Imagine there were no doctors

To highlight the depth of Nova Scotia’s doctor shortage I’ve studied the 2016 census figures to provide a geographic perspective and give these statistics a sort of face. Picking up on John Lennon’s theme of imagining, imagine there are no doctors…

If Corporate Research Associate’s recent finding that 13 percent of Nova Scotians, roughly 123,500 people, don’t have access to a family physician is accurate, here’s what that means:


Block out counties as you read to grasp the scale of our physician crises.

  • imagine no one in all of Cape Breton having a physician. That’s 122,311 people. Imagine 12 hospitals and health centres without doctors.
  • or imagine no doctor for the residents of nine of our 18 countries: Antigonish, Annapolis, Digby, Guysborough, Inverness, Queens, Shelburne, Victoria, Yarmouth. That’s 124,860 people. That would leave 20 hospitals and health centres without physicians.
  • consider the 132,525 people who live in Kings, Annapolis, Digby, Yarmouth, Shelburne and Queens counties without family physicians. That’s a doctor-less Southwest Nova. Not only that, there would be 16 hospitals and health centres without access to a doctor.

If the actual number of Nova Scotians is the 155,415 orphaned patients suggested by the October 2016 Freedom of Information request, then stretch the imagination to this doctor-less geography:

  • most of Southwest Nova (Kings, Annapolis, Digby, Shelburne, Queens and Lunenburg counties) without a physician. That’s 155,232 residents. That’s the bulk of our agricultural, fishing and forestry sectors at risk.
  • imagine driving from the New Brunswick border by Amherst to Meat Cove on the tip of Cape Breton without crossing any community with a doctor. Cumberland, Colchester, Pictou, Antigonish, Richmond, Inverness and Victoria counties have a population of 156,214 Nova Scotians. They’re home to 18 hospitals and health centres.
  • finally, imagine no doctor for the 156,150 residents of Halifax’s commuter counties: Annapolis, Kings, Hants and Lunenburg.

Imagine driving through county after county without a single physician available. This is how severe our doctor shortage is. It’s more than being down a few physicians here and there.

There aren’t just the current vacancies to fill, there is a rising wave of physicians about to retire, who must be replaced. Our current health care executives are not adequately addressing the issue of physician retention or recruitment.

And given how badly physicians are paid and treated in this province, why would they want to practice here.

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6 Responses to Imagine there were no doctors

  1. Tim Segulin says:

    Premier McNeil says the cupboard is bare. (Well, except during elections).

    We simply can’t afford teachers or nurses or doctors. We simply have to do more with less. We’ll be better for it in the long run. I’m sure that with the combined expertise of government backed up by reports from the odd hired expert we will be able to find a solution to shortages of medical staff that works brilliantly on paper.

    We don’t wouldn’t want to be fiscally irresponsible. That’s the most important thing, isn’t it?

    • Nova Scotia owes $15 billion. Yes, the cupboard is bare. No one said we can’t afford teachers, nurses or doctors. What the politicians said was that government couldn’t afford to give the raises that some asked for. A one percent raise translates to $50 million a year more in expenditures. And if you recall, originally the teachers said their demands weren’t about money. Only after the second or third contract acceptance by their negotiators did it become about money.

      Unhappy unions aside, the shortages of nurses and doctors in this province didn’t just happen in the last four years. This has been building for over a decade. And the problems have been created not by politicians, but by health executives. It would be easy for a politician to toss money at the problem – something the opposition parties promised during the election and something they have pulled back from after the vote – but more money as I have said since starting this blog isn’t the solution.

      The solution starts in the executive offices. Government after government, of all stripes, have made changes to health care. They have pumped more money into it. They have changed how people are educated. Realigned service delivery and duties. There has been a lot of change, a lot of study and a lot of money. And the main constant is poor patient outcomes and declining numbers of medical professionals overseen by the same executives.

      Whether it’s an Conservative, an NDP (*) or a Liberal government, the executives have remained the same. So have the problems. The public has to stop expecting the politicians to react to every issue du jour. Governments write cheques. The executive allocate how they are spent. As we are starting to appreciate from the IWK fiasco we should demand greater oversight of health executives and not be afraid to replace them. They are not gods. They are all too fallible.

      The public grumbles about government and the money we pay politicians. The Premier is paid $202,026 to oversee a $10.5 billion budget. The CEO of the Nova Scotia Health Authority is paid $342,043.68 to oversee a $2 billion budget. Janet Knox is paid 70 percent more than the Premier to manage one fifth the money. Why isn’t the public demanding more accountability, more transparency from her?

      And it’s not that she doesn’t have enough money. That’s a bullshit excuse every health executive has claimed for over a generation. Her hands weren’t tied when she wanted $500,000 in new office furniture or subsidized lunches for white collar workers or hundreds of other expenses.

      I keep saying, be angry, but be angry at the right people for the right thing. It’s too convenient to blame long-term planning and performance failures on any government and give those in charge of day-to-day operations a pass. This misplaced anger is part of what prevents us from having the system we need, want and expect.

      (* there is a mythology that this government is unique in trying to keep expenses down. We were in hospital in December 2009 when the entire health care system went on strike. It was a brief strike, but caused months of rescheduling. In 2010-11 took 102 weeks to negotiate a 104-week nurses’ contract. Then the paramedics almost went on strike in 2012. In opposition parties say whatever will get them to office. In office, all parties act alike.)

  2. Tim Segulin says:

    I strongly support your view that the way we manage delivery and access to public health care in NS is likely the core of the problem. Yes, that means the IWK and NSHA, which seem to be “off limits” to successive governments to whom they are responsible.

    My point was that this government is putting so called ‘fiscal responsibility’ above all else, including perhaps access to quality public health services in a reasonable time. In my view this is based on the fiction that NS is an economic ‘basket case’ approaching Grecian fiscal catastrophe. That is not borne out by our net government debt to GDP ratio, nor our government debt per capita. Yes, we could be doing better, but we are not a huge way below the national average for these measures and certainly now is not the time to head for the lifeboats.

    Yes, I knew the NDP tried to hold down the growing cost of this program which was rising at an alarming rate (reducing an annual 7% cost increase to around 4%) yet they too dared not venture into the hallowed halls of the many DHAs to analyze and reform management – which was where they really needed to be.

    My (perhaps poorly put) point was that last I checked both the majority of our teachers and doctors were among the lower end of their respective remuneration scales in the country, yet Premier McNeil apparently wants to push them down further in real terms, while insisting he is maintaining or even improving education and health care. This conveniently ignores the risk of encouraging experienced teachers and doctors to take early retirement, or they and others simply decamping to places where they feel respected. Two years ago my family doctor was considering moving to NB, where he claimed he could earn and additional $50k for doing exactly the same job. How is it possible that in HRM we have a serious problem with people finding family doctors – the ‘medical home’ under our system, yet this government is trying to cut remuneration of doctors already paid at the low end of the scale? That should attract more…

    I don’t see paying doctors the going rate for their services as ‘throwing money at the problem’. How would this government succeed in trying likewise to low ball Irving or NS Power for cheaper energy?

    Fiscal responsibility is laudable in principle, but it needs to be applied with a modicum of wisdom and it’s not the only responsibility for which the Government of Nova Scotia is liable.

    Lives may also be on the line here.

    • I’m not an apologist for the government, but I question a couple of your points. Your doctor said he could make $50,000 more in New Brunswick. Have you been reading about their system? They’re in a worse situation than we are. He might make more money, but that still isn’t helping patients.

      I never heard the Premier speak of keeping doctors’ incomes low. He’s talked about controlling government salaries. I don’t accept debt-to-GDP ratios. Debt still needs to be serviced, gawd knows we’ll never be able to pay it off. Servicing that debt is taking away from today to pay for the past. It cheats our now and future.

      The impediment to real change in this province is the way health executives blackmail politicians. If the health executives don’t get what they want they go to the public and complain that they’re kept from providing the services they want because of the limited budget. Those executives have never said how much is enough.

      When the NDP formed the government, they attempted to get costs under control. The then health minister said health care spending was frozen at the previous year’s level (there were no new contracts kicking in). Health executives ran to the media and complained that the government had cut their budgets. There was no cut. There was the same level of funding, but the executives who are addicted to always increasing numbers misrepresented that as a cut. The politicians got burned and learned how deceptive the executive class can be. The executives, they learned, were not to be trusted. And because the public is lazy, it buys into the concept that money is the fix. The fix are different people in charge of health care.

  3. Bubbie says:

    We’re up to 13% from 10% of the population, from a few months ago, for people needing a doctor. Still, our provincial government, under Stephen McNeil, refuses to acknowledge our health are system in this province is in a crises.

    • I don’t know that the numbers have changed significantly in a couple of months. The doctor shortage, the nurse shortage has been around for all the years I have written this blog. If anything, the mythology for counting perhaps changed.

      The real crises in health care is the management. Prior to the realignment of health authorities we were bleeding doctors. As I have repeatedly said: Annapolis Valley Health under Knox and Harrigan allowed an orthopaedic surgeon leave the province. They claimed there was no budget to pay her. She travelled across Southwest Nova performing surgeries. She left and her husband, a respiratory specialist, also left.

      Pictou lost an orthopaedic surgeon because he couldn’t get OR time. He left and his wife who is a family physician left. Then there was the loss of 34 doctors in Cape Breton and Yarmouth.

      When we look at the history of health care in Nova Scotia it’s not the government who is the problem, it’s the executives who activity work against retention of doctors.

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