scotia’s ten health authorities, using their existing army of over 400 administrators, can’t schedule staff?
And does the Province actually know the problem? Will this contract address all the issues?
On Wednesday, September 19th, a friend travelled to Halifax to meet with a surgeon about potential treatment. The surgeon was mad as hell over two surgeries which had to be cancelled that day because there were no operating room nurses. He was there, the patients were there, the nurses weren’t. Now, nurses, like anyone else get sick or have family emergencies arise. So how is it that in all of Halifax, which lists 222 health care administrators in the six-figure club, no one was capable of scheduling back up OR support?
This isn’t a unique situation. I’ve spoken with a psoriasis sufferer who had their treatments set back by four months because a support person in Halifax was out sick. In June, Middleton Mayor Calvin Eddy complained that Annapolis Valley Health (AVH) scheduled ER closures at Soldiers’ Memorial Hospital on weekends when the town was hosting large events, like the ironically-named Relay for Life which drew an additional 1,000 people to the community and again for the following weekend’s Antique Show and Shine. AVH said these closures were due to a doctor shortage.
Doctor shortages have been the quick and easy answer. But as we later learned, there appears to be a resistance by doctors to fill in at the Middleton ER because they’re paid $55 an hour less than their colleagues working in the Kentville ER, which are both under Annapolis Valley Health. It seems there are doctors, but the issue may come down to administrators who are trying to cut front-line costs.
Additionally, the Annapolis Spectator, reported that two ER closures in Middleton and Digby in the week between events were due to a nurse shortage.
In a November 26, 2011 letter to the Herald, Wayne Boucher, Chairman of Friends of the Annapolis Community Health Centre, referencing what he described as “a feel-good” announcement of a Collaborative Emergency Centre at the Annapolis Community Health Centre said the 1,512 hours in ER closures in 2010-11 credited to doctor shortages was “emphatically not the case. Those hours had more to do with AVH decision-making than a doctor shortage. It is unclear why there were 104 hours of ER closure from July to October 2011. It was not due to a doctor shortage.”
There are enough examples coming out to suggest that ER closures and other treatment delays are more of a scheduling problem that a lack of available medical professionals. Otherwise where is this private company finding a pool of available doctors? How come they can do it, but publicly paid administrators can’t? Is this some sort of subtle movement towards a private health system?
If we had better scheduling then maybe we wouldn’t lag behind the rest of the Canada in terms of treatment and delivery of services. Maybe then the 58 percent of Nova Scotians not getting knee replacement surgery and 46 percent not getting hip replacements within recommended treatment times, would. Maybe children on eight-month-long, pain-treatment waiting lists wouldn’t have to suffer so long.
We are always being told that productivity is a problem in Canada. The implication is that the “workers” have to do better. But what happens when the productivity failures are at the top?
Clearly having our health care organized into 10 separate, competing, non-communicative silos is not productive, efficient, coordinated or in the best interest of patients. This contract illustrates the on-going failure of our organizational structure. One provincial authority would ensure everyone working in health care was treated fairly and paid equally, and would result in better coordination of facilities and scheduling of doctors, nurses and support staff so that patients are treated in a more timely manner.
Nova Scotia is looking at all manner of ways to save money by reducing the numbers of council seats, re-aligning school boards, and discussing cutting the number of municipalities and merging driver’s licenses and health cards. Yet health care, which consumes 40 percent of the provincial budget, is allowed to flounder with an inefficient, non-responsive, top-heavy organizational structure. It’s clearly not working, why stick with it?