Nova Scotia’s Auditor General, Michael Pickup, revealed the shocking news that a physician recruitment plan for the province wasn’t put in place until the spring of 2017! Further, he said that the recruitment efforts of the Nova Scotia Health Authority and Department of Health weren’t coordinated.
This is a surprise because physician recruitment, retention and loss has been a long-running, hot topic in Nova Scotia. A key campaign theme in the 2013 provincial election was the recruitment of more family doctors to the province.
So, compounding the surprise that it’s taken four years to launch some sort of last-minute, uncoordinated recruitment plan, was an interview NSHA CEO Janet Knox gave to CBC Information Morning. 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.”
How sheltered a world does Knox inhabit? Given the fortress-like mentality of the Nova Scotia Health Authority, the secrecy of its operations and invisibility of the NSHA board Knox seems to have designed a corporate structure and culture that provides her with a level of deniability about the biggest topic in medicine. Her response suggests she doesn’t read newspapers, listen to radio, watch television news, have summaries provided or actually listen to doctors, medical groups and politicians of all parties. I don’t mention the public because the public hasn’t a snowball’s chance in hell of reaching her.
In her CBC interview Knox said she had made 60 trips across the province to “engage” with Nova Scotians. That level of travel is not reflected in her expenses. She expensed $28.40 for a lunch with a Dr. Mayne in June, but there is no detail or suggestion of mileage for such extensive, expensive travel across Nova Scotia. It may be that she is provided with a car and operating costs, but that also isn’t itemized anywhere in her compensation or expenses.
“Engage” is an interesting word. Language in health care is critical. It’s not merely to discuss actual medicine, it’s important for public relations. NSHA says it “engages” and holds “consultations” with medical professionals. But their definition of “engage” and “consult” is not a two-way communication. It’s not even fact-finding because it is devoid of the listening function. I have heard of senior specialists telling NSHA executives to “shut up” so they – the front line medical professionals – can speak. Another meeting I heard of had 40 doctors shout “liar” to an executive. Then there was the meeting that left many in tears and shock. At that meeting the NSHA executive advised doctors not to renew office leases.
Doctor after doctor said meetings, conference calls and other “consultations” were a one-way information stream, where NSHA executives and zone managers deliver corporate decisions about how doctors practice medicine. It is not a collaborative process, which is ironic given how the NSHA has focused on developing collaborative care practices / collaborative care centres (CCC).
Four quick things to know about collaborative care:
- The NSHA’s focus on these has actively discouraged, limited and/or prevented family physicians from establishing medical practices where they wish or taking over an existing practice;
- CCC’s are more expensive medical models, which Ontario has abandoned;
- Because the CCC may be called a “collaborative” practice, doesn’t make it so. A long-time family physician maintains doctors have always collaborated with other professionals to deliver care. Many doctors and other medical professionals have said putting people in the same location can’t make them cooperate or like each other. I was copied on an email which said, “… in the spring I received a copy of an email from a doctor in XXXX to a colleague complaining about the CCC there. He estimated that its operating costs were double what another clinic cost and the various members of it hated each other so that they stopped speaking to each other.”
- And there is the big lie of CCCs. It’s a lie based on a false impression. The public has been sold on CCCs as a centralized, convenient one-stop medical delivery facility. A patient won’t just find their family doctor there, they will have access to a variety of medical professionals. The way the CCCs have been sold is that one visit handles all. Here’s the rub: a patient may access a variety of professionals at a CCC, but those will require a variety of appointments. Another physician wrote, “Just because people are located in the same spot doesn’t assure a patient they will be able to be seen on the same visit. The evidence is that the costs are higher and that access per clinician seems to be reduced not increased. There is a cost for unnecessary collaboration.”
Our doctor numbers are not good. The implementation – of any and everything – is not good. Communications are not good. So what expectations can the public have?
If you study the NSHA website there is a reference to succession planning for a new executive. To help health care perhaps this recruitment should be accelerated and a quick deadline set. And met.