There isn’t a single best answer to handle the finance implications of dual income households.
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.
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.”
Submitted by David Nurse
Have you seen this article about how we have “too many doctors” in Nova Scotia?
I find this really bizarre, and I’d like to get your thoughts on it. To me I see a real disconnect between the Liberal government and the Health Authority on this issue.
The Liberal government committed in their election platform in 2013 that every Nova Scotia would have a doctor.
For most people this means a family doctor or another type of primary care provider.
While the Liberals made a few small steps to encourage doctors to stay here, there are still thousands of Nova Scotians without a family doctor or a primary health care provider.
They are forced to emergency rooms, or go begging to doctors in Halifax – sometimes hundreds of kilometres from their home community.
The Health Authority uses the euphemism “unattached patients” or “orphan patients” but let’s be clear: these are people who do not have a family doctor, and have little prospect of getting one in the current environment.
Now these people are being told by the most senior doctor in the Province that we have “too many doctors.”
It sure doesn’t feel that way, especially in rural Nova Scotia.
As stated in the article, there are 20 current vacancies in Metro Halifax (or Central Zone) and – if you look at the Health Authority’s own websitehttp://physicians.novascotia.ca/opportunities.html– there are currently family physician vacancies across the Province.
The vacancies stretch from Sydney to Yarmouth to Amherst.
This list excludes other specialists AND the 20 vacancies in Metro. I count at least 25 communities here, and I expect some need 2 or more physicians to meet current needs.
So something doesn’t compute here. We have “too many doctors” but 75 vacancies for family physicians today?
If this is true, what real, tangible steps is the Health Authority taking to move the so called “boutique physicians” out of Halifax?
Do Nova Scotians have to wait an entire generation for doctors to redistribute themselves? Sounds sort of like a budget balancing itself.
I hope that Liberal MLAs are NOT bringing this message from Halifax home to their constituents,
“You can’t get primary care? Hey relax, we have too many doctors anyway.”
For your reference, here are the communities that should just relax because we have “too many doctors”:
- Mahone Bay
- New Germany
- Antigonish Town/County
- Glace Bay
- Guysborough County
- New Waterford
- North Sydney
- Richmond County
- New Glasgow
- Tatamagouche – CEC
The search for a new family physician is under way in Weymouth.
The Muncipality of Digby hired CanAm Physician Recruitment earlier in December to find a replacement for recently-retired family physician, Dr. Don Westby.
CanAm CEO John Philpott says within the first week of the signed agreement, CanAm was able to source, screen and attract a fully-licensed Canadian candidate who will complete the interview process in Weymouth on January 21, 2016.
Warden Linda Gregory, chair of the Weymouth Doctor Recruitment Committee, says the group has been working for more than two years to ensure there wasn’t a lapse in medical care in Weymouth.
The community was “loud and clear” that action needed to be taken quickly, so the committee decided to enlist CanAm — one of the country’s leading recruitment firms.
The Burin Peninsula on Newfoundland’s south coast is facing a serious doctor shortage, and a local physician says the future of the area’s healthcare is “scary.”
Dr. Lyn Power operates her own practice in the area and is also a full-time faculty member with Memorial University’s medical school. She believes municipalities need to do something drastic to attract more family physicians to the area, which has an aging population and an aging physician population.
While there are many local medical students who have expressed an interest in family medicine, Power says the Burin Peninsula doesn’t have a great track record of promoting itself as a desirable place to live and work.
Power says today’s medial students are seeking a work/life balance and enjoy the idea of working in a group practice with more flexible hours, and the Burin Peninsula could offer that to prospective physicians. It’s just a question of how to recruit and retain them.
Doctors working in walk-in clinics are allowed to stay put, but a recent health authority document says if a new physician requests to work in a walk-in clinic they will “most likely be denied.”
Dr. Lynne Harrigan, vice president of medicine for the Nova Scotia Health Authority, says the decision is part of the authority’s transition to collaborative care.
“Care that’s provided in walk-in clinics is not the ideal, so we want to focus our limited resources on team-based care,” Harrigan said. “We know the best care patients can receive is from team-based care with a family doctor, nurse, nurse practitioner, dietitian, psychologist, etc.”
Harrigan estimates it will take 5-10 years to move from the current system to the collaborative approach — and that the new model may involve walk-in clinics providing after-hours coverage.
Not everyone is on board with limiting the number of doctors at walk-in clinics. Former health minister Dave Wilson says it’s “irresponsible” because many patients count on walk-in clinics for care.
“There are huge voids in communities across this province that don’t have access to a family physician, and a walk-in clinic really is the only way for many of them, thousands of Nova Scotians, to get the primary care that they need,” Wilson said.
“I think the government needs to revisit that move and hopefully ensure that people have the access to a family physician or primary care personnel before they restrict the ability of people to practice.”
Wilson says he believes the move to limit doctors from working at walk-in clinics will hinder the province’s attempts to recruit and retain physicians.
Health Minister Leo Glavine says walk-in clinics aren’t going anywhere — although they will change — but the goal is to make sure there’s a family doctor available for everyone who wants one.
More than 800 people in Ashcroft, B.C. have been without access to a family doctor.
So a new initiative is — pioneered by the Ashcroft Wellness and Health Action Coalition, doctors at the Lillooet Hospital and Interior Health — is shuttling them 100 kilometres away to Lillooet where they can be seen by a resident in the final stages of their coursework under the B.C. Practice Ready Assessment program.
David Durksen, vice-chair of the Ashcroft Wellness and Health Action Coalition, says two of these doctors-in-training will relocate to Ashcroft in February.
“It’s been a lot of work, but this is something that’s never been done before, and we’re quite excited to be piloting this and seeing how we can make it work,” Durksen said.
He admits there are people who believe it’s a “terrible” idea and that he would love to find a solution that didn’t involve patients riding the bus for an hour and 15 minutes each way. But in the meantime, patients can access the service for $10.
H/T CBC News