Archive

Monthly Archives: May 2016

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:

  • What crisis?  

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.

  • Retention is also receiving inadequate attention through the transition to the new single health authority

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.)

CanAm Perspective: Talk of doctor shortage boils over in Nova Scotia legislature

CanAm Physician Recruiting called it a year ago when meeting with NS Premier, NS health system is on the brink of disaster. Followup meetings with top health bureaucrats confirm the ignorance is wide spread throughout the Department of Health and what is now the NSHA. Less than a year later the top is starting to blow as the public are just now seeing and understanding how bad things really are in healthcare across NS. Not only is it the most difficult province in Canada for an International Physician to get licence and work approval BUT it is also the most difficult for Local Canadian grads to get work approval. Dalhousie grads are waiting 6 to 8 months for approval to start work and clinics are struggling to stay open. 
 
While the opposition and public are screaming about Physician shortages Dr. Lynn Harrigan and NSHA are stating we have too many Physicians and the ones we do have are operating in Boutique practices in areas of no need. LOL
Original article by: Donalee Moulton, May 16, 2016 for canadianhealthcarenetwork.ca

Nova Scotia MLA Alfie MacLeod was recently ejected from the house of assembly after a heated exchange with the provincial health minister over a shortage of doctors. MacLeod contended the issue is crippling Cape Breton, where he lives, and affecting the well-being of the entire province.

Before being tossed from question period, MacLeod was grilling the health minister about the government’s response to the doctor shortage on Cape Breton. The final straw in the heated debate came when Health Minister Leo Glavine said that “three to four per cent of Nova Scotians never ever look for a doctor.”

It was a statement MacLeod, a Progressive Conservative member of the legislative assembly, could not accept at face value. “I would like to remind the minister of health he’s the minister of health for Nova Scotia, not for Disneyland,” MacLeod said.

Glavine also stated that 10 new doctors have been recruited for the Cape Breton area and will be in place by this September. MacLeod, however, said that in the meantime more physicians are leaving the island for greener practices elsewhere.

The Sydney River-Mira-Louisbourg MLA pointed to a walk-in clinic opened in Sydney earlier this year by the Nova Scotia Health Authority. Originally staffed with nine physicians, that number is now down to two, forcing many residents to seek healthcare services from the local emergency department.

According to Doctors Nova Scotia, the province needs 112 more family physicians over the next 10 years, as well as an increase in the number of full-time internal medicine specialists and general surgeons. (These figures are based on 2010 data, which is expected to be updated.)

In the heated exchange with MacLeod, who publicly admitted he was embarrassed to be tossed from the legislature, the health minister also promised another 10 physicians will be recruited for Cape Breton, but MacLeod says it could be as long as two years before any new doctors are able to accept patients.

The best way to resolve the shortage of physicians, MacLeod told reporters, is for the department of health to meet with doctors and hear first-hand about the nature of the problem, proposed solutions, and resources required.

Glavine, who has said that the ratio of patients to family physicians in Cape Breton is about 1,200 to one, disagreed. “We need to take it community by community, hot spot by hot spot, and deal with it, then make sure we have the global picture while working to solve the doctor shortage,” he told the Chronicle Herald.

The health minister also took heat for not living up to commitments to enhance healthcare facilities in the province. The Liberal government’s last three budgets have allocated $146 million for hospital improvements. Less than half this amount has actually been spent, however.

In response, Glavine said that, “Overall, since 2012, we have seen the number of family physicians increase by almost 15% and the number of specialists by almost 17%.”

He added that, “We know from the Canadian Community Health Survey administered by Statistics Canada that about 6% of Nova Scotians who are looking for a family doctor are unable to find one.”

CanAm Completes Weymouth Contract; Health Authority Withdraws Support for Position in community with significant need 

CanAm will complete its contract with the Weymouth Physician Recruitment Committee this month.
Through the course of our work with Weymouth, we learned a lot about what is happening – and what is not happening – with the Nova Scotia Health Authority’s physician recruitment activities.
CanAm was successful in identifying a strong potential candidate for Weymouth and that physician came to Canada for a multi-day site visit in early 2016.  The community committee pulled out all the stops and the physician felt welcoming and enjoyed her time in Digby.
Unfortunately, through the course of the winter and spring, it became apparent that despite advertising a vacant position in Weymouth, the Health Authority had no intention to support a physician for the Weymouth clinic.
It was subsequently confirmed by the Health Authority in writing that they were not approving a physician position for Weymouth.  This effectively cut the legs out from under the community committee.
There were even local candidates in play, who were told unequivocally that there was no position in Weymouth.
This put the community and CanAm in an impossible position – of attempting to recruit for a position that the employer – the Health Authority – continued to state did not exist.
The Health Authority has now confirmed that Dr. Westby’s former position in Weymouth has been transferred to Digby.
CanAm would like to thank the dedicated members of the Weymouth Physician Recruitment Committee for their support, and all their efforts over the past 6 months.  They are strong advocates for their community and should not be blamed for the inability to fill the position.  They did their best to advocate for the citizens of Weymouth.
Submitted by David Nurse

 

Provincial hiring practices benefit from third party input

This May 2, 2016 article from the Regina Leader-Post by D.C. Fraser highlights the responsibility that provincial governments and provincial medical associations have in the management of taxpayer funds in hiring and retaining physicians.

In Saskatchewan, the processes that are in place now seem to be working in their goal of hiring and retaining physicians. However, they also recognize the need for third party input from organizations like CanAm Health Management Consulting.

Congratulations to the province of Saskatchewan and the Saskatchewan Medical Association in recognizing that although the current hiring practices are working there is always room for growth.

To read the full article please click here.