The hidden costs of the doctor shortage

More and more doctors, specialists, surgeons are speaking out about the hidden costs of the shortage of family physicians in the province.

On the first work day of 2018 vascular surgeon Dr. Gerry MacKean said a complaint at a meeting of specialists was how all were being asked to step outside their medical specialties to supply the basic care normally provided by family physicians. This included writing prescriptions. Dr. MacKean knows his specialty, but he isn’t a general practitioner, isn’t up on certain pharmacology and is uncomfortable with some of the care requests being made of him. His colleagues feel the same. It’s also an expensive stop-gap measure that diverts him from more urgent cases that need his specialized knowledge.

Then Dr. Kirk Magee, interim head of emergency medicine at the Queen Elizabeth II Health Sciences Centre, added his observation about the impact of the shortage of family physicians. The shortage is driving more people to treat ERs as a type of walk-in clinic.

According to Dr. Magee 14 percent of patients visiting the Halifax Infirmary ER are orphaned patients seeking basic medical care. As many as half of the people using the ER are seeking a prescription top up.

According to the Nova Scotia Health Authority’s website, 561,516 people visited provincial ERs in the previous year. An earlier report said that 48 percent of ER visits were not medical emergencies, they were people seeking walk-in care that normally would be provided by a family physician. That means 269,527 visits were not an emergency.

This is a waste of resources, a great waste of individual’s time and a massive financial hit. The Legislature’s Public Accounts committee have been told it costs approximately $200 per ER patient. Provincial doctors say that $200 figure doesn’t include the supporting costs: like nurses or operating the facility.

Using the $200 figure means that the 269,527 non-emergency ER visits cost $53,905,400. If those patients were seen by a doctor in his or her office, the doctors would have billed an average of $31 per appointment or $8,355,337. In short, the system is wasting $45,550,063 delivering care in this format. Furthermore, since writing prescriptions isn’t a billable fee for family physicians in private practice, writing ER prescriptions is an additional $3.5 million payout. I’ve said it before, it’s not a matter of money, it’s management. If we had more family physicians the pressure would be off ERs and specialists, and the population would be healthier.

This is reminiscent of the telephone changes made in the provincial civil service in the 1990s. Efficiency experts decided a new system would cut connection charges and reduce the need for support staff across the civil service. As a result, people in the $25,000-a-year range were eased out and positions eliminated. The result was that senior executives found themselves performing the work of people paid a third or a quarter of their pay and the work they were hired to perform was impeded. Sounds a lot like health care today.

 

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3 Responses to The hidden costs of the doctor shortage

  1. billybob1963 says:

    Or, perhaps, it may be an opportunity. MD’s get — at best — a few weeks of pharmacology. My own family physician (I am one of the lucky ones), throws her hands up on frustration when I talk to her about a new asthma med (“There’s too many drugs!!!”). Yet, pharmacists get a whole education on pharmacology. Maybe they should be doing more of the prescribing, while asking doctors to focus on the diagnosis and indication, which BTW they are not required to provide when they prescribe – though don’t you think they should?

    • I’m concerned that with the current executives too many ideas will further stall them from creating actual solutions to recruiting more doctors and their blockages to practice by those who want to establish practices in the province.

      One issue I encountered was that the pharmacy I use turned out to have two files for me. I wonder if duplicate pharmacy files contribute to the opioid crises?

  2. buddyboy546 says:

    It seems obvious to everyone except those in control of the system of health care that the system is badly broken. The situation is made far worse by the continuing secrecy of the NSHA who hold closed meetings and publish no minutes for public scrutiny. Our doctor shortage, due to an aging population, has been predicted for years.

    My MIL at 94 had a stroke and was admitted to hospital on December 4 last. After a couple of weeks it was determined she needed no more hospital care but needed a new placement into a facility which provided a higher level of care than her previous placement. As there was no placement available, she remains languishing in hospital among many, many others in the same situation. Hospital beds cost, I am told, about $2800 per day, compared with far less per day in a care facility. Bottom line, as in the scenario described in this article, bad decisions being made over a prolongued period by those in charge (government and NSHA) are costing us all an absolute fortune while health care implodes.

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