The acute doctor deficit in Kings County should concern all Nova Scotia

Nova Scotia’s health care shortages are almost biblical: no room at the inn, or hospital, clinic or doctor’s office.

Common-sense, backed up by research, says that having a family physician improves health. The physician-patient relationship means illnesses are caught earlier, when it is faster and cheaper to treat, thereby improving health and reducing emergencies. Hospital over-crowding comes from sicker patients who don’t have a family physician as well as a shortage of long-term care beds (some of which might be unnecessary with better access to doctors).

The whole system seems bogged down a type of creative accountancy seemingly designed to spare us from the hellish truth and cover years of inaction by health care executives.

A front-page article (Doctor shortage takes toll on Nova Scotia specialists) focused on the problems faced by specialists and ER doctors at Valley Regional Hospital in Kentville.

https://www.thechronicleherald.ca/news/local/doctor-shortage-takes-toll-on-nova-scotia-specialists-291329/-

The most succinct summary of the situation in Kings County is a sign posted on the door of the walk-in clinic in New Minas. In a classic Catch-22 situation the walk-in clinic is so overwhelmed it can no longer accept walk-in patients.

DSCN1299

This notice is on the door to the walk-in clinic in New Minas, Kings County. (Allan Lynch Photo)

Kentville is a bell-weather community for the state Nova Scotia health care. First, the Valley Regional Hospital was built as a medical hub where the bulk of specialists in SW Nova are located. Secondly, for the 10 years before she became CEO of the Nova Scotia Health Authority, Janet Knox was president and CEO of the Annapolis Valley District Health Authority. Former NSHA VP of Medicine Dr. Lynn Harrigan was also with the AVDHA, as was Tim Guest, NSHA vice president of integrated health services. They know this hospital and this community intimately, and should know its problems at Valley Regional better than anyone.

The article said 4,752 doctorless patients visited Valley Regional ER in 2018, up from 1,302 in 2013. It’s going to get a lot worse. There’s an easy parallel for understanding this.

Officially, the NSHA’s family physician waitlist has 51,119 people on it. Since November 2016 the NSHA says 75,645 people found a physician. Perhaps they have, but focusing on the official NSHA figures is like jogging on quicksand.

Adding up those waiting for a doctor with those who found a doctor equals 126,764 people. However, an October 2016 Freedom of Information request revealed that 155,415 Nova Scotians didn’t have access to a family physician. The FOI numbers said 20 percent of HRM (78,019) and 14 percent of rural residents (77,396) didn’t have a family physician. Subtracting the official NSHA figures from the FOI number shows 28,651 unaccounted for potential patients.

The population of Kings County in 2016 was 60,600. Fourteen percent of 60,600 is 8,484 people without a family physician. Between June 2017 and February 2018, seven family physicians in Kentville, Kingston, New Minas and Berwick closed their practices. Two other GPs closed their practices and relocated out of the county. One of the departing physicians also held clinics two days a week in Berwick, so his loss was both to his patients (I was one) and the Berwick walk-in clinics. We also lost an eye-ear-and-nose specialist. A common, conservative figure used for average patient loads for established family physicians is 2,000. However, two of the seven had long-time practices which had in excess of 7,000 patients. If you can keep up with the math that means in nine months 21,000 Kings County residents lost their family physician. Add on the 8,484 FOI number and we see that 48 percent of the population of Kings County (29,484) are without a doctor.

A Nurse Practitioner has been found for Kentville and two GPs and a psychiatrist have announced plans to open a New Minas clinic in November. Using NSHA new guidelines for patient loads this gives 3,200 people access to a primary care professional, leaving 24,284 without.

It’s been over a year and up to a year-and-a-half since these seven doctors left their practices. They would have given several months’ notice of closure and yet, the NSHA has failed to hire replacements. The “employment opportunities” listed on NSHealth.ca on March 16, 2019 shows openings for family physicians in Berwick, Kingston, New Minas, Kentville, Canning (full- and part-time), as well as a pediatrician and two anesthesiologists in Kentville, and a Family Practice Department Head – Western Zone.

On top of the physician openings, the Western Zone – Valley, South Shore, Yarmouth – doesn’t have a Zone Medical Executive Director. The job description says, “The Zone Medical Executive Director is accountable for developing physician leaders as well as utilizing resources in an efficient and sustainable manner. Working with a provincial set of policies and standards, the position has zone-level responsibility for the following areas: physician engagement, integration and performance management; privileging and credentialing; appointment and oversight of physician leaders in compliance with the medical bylaws; physician resource planning; coordination of residents and medical students, and physician professional development. In addition, the Zone Medical Executive Director is responsible for integrating provincial programs in the Zone.”

Many doctors question the levels of bureaucracy in the health care system, but this posting shows that no one is in charge in SW Nova. If we are to believe all the layers of executives serve a purpose, then the situation in the Valley can be likened to an orchestra without a conductor. The fact that the NSHA has trouble filling executive posts – Cape Breton is also short a Zone Medical Executive Director as well as 15 other vacant management positions – suggests no one wants to work for this organization. Or at least not under the current executive.

With nearly half of Kings County without a doctor, the walk-in clinic and Valley Regional are bound to be swamped by people seeking medical attention. How serious their need is relative because just getting a prescription refill requires authorization by someone with a medical degree. (BTW, doctors aren’t paid for renewing prescriptions.) If you don’t have a family doctor, if the walk-in clinics no longer accept walk-in patients, the only option is the ER. That is a situation foisted on people by the NSHA’s cavalier physician recruitment plans.

Kentville and Kings County are a health care bell weather situation because they are such highly attractive places to live and work that the NSHA prominently features their position as the heart of Nova Scotia wine country in recruitment marketing. If the poster place for recruiting struggles with a net loss of physicians and ever-growing numbers of orphaned patients, how bad is it the further from Halifax you live and work?

We have heard of the dissatisfaction in Cape Breton. We have heard of the problems in Kentville. A physician in Yarmouth tells me they’re next. By June Yarmouth General will be down to one anaesthetist, which he says makes surgeries almost impossible. The NSHA is looking at a replacement from South Africa but that anaesthetist is still in South Africa and not here. The majority of the residents who were trained in Yarmouth either left the province or became hospitalists elsewhere. And another town doctor is moving his practice to Kelowna. In 2011, six local doctors closed their practices, so the problems aren’t new, they just haven’t been fixed.

In a rebuttal piece about the Kentville situation (Valley patients not in peril while waiting for surgery) Guest said they have teams working hard to address operating room resources, bed flow and human resources. “Our multi-year hip and knee action plan included approval to recruit four additional anesthesiologists for the province.” That’s confirmation of approval to start recruitment, which isn’t the same as having hired someone. The need is not new.

Guest’s rebuttal is here: https://www.thechronicleherald.ca/opinion/counterpoint-valley-patients-not-in-peril-while-waiting-for-surgery-291599/

In response to Guest, local resident Bob Levy, who is a former NDP MLA for Kings South and retired judge, wrote this: https://www.thechronicleherald.ca/opinion/letter-to-the-editor/counterpoint-nsha-blame-shifting-292255/

The NSHA attitude towards doctor recruitment is casual in the extreme. We have been bleeding doctors long before the NSHA was formed. The Physician Resource Plan published in 2012, and which family physicians complained was outdated when it was published, said we needed 100 new physicians a year to maintain a status quo which was already stretched to breaking. The PRP predicted that by 2021 our medical needs will equal those of 1.1 million people. That need is based on age, not an actual growth in provincial population.  The increased needs of our aging population is a popular excuse for NSHA problems, but not something they or their predecessor authorities seem to have addressed.

Nova Scotia’s Auditor General, Michael Pickup, highlighted the NSHA inaction on November 27, 2017 when he revealed that a physician recruitment plan for the province wasn’t put in place until the spring of 2017! That was two years after the NSHA was officially created. Further, he said that the recruitment efforts of the Nova Scotia Health Authority and Department of Health weren’t coordinated. Which perhaps explains by the NSHA skipped medical recruitment fairs.

After these revelations, NSHA CEO Janet Knox was interviewed on CBC Information Morning. Then-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.”

This is a surprise because physician recruitment, retention and loss has been a long-running, hot topic in Nova Scotia. It was the key issue the 2013 provincial election was fought on. Politicians, professional associations and the Physician Resource Plan have long urged action. More and more doctors have been speaking publicly about the declining conditions in our health care system. It boggles the mind that NSHA executives can claim to be surprised by the complaints.

This is not a system failure, it is a management failure. We don’t need more studies, we need to find executives who will act on existing studies, recommendations and needs rather than talk about them.

 

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4 Responses to The acute doctor deficit in Kings County should concern all Nova Scotia

  1. buddyboy546 says:

    Your last paragraph hits the real problem squarely on the head and I am glad to see the point made, again, so clearly. Ours is a management problem, both at the executive level and the political level.

    I was also pleased to see you referenced and linked the column by Guest and the perfectly presented counterpoints by Bob Levy. Mr. levy shows Guest’s statements for what they are, specious. Things will change, hopefully, after the next provincial election, This Liberal government have wrecked our health care system by obfuscation and neglect.

  2. Bubbie says:

    My opinion is, Premier Stephen McNeil is fast tracking our provincial public health care system to a privately run system. He is creating the crisis by not addressing the doctor shortage along with his declared moratorium for not creating new long-term care beds which is at the root of the problem for clogged ERs with EHS paramedics doing their whole shifts waiting with mostly, elderly patients in emergency hallways. A new report revealed the McNeil government is fudging the figures that show there are far more than the reported 1200 patients waiting for a long-term care bed, more like 2500 and the very root of the problem for paramedics not being able to respond to other emergency calls.

    The ACE Team has been waiting for more than three years for the finalization of a five year plan for long-term care, In the words of MJ MacDonald, CEO for the Long-term Care Department, the five year plan has been put on hiatus pending the report of the Expert Panel for Long-Term Care, released on January 16, 2019. This Panel was instructed by the McNeil Government not to speak to new long-term care beds or funding which tells me the Liberal Government is not even a little bit serious about solving the backlog of patients waiting in hospital for a long-term care bed. Long-term care staffing levels is another issue that is not being addressed, according to the Expert Panel, that has not even mentioned the fact CCAs have had their salaries frozen for the past six years. How can they hope to attract anyone to a career that has had their salaries frozen for six years?

    Buddyboy546, hopes that things will change after the next election. I have been listening to the rhetoric surrounding health care which appears to becoming the number one issue for the next election. We already know McNeil and his Health an Wellness Minister have been touting of what a great job they are doing to address the morbid state of our health care system which is trading hospitals for clinics in Cape Breton and Family Practices into “Wellness Centres” where patients may never see a doctor. McNeil states, “We cannot expect to have the same medical system we have had for the last 50 years and need to adapt to a new system for the next 30-50 years.” Trouble is, he is not saying nor has revealed any kind of plan for what his vision for health care is going to look like for the next 30 – 50years. At the moment, besides the Expert Panel for Long Term Care, there is the Legislative Committee made up of member from the main provincial parties where Liberal members outnumber the remaining political parties and another committee that has been struck that they report to. In other word just more talk, talking about, talking about health care.
    Don’t expect anything different from Tim Houston, newly elected premier of the Provincial PC party. He has already stated he does not like to make promises he feels he will not be able to keep and prefers to be able to have facts and figures before devising future planes for health care, In other words more talk, talking, talking about health care. What we don’t need is another government who is going to waste four or more years, if re-elected , talking about health care while they suck up valuable taxpayer dollars in salaries and people die waiting for medical attention. Tim Houston, danced all around the question of how he would address the health care system on the Todd Veinotte Talk Show, March 17, by spewing the same old rhetoric we have been hearing from the McNeil Government only with a different twist. MORE STUDIES AND CONSULTATIONS!
    Gary Burrill has been more direct and consistent saying more new long-term care beds are needed. The trouble is, he continuously repeats the number 300 beds from a previous NDP plan which is far below the number actually needed. I am not a card-carrying member of any party and have voted for all stripes and colours throughout my lifetime only to see the wheels for our health care system just spinning but are now slipping backward.

    The way I see it, the elderly are continually being denied timely access to quality health care that, in my opinion, is turning into almost, third world conditions and are being discriminated against by not providing the necessary medical attention they paid for over the last fifty years. The elderly are being devalued and dehumanized and are treated as a liability even though they continue to pay taxes, even if it is just GST, which is suppose to go toward paying for their health care. Instead of “Dying with Dignity”, it should be “Living with Dignity.” HEALTH CARE DELAYED IS HEALTH CARE DENIED. DON’T SICK AND DON’T GET OLD IN NOVA SCOTIA.

    • I have planned a short series of health care fixes and issues which I hope to launch in a few weeks. I believe some of the points I will make will shake up health care.

      I’m not an apologist for the Premier, but, frankly, I don’t see his actions as much different than previous government. Parties campaign on an idea, come into power with a vision and then have that squeezed out of them by the bureaucrats who are in place and health executives who are adapt at blackmailing/bulling politicians. For example, the NDP froze health care spending as part of a province-wide attempt to bring the budget under control. Chris Powers, then CEO of Capital Health, lead a group of other CEOs in complaining to the media that the government had slashed health care spending. What the government did was, for the first time in decades, not allowed inflation-adjusted increases. The government had to back down.

      The current leader of the NDP talks about the needs of seniors, but the previous NDP government was so bad that ACE (Advocates for the Care of the Elderly) wrote Minister Dave Wilson that he was the worst minister ever for seniors. You’ll find part of that letter published on this site.

      You raise a lot of issues. I’m working on something that should over the next month or two shake things up.

      The biggest impediments to better health care are a) the executives in place and b) public complacency. The public has short memories and like a vain teenager is prepared to believe whichever politician who promises a magic bean solution. The public is too anxious for a snap-of-the-finger solution. We are too ready to believe more money is the answer, when study-after-study have said the problems with health care is not money. Sadly, that’s too radical for the public – and politicians – to believe. Stay tuned.

    • PS – Regarding the number of people waiting for long-term care beds, I forgot to mention that in 2009, when our family faced this issue we were told the wait-list was over 2,000-people long. In October 2009 I was told the wait for a bed was 8 months for someone in hospital and two years for someone living in their own home.

      The recommendation from the placement people was to have a family member stay in hospital to expedite the process. Long hospital stays were a way to queue jump. Janet Knox was head of the Annapolis Valley District Health Authority, where this practice was in use. Valley Regional Hospital actually has a section of eight or ten semi-private rooms which was/is used as a holding area for seniors waiting a long-term care bed facility.

      I kept in regular contact with the placement people. Eight months into our hospitalization I wrote the placement people about my concerns and asking for a bed for our family member. They ignored me for over a month. Finally I was able to corner them for an appointment. They told me we had missed a deadline – in spite of four doctors pushing our case – and would have to start all over again at the bottom of the list!

      WE didn’t miss the deadline they did. I was angry. I was called into a meeting with the hospital manager, nurse manager, the placement manager and a political operative. At the meeting I was told they expected a certain level of behaviour from the public – the penny dropped, I had been accused of threatening the two placement women. It was the word of the two of them, against me. Unfortunately for them I had taped the meeting. I pulled out my tape recorder and offered to play it for the assembled managers. Their faces dropped.

      I gave them a choice, find a bed now or stand before TV cameras and explain themselves. In two hours they found seven vacant beds in three facilities in our area! These were beds the placement women didn’t know about because the placement women went through a tortuous long, monthly process to get inventory updates. They were too important to call or accept calls from local facilities.

      Long term care has been screwed up for a very long time.

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