95,000 Nova Scotians have no family doctor…but it’s not a crisis.

by in Nova Scotia’s future

Last week, Sheldon MacLeod with News 95.7, had a number of guests on who discussed Nova Scotia’s physician shortage and how the Nova Scotia Health Authority is responding to this challenge.  I went back over the weekend and listened to Sheldon’s interviews from May 19 with Dr. Lynn Harrigan, Vice-President Medicine, and the medical residents from Dalhousie.

I gave these issues a lot of thought over the May 24 weekend and here are my thoughts:

In the course of her conversation with Sheldon last week, Dr. Harrigan acknowledged that there are areas of the province with a high need – she called them “hot spots” – and that the supply of family physicians always ebbs and flows.

What I didn’t hear her say was that the current situation – with vacancies in family medicine across the province – is a crisis.

I did not hear a sense of urgency.

If the Health Authority truly viewed the current physician shortage as a crisis, they’d be approaching it differently – they’d be attacking it withmore resources and much, much more urgency.

They would be conducting aggressive recruiting both within Canada andoutside of Canada, and they’d be looking at innovative new approaches to fill positions NOW.

What would an aggressive approach to recruitment look like?

First, let’s talk out the Dalhousie family medicine residents.  These are new doctors who trained here and are ready to start practice.

The two co-chairs for the family medicine residents were on Sheldon’s show and essentially said the communication with the Health Authority was non-existent.

This makes no sense if you are conducting aggressive recruitment.

Our own residents?  They would be the first and most obvious target for recruitment.

Honestly, this group of young recruits should be so jazzed up about the new collaborative care model that they are ready and willing to act as leaders in the new collaborative practices going forward.  They should have drank the collaborate care Kool-Aid.

The fact that the Health Authority has not focused on the graduating residents, met with them, courted them, convinced them to get on board with the new collaborative care model, AND offered them written contracts, makes no sense.

All of this is Recruiting 101.

If the Health Authority’s leadership saw this as a crisis, they or their staff would be visiting as many family medicine job fairs across Canada as they could every year.  New Brunswick, Newfoundland, Ontario, Quebec, Alberta, – all of them.   AND looking at appropriate US job fairs as well.

They should also be advertising, both in traditional publications like the Canadian Medical Association Journal and the Medical Post, and through social media (LinkedIn, Facebook, etc.) and niche social networks like The Rounds – a social media space reserved for Canadian physicians.

They would also be looking for both short-term and long-term candidates.  The recruiting company that I work with – CanAm Physician Recruiting – was recently successful in recruiting a candidate from New Zealand for a one-year locum in rural New Brunswick.  Although this doctor won’t provide the long-term solution, the people in that community will be well served by a skilled physician for the next year.   They key here is to communicate effectively – communities will welcome short-term physicians if they understand the long-term plan for their community.

One final point from the recruitment perspective.  If the Health Authority leadership saw this as a crisis, they would also be actively looking internationally for candidates.

It is naive to believe that we can meet Nova Scotia’s long-term physician needs exclusively with Nova Scotians or even with Maritimers.  Physicians from outside of this region and this country will continue to be – and should be – part of the plan.  They bring expertise and international experience that will improve care here.

It seems absurd to me for the Nova Scotia to embrace increased immigration as a great idea, but not link immigration and our current physician shortage.

So, is the Health Authority looking in the US, the UK, and Ireland?  These countries are an obvious start as most family physicians from those countries would be immediately eligible for a defined license in Nova Scotia.  They can start quickly, and their medical education, language skills, and past practice makes them ideal for Nova Scotia.

Is the Health Authority working with the Nova Scotia Office of Immigration to attract more family physicians?  When the Office of Immigration goes overseas with employers in the video game industry, or home care who need workers – where is the Health Authority?

The Health Authority may be doing some of the things I mention above, but I have seen very little evidence of an aggressive recruitment campaign.

Perhaps if we stopped calling it a physician shortage and focused on the fact that approximately 95,000 Nova Scotians do not have a primary health care provider, the conversation would be different.

A closely-related issue to recruiting is physician retention.

This is not rocket-science.  Retaining a physician is much like retained any other skilled worker.

An employer can improve their chances of retaining a worker if they show them respect – by paying them on time, for example – by explaining the opportunities for a satisfying and rewarding career, and making them feel at home in the organization and the broader community.

You also encourage retention by creating a supportive workplace where an employee’s opinions and concerns help shape the pathway to the future – a future where their careers are much less uncertain.

I am seeing some concerning trends with the Health Authority in this regard.

I am aware of a number of instances where physicians have waited weeks and sometimes months for their pay.

I have also heard frustration from any doctors about the process for approving new physicians.

In some cases, physicians that are already in communities working on a locum basis are waiting months and months to be approved even when there is a known vacancy in their speciality.  Some of these cases are complex, but some are “no brainers” and should be approved quickly.

Why is this happening?

It is not entirely a new phenomenon – the former Regional Health Authorities were not known for the lighting fast and efficient response to physician concerns.

However, the move to the new board meant the removal of local physician leaders in many areas of the Province.

For example, on the South Shore we had – until April 1 – a medical Chief of Staff.  That person could trouble shoot any physician-related issues quickly.  That position is now gone, with decision-making moved to Kentville.

There are some mid-level administrative staff in place who work hard to deal with issues as they arise, but they rarely have the authority to deal with an issue quickly.

So, it seems that issues get stalled until the small group of key decision-makers in the new Health Authority are able to address them.

Overall – I am very concerned with the lack of attention to both physician recruitment and retention.

(Interesting note: – I went to update my information on current vacancies, and it appears that the Department of Health and Health Authority have now stopped publishing a list of current vacancies.  The information there may have been outdated, but the correct solution would have been to update it, not to delete it and provide less info. to the public.)