Access to a family physician is always a hot topic in Nova Scotia. It heated up in October when the struggles the community of Weymouth had in recruiting a doctor became more public. For the first time in 150 years the community doesn’t have a resident physician. The community’s efforts to attract a new doctor have been thwarted by the Nova Scotia Health Authority (NSHA), which is reluctant to grant billing numbers to new solo practices.
The NSHA is focused on establishing Collaborative Care Clinics (CCC) across the province. The NSHA has discovered that new doctors don’t want to work in isolation as a solo practitioner. A study conducted by Dalhousie medical students and presented to a Liberal Party health policy day in January 2014 said new doctors want to share their practice with others so they have a better work-life balance than previous generations of doctors, and also have colleagues to consult. Fair enough.
I get that many doctors like to work together for the work-life balance. But what if there’s a lone-wolf medical maverick out there, an individual who prefers to or is at least willing to work on his or her own? Are we telling him/her “No, you can’t?” What if two or three friends from medical school are willing to open a shared practice? Are they also refused billing numbers because their willingness isn’t allowed under our tight-fisted regime? Why are the willing unacceptable? And why not recruit rural doctors now on the understanding that theirs is in interim practice which will be melded into a CCC in two-, three- or five-years? That interim measure would seem to deal with many of the problems people face now. It could cut costs by providing faster access to care, so diseases and other maladies don’t progress as quickly or at all, and could impact the level of extensive, heroic care provided to some. Two years ago a provincial cancer specialist told me that many of the cases he saw were too far advanced to help. The advanced progression of the disease was due to the length of time it took the patient to either see a physician and/or get a referral. High mortality rates arise from lack of access.
But NSHA is absolutely intransigent about change to their not fully-articulated CCC plans.
During the election and again last month Premier McNeil said a doctor for every Nova Scotian is a priority for this mandate. His office says there are 100,000 Nova Scotians without a family physician. Without a physician, people are forced to go to hospital Emergency Rooms or Out Patient departments for their medical problems and even simple things like a prescription refill.
While the Premier has made physician access a priority, it is less high up on NSHA’s to do list. In October NSHA VP of Medicine, Lynn Harrigan, admitted the authority doesn’t know how severe the doctor shortage is. She told Halifax media the only numbers known are physician vacancies, not the number of people without a GP.
On top of not knowing how many people are without a family physician NSHA president Janet Knox has said it will take five years to develop and staff all the CCCs the province hopes to build. That’s not exactly a sign of urgency and doesn’t recognize the concerns and fears people have at not having a doctor. Knox’s comment also raises the question that if you don’t know how many patients are in need of a GP, how do you know many CCCs you’ll need and how long it will take to build and staff them?
Given this new CCC focus, what happens to the practices of retiring GPs? Will replacement doctors be discouraged from coming in to assume that patient load? Or will new doctors be allowed to practice in some – not all, witness Weymouth – areas?
Another example of this preferred five-to-seven health care timeline arose in the fourth quarter of fiscal 2010-2011. It was a different administration, but it was discovered that Capital Health took up to 133 minutes (two hours +) to offload a patient from an ambulance instead of the provincial criteria to complete this in 20 minutes. Capital Health told the then NDP government they would improve by 10 percent per quarter to achieve the provincial requirement. For some unexplained reason, then Health Minister Maureen MacDonald allowed then Capital Health CEO Chris Powers to dictate to the ministry. Doing the math, this incremental quarterly change meant Capital Health/NSHA wouldn’t meet the provincial requirement for five years. The health authority’s self-imposed deadline was September 2016. In those five years, people in dire enough condition to be delivered to hospital in an ambulance could be left for hours in an ambulance without being seen by hospital staff. Allowing the authority to determine what would happen is insensitive, unresponsive and arrogant.
In September 2013, speaking about a replacement facility for the VG, Powers told The Chronicle Herald, “Any expansion would take at least five years to complete.”
Fast forward to April 2016, Knox told Halifax media the overall project timeline for a replacement facility for the VG “is between five and seven years”.
To reiterate, when the Premier expressed his wish for a doctor for all citizens ASAP, Knox gave herself a five-year term to complete this task.
Back-tracing to pre-merger days: former Health Minister Dave Wilson came to Kentville in November 2012 with a $1 million announcement for a new dialysis unit for Valley Regional Hospital. After the Minister had his photo opportunity and left, then VP Tim Guest (now a VP with the NSHA) told The Advertiser that it would take two years to design and construct a dialysis unit.
As of October 31, 2016, four years later, there is no new dialysis unit in operation. Nor has ground been broken for one. Considering the schedule health executives work to, this is another project that will exceed five years before it opens. Meanwhile, dialysis patients in South West Nova still have to struggle with transportation issues and costs to reach care in Halifax.
Another five-to-seven year project was Colchester East Hants Health Centre in Truro. In September 2005, provincial cabinet authorized $78 million for the construction of the new hospital. The community raised $26 million towards the cost. It opened in November 2012, seven years after it was given cabinet approval, five years after the designs were completed and 11 years after the launch of a campaign to build a new facility. These lengthy time lines don’t seem to suggest executives do extensive or complete planning. As everyone knows, Truro was behind schedule and over-budget. Among the problems the Auditor General identified with this hospital was oversight by people with no experience in capital projects and lack of consideration given to the additional operating costs for a building that was 100,000 sq. ft. larger than the building it replaced. (Nor, in all those years of planning for a new facility was any focus put on finding an alternative use for the existing hospital, causing the health authority to spend over $1.2 million to maintain an empty building.)
The commonality of this timeline raises the question of why everything requires five or seven years? Is it because health executives count on the public having a short memory so won’t be held accountable when they again fail to deliver on what they said?
Five years is also outside the mandate of whatever government is in office. Health executives can expect that a new government will cooperate with anything that discredits the previous government. If the same government is returned, then there’s probably a new minister who, for the sake of party unity, won’t say anything that could reflect poorly on his predecessor, even if it’s not the former minister’s fault that health executives failed to act.
And, given the age of many health executives, does a five-to-seven-year timeline now take them to retirement?