The Nova Scotia Health Authority caused panic among medical residents when it announced they were requiring new family doctors to have their positions approved, and then physicians would need to undergo a long privileging process.
CanAm Physician Recruiting CEO John Philpott says he questions why anyone would create any kind of delay for a fully-licenced Canadian graduate in a province that is “underserved” by family physicians.
“Apparently new start-ups are being delayed by a minimum of three months,” says Philpott. “This will obviously force Dalhousie grads to look elsewhere.”
Dr. Lynne Harrigan, Vice-President of Medicine and Integrated Health Services with the Nova Scotia Health Authority (NSHA), admitted there was a communication breakdown and the process would most likely take under a month “for most people.”
The Health Authority is also cracking down on walk-in clinics.
Dr. Mark Fletcher owns seven walk-in clinics across Halifax as well as the Medicine in Motion Medical Centre. He says the NSHA’s vision of having every citizen belong to a collaborative practice — which would include family physicians, nurses, dieticians, social and workers — that provided all after-hours care would completely eliminate walk-in clinics like his own.
When he first heard what the new Nova Scotia Health Authority was planning, he felt it was “pretty extreme.”
“For a new physician starting up their practice to be forbidden from working at a walk-in would lead to all sorts of staffing problem and closures — which seemed to be their end game,” says Dr. Fletcher.
He says what the Health Authority doesn’t realize is that walk-in clinics exist because the demand is there.
“These facilities aren’t ever going to replace primary care providers, because people with diabetes or heart troubles or anything complex need a primary care physician,” says Dr. Fletcher. “But for a young healthy person with a bladder infection or a sore throat, they can be very effectively managed in a setting where they don’t need a nurse or a social worker or a dietician.”
Dr. Fletcher says it’s encouraging that the NSHA seems to have “softened” their stance slightly due to the negative feedback from physicians and patients. He predicts the end result will be a blend of the status quo — which didn’t cost the province anything — and what the NSHA is seeking, which is a costly system of collaborative healthcare.
“Now they’re saying they don’t want physicians ‘exclusively’ working in walk-in clinics — they need to provide primary care as well,” says Dr. Fletcher. “They don’t want a walk-in practice that’s only open from 9 a.m. to 3 p.m. on weekdays because that wouldn’t be supporting a primary care physician, but clinics that are offering after-hours care seem to be OK in their eyes.”
Philpott doesn’t think collaborative health practices will work well in Nova Scotia because — unlike Ontario or Alberta — the province restricts billing for tests conducted or equipment used outside of a hospital. He says Dr. Harrigan and the board need to find a way to reward physicians who want to work in the style of practice “she believes is correct,” not restrict them.
Although Dr. Fletcher no longer runs a primary care practice, he’s also concerned that the NSHA is taking a hard stance on physician recruitment by regulating the number of physicians in a given area.
“If a town loses two doctors but the Department of Health doesn’t think they need to be replaced, they might not get approval to replace them,” says Dr. Fletcher. “It’s all going to be based on their metrics — not the patients’ best interest.”
The Nova Scotia Health Authority’s website indicates the province is short 50 specialists and family practitioners, and the wait list for care in most areas exceeds the national accepted standard.
Close to 30 per cent of walk-in patients in Halifax don’t have a family physician, and the 70 per cent who do have their own doctor often struggle to get an appointment in a timely manner. A walk-in clinic allows them to get same-day treatment quickly and easily.
Philpott says the CanAm team believes the Nova Scotia Health Authority is heading down a dangerous path that’s only going to worsen the province’s healthcare system.
“Restricting physicians and creating delays for practice start-up is a recipe for disaster in a province where physicians are among the lowest-paid and one of the highest taxed in Canada,” says Philpott. “If we’ve learned anything from past mistakes, it’s that physicians have options on where to practice.”
“Bulling them will certainly backfire.”
