NSHA’s failed doctor recruitment

There’s a theory that numbers don’t lie. However, their interpretation can colour the message.

Over the years, great minds have questioned numbers and facts used to promote an idea. In 1891 a letter writer penned, “It has been wittily remarked that there are three kinds of falsehood: the first is a ‘fib,’ the second is a downright lie, and the third and most aggravated is statistics.”

The following year, a writer to The Economic Journal said there are “three types of unreliable witnesses: a liar, a damned liar, and an expert.”

Later Mark Twain added his take: “Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: ‘There are three kinds of lies: lies, damned lies, and statistics.'”

Lies, damned lies and statistics sums up Nova Scotia doctor recruitment.

The lie is one of omission. The Nova Scotia Health Authority let Nova Scotians believe doctor recruitment was one of their first and on-going action areas. The NSHA was formed in April 2015. While the initial planning for the merged health system started under the NDP government of Darrell Dexter, who refused to admit it was an idea whose time had come, the NSHA was created after the Liberals won an election in October 2013. The two prime election planks of that election were re-aligning health care AND providing a family physician for every Nova Scotian.

Based on the election campaign and promise, Nova Scotians thought hiring doctors was job one for the new health authority. We were wrong. It is thanks to Auditor General Michael Pickup that we learned the NSHA didn’t put a doctor recruitment plan in place until the spring of 2017! Doctor recruitment wasn’t a priority for or even on NSHA CEO Janet Knox’s radar. In November 2017 Knox appeared on 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.”

That exchange is a prime example of the disconnect Knox has with the reality of health care delivery in Nova Scotia. Knox lives buffeted from the public and any unpleasantness by an army of VPs, senior managers and communications professionals who provide the distance on which her deniability is based.

The damned lies are the confused doctor recruitment numbers the NSHA has published. In April 2017 a communications person from NSHA sent me a list of 177 new medical recruits. However, a political operative told me those numbers varied from the 133 the governing party’s numbers showed. Around the same time the NSHA pointed to their success in doctor recruitment for Cape Breton. A Cape Breton doctor quickly challenged that success and said he had recruited some of the doctors the NSHA took credit for. Other hires were double counted – his became theirs, while his and theirs created ‘ours’.

The statistics fall into a wave of positive numbers around physicians accepting new patients. On June 2ndthe Department of Health and Wellness said since April 1st 319 provincial doctors had accepted a financial incentive to take on 4,904 patients. Seemingly good progress. Then we are told that because doctors took on patients from multiple zones the number of physicians in the program “equals 322”. Really? This is only a difference of three, but is the type of statistical bullshit favoured by bureaucrats and do-nothing executives. It is meaningless in delivering care to people. There either are 322 living breathing doctors treating patients or there are 319 doctors. Three doctors can mean the difference to 4,050 patients.

Whether you’re treated by an actual doctor or some sort of medical hologram, there are still a hell of a lot of Nova Scotians without any family physician.

In October 2016 a Freedom of Information request found there were 155,415 Nova Scotians in the “orphaned patients” category. That means without a family physician.

To address the lack of doctors, the NSHA launched the Need a Family Practice registry where people seeking a doctor could register by calling 8-1-1. Good luck getting through to that line. Many people have written letters or called radio programs to complain about the challenge of getting through to the line and then not hearing anything back.

In spite of the dissatisfaction of the public, the NSHA happily announced that in the first year of operation the physician resource line found matches for 10 percent of patients who registered.

Read about the NSHA success here:

https://www.cbc.ca/news/canada/nova-scotia/nova-scotia-physician-wait-list-matches-10-per-cent-patients-first-year-1.4380999

But the success of this registry is short-lived. Here’s its history in numbers:

Sept. 1, 2017  – 36,000 people registered for a doctor

Oct. 1, 2017     – 37,339 people were registered

Oct. 1, 2017     – NSHA reports that 4,331 people had been matched with a doctor

Jan. 1, 2018     – 41,877 people are registered on the doctor wait list.

May 1, 2018    – 47,669 people are registered for a doctor

June 1, 2018    – 50,024 people are registered

July 11- a story in the Chronicle Herald says more than 52,000 Nova Scotians are listed on the registry.

These represent the “official” number of Nova Scotians waiting for a doctor. The NSHA maintains it doesn’t know how many Nova Scotians are doctorless and the Department of Health and Wellness ignores the number given in the Freedom of Information request.

What neither the NSHA or Department address is how or why the registry numbers keep climbing in the face of the announced new doctor hires and expanded practices. Of course, when any new doctor is hired or a new residency is announced, there are caveats. It’s never now. It’s in the fall, in a year, in four years when students graduate …

The Province and NSHA are celebrating the creation of 10 new family doctor residencies – starting in July 2019. The Province and NSHA are mute on the loss of 10 doctors in Truro THIS year. They are equally silent on the 10 doctors Kings County lost between June 2017 and February 2018. And then there were all the solo practitioners around the province who stopped practicing.

The 2012 Physician Resource Plan, which was outdated when it was accepted, said that 1,100 Nova Scotian doctors would retire between 2012 and 2022. We are not keeping up with recruitment or training for the 100 doctors a year we need just to replace the retirements. There is no consideration for doctors who get sick, die or quit the province in frustration. Nor is there consideration for increased demand created by population growth. In the three years the NSHA has been in existence it is more than 200 doctors behind in physician recruitment. A clear fail. But not a number they would ever mention.

Lies, damned lies and statistics rule.

 

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