The good homes need to be identified and need to be given the support and latitude required to care for this ever increasing portion of our American society.
Dr. John Haggie, Newfoundland and Labrador’s Health Minister discusses the budget deficit his province is facing in this June 29, 2016 article in The Telegram (St. John’s, NL). He called it “unparalleled in Canadian history in any jurisdiction”.
At the July 2016 Primary Healthcare Forum Conference, Dr. Haggie compared the $2.4 billion deficit to the likes of countries such as Venezuela and Puerto Rico. He also stated that Newfoundland and Labrador spend 29% more per capita.
The Newfoundland and Labrador Medical Association has come up with a series of recommendations for the government to consider and has also recommended that their members be a part of the process.
CanAm Physician Recruiting feels the NLMA’s recommendation of including its members in creating solutions is a brilliant idea. Who better than the people who will be trying to balance these new policies and procedures with providing their patients with the highest quality of care?
Submitted by: Hedi Cameron, Regional Manager, CanAm Physician Recruiting
This is a great example of how looking at a problem in a different way or from a different perspective can make improvements, which may appear to be small on their own, but cumulatively amount to significant changes. The same principles that work at making financial institutions and auto manufacturers more efficient can be applied to many industries, including healthcare.
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.)
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.”
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.
There is a lot of talk in the media these days about Medicinal cannabis and how successful these clinics might be. Canada’s largest and most reputable is Cannabinoid Medical Clinics (CMC); headquartered in Toronto this clinic has, in the past 10 months gone from one clinic in downtown Toronto with two physicians to 6 clinics with upwards of 25+ physicians from Edmonton, Alberta through to St. John’s, Newfoundland with further expansion of another 6+ clinics in the remainder of 2016.
It is CMC’s mission to continue providing the same education, experience and quality patient care nationwide that has become synonymous with their name in this rapidly growing market.
Through the hard work and perseverance of the entire CMC team over the last year, CMC Toronto has become the largest and most preferred cannabinoid medical clinic company in the country. In the month of March alone, they had a record of over 1,000 patient visits.
With this increased focus on supporting growth through quality systems, protocols and an excellent standard of patient care across the country, there is every reason to believe that CMC will continue to see exponential growth both organically and through strong partnerships.
This April 15, 2016 Medical Post article by Dr. Sarah Giles once again addresses the high cost of credentialing and licensing for physicians seeking to do locum work in neighbouring health boards and provinces. CanAm has been out spoken on this issue. What the general public and government officials don’t realize is that we are talking about thousands for dollars not a few hundred. The redundancy is unreal and in no other profession is it tolerated. Why is it that the only government championing this issue is the smallest province of Canada? Prince Edward Island’s health minister appears to be the only brave government official to champion regionalization of Licensing Colleges.
See full article below:
‘Alphabet soup’ isn’t always easy to swallow
April 15, 2016 by Dr. Sarah Giles
Yet again, I’ve traveled to another province and paid a rather large sum of money to re-certify one of my alphabet courses. The “alphabet courses” is my name for those “mandatory” courses hospital administrators insist locums have up to date but look the other way when none of the physicians in their own ER department have done them in six years. I have quite a collection of these courses: BLS, ACLS, NRP, ALARM, PALS and ATLS, to name the big ones.
I think there is benefit in continuing education, reviewing changes in practice, and going through mock scenarios. I do, however, have some reservations about these courses:
1. Some of the courses are cash cows. They cost a lot of money to attend and for those of us who live outside major urban centres, they are difficult and expensive to get to. I do not believe the vast majority of courses need to be recertified in person or every two years. I think it is likely possible to read the text, write a test, and Skype into a few mock scenarios to prove one’s abilities in a given area.
2. There is an inherent bias in these American-made courses against rural and remote care provision. Basically, in these texts, if you don’t have a CT scanner, thoracic surgeon, interventional radiologist or high-level NICU within your facility, you need to drop everything and call in a plane. Now, that’s often the right thing to do but in rural and remote Canada, there are some opportunities to watch stable patients and to use clinical judgment that these U.S.-based practitioners, who face far more lawsuits than Canadian practitioners, are unwilling to consider.
3. The course faculty are almost exclusively Ivory Tower practitioners because the courses rarely come to the places I work and it’s cheaper to get to a big city than it is to travel to another small town where the courses may have local doctors running them. We need big-city specialists to help our patients but I become enraged when every story coming from the course faculty is about screw-ups in the periphery. I’ve never heard a story about a remarkable save from a resource-limited environment and I think the instructors are often disrespectful of the work remote and rural practitioners do. Of course, I’m not exactly part of the solution but in my defense, becoming a course instructor would require me to spend a lot of time in major urban centres and I would likely have to spend even more time there in order to teach the minimum number of courses needed to stay current.
4. I realize that we need to break the material down somehow, but it seems unrealistic to look at trauma and resuscitation without looking at cardiac rhythms. We need courses that allow us to bring these skills together. Courses such as the Comprehensive Approach to Rural Emergencies (CARE) are dreamy answers to this need but it doesn’t meet those alphabet soup needs, and it requires a hospital administration that is supportive and has money.
In the end, it’s probably best for me to try to recertify these courses at rural conferences, when the room is full of like-minded people. Unfortunately, it turns out that rural doctors who toil away in their small communities really need locums so they can leave to attend the big rural conferences, so I’m usually working during those events. I could try to help create a rural/remote supplement for these courses but I’m not sure I could win a conversation with the ivory tower academics when they often have big studies to back them up and I only have anecdotes.
Dr. Sarah Giles is locum family physician.