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From patients to practitioners, the doctor shortage impacts anyone and everyone connected to the health system. In our four weeks of reporting we learned there’s a real ripple effect happening across Atlantic Canada. Communities are grappling with everything from closed emergency rooms, staff shortages and an aging population and workforce. As a result, these challenges have led to unique solutions, grassroots responses and Hail Marys. We’re a resilient bunch, but we’re at our best when we’re healthy. Here’s what we learned.
BREAKING IT DOWN:
WHAT ARE THE REGION'S BIGGEST CHALLENGES?
TALENT RECRUITMENT AND RETENTION
- Rural and remote communities continue to struggle to recruit and retain doctors. Fewer medical school students are pursuing family medicine as an area of expertise and of those pursuing family medicine, just 6.2 per cent practise in rural communities.
- Recruitment practices are not standardized across the region and instead of preemptively searching, the practice is often reactive to a departure or retirement. All four Atlantic provinces are competing with one another to attract health-care staff.
- P.E.I. is developing a five-year human resource plan while Nova Scotia has projections of the number of physicians needed over the next 10 years and a recruitment strategy is in place.
- Tracking recruitment and retention data is a new practice and information is not easily accessible or not all jurisdictions are tracking the same information.
SYSTEMS AND PROCESSES
- A blended payment model may be helping New Brunswick keep more local doctors.
- Streamlining doctor licensure would make Atlantic Canada a leader. The creation of regional licensing of doctors would simplify a process that’s currently cumbersome and complicated. Regional licensure would allow doctors to more freely practise on locum or outside their home province.
- Nova Scotia doctors are amongst the lowest paid in Canada.
- Updating the pay structure from fee-for-service to a blended capitation would allow for a combination of fee-for-service billing and per capita funding for a set number of patients. New Brunswick is the only province testing a blended payment model at this time and with great sucess. 42 physicians have signed up for the program.
READER FEEDBACK: IN YOUR WORDS
I would like to share with you three succinct conclusions I have come to with regard to the current status of health care.
- Canada needs a whole new federal engagement on health-care standards and delivery with a stiff look to European models of delivery.
- Health services administrations need to be reorganized by getting rid of ineffective centralized administrations that have proven a disaster both in P.E.I. and Nova Scotia (we have some of the lowest health services in the OECD). Local administrations, right-sized to a provincial organization, community elected boards to connect to the real needs of the people, less bureaucracy and more frontline services.
- We need to establish a new relationship with doctors. Canada can do this by nationalizing the College of Physicians and Surgeons so that if you can practise anywhere in Canada as a physician you can practise everywhere in Canada. Canada needs to triple the size of medical schools graduating doctors and to assign doctors licences on a per capita basis by community and to enact those licences on a triage basis to ensure there is some equality aspect to provision of health care in Canada.
How to achieve this: firstly, public discourse, inform the public and change public opinion, political opinion and public policy will follow. How to do this? Well, crisis keeps building which leads to increased public participation. IWHA is hoping to help organize a regional rural health conference in order to build networks and influence to advance the aims of a what could truly could be a top healthcare system in Canada.
We Can Do Better.
— Alan E. MacPhee, Souris, P.E.I., Chairman, Island Hospital Access
I came (to P.E.I.) in 2018. I am 71 and have no family members elsewhere in Canada that I can look to for support other than my daughter who lives in Charlottetown.
I have several health issues that I need a family doctor to oversee and help me with. I am a breast cancer survivor and I have thyroid issues and high blood pressure. When I got my health card I immediately got put on the registry to get a doctor. Imagine my shock when I found out that I might wait three or four years for a doctor. The people at the registry told me they make no distinction between someone with health issues who urgently needs a doctor and someone with no health issues at all. They suggested I might call around and try to find a doctor. They also suggested I ask my daughter to refer me to her doctor. Well, my daughter doesn’t have a family doctor either and she has been here two and a half years. If people knew what they were getting into, I wonder if they would even come here to work. They then told me to go to a walk-in clinic in Summerside and hope that I can get looked after there. I am very discouraged. I need someone who knows my issues, not someone who has no idea what is wrong with me.
This is a wonderful province. I love it here. But it’s really scary not having a family doctor. Sometimes I can’t sleep at night because I worry about my health. If you are not paying enough to doctors who work here, then you need to offer more. If you are expecting doctors to overwork so that they have no joy of life, then you need to make sure they are not expected to take on more patients than they can comfortably handle. If nurse practitioners would help, then take on more of those.
It sounds to me like anyone who runs a good business would know how to deal with problems like this. Any employer knows that if his staff is unhappy they won’t stay. Let’s make our doctors happy so that they will want to live and work on our beautiful island. If it’s politics that are making these things impossible then we need to know that too so we can vote for more reasonable measures.
— Nancy Bourque, Senior living in P.E.I.
HOW DO WE ALL LEARN MORE? ONE QUESTION AT A TIME
How our journalists dug into the decades-long shortage to uncover new information and find solutions.
BY STU NEATBY
QUESTION: WHAT’S THE BIGGEST GAP BETWEEN CHALLENGE AND SOLUTION?
I had a conversation with some family members about physician shortages a few days ago. Quite a few members of my family have a background in health care. I remember someone saying that the solutions to the issue were all complicated, and asked what any concerned provincial health minister could possibly do. I practically spit out the word “planning!”
The Newfoundland and Labrador Medical Association has pressed for an HR plan that takes into account projected retirements and population health needs over the next 10 years. Although some provinces are developing or have developed some aspects of this, I did not see evidence that this has been fully and comprehensively completed by any province. Basic numbers about recruitment and retention from the past five years were also difficult to obtain from health departments from all Atlantic provinces except for P.E.I.
QUESTION: WHAT’S THE ONE PIECE OF RESEARCH YOU EXPECTED TO FIND, BUT DIDN’T EXIST?
Recruitment and retention data from each province. I requested the number of family physicians who began work in each province, and the number who either retired or left the province, each year, over the past five years. I thought this would be relatively easy information to find and compare between each province. Health authorities and departments of health from Nova Scotia gave me ample details about departures going back three years, but initially little about recruits. A link was sent to me that included information about recruits, but I was unclear whether the time period matched up with the departures. Newfoundland and Labrador said they did not keep this information, and referred me to each of their four health authorities. None have responded to requests for this information. New Brunswick gave me some numbers going back two or three years, but not the full five. Only P.E.I. provided this data going back five years.
BY GLEN WHIFFEN
QUESTION: DID YOU SEE ANY GAPS BETWEEN CHALLENGES AND SOLUTIONS BEING EXPLORED?
Family doctors in rural areas may feel isolated and not have access to the same support regarding ordering tests and access to specialists. Solution would be better communication and efforts — of which many are underway — to ensure they are on same playing field as urban family doctors. Also, issues with the pay-for-fee service need to be addressed to reduce time spent on paperwork and more time to be spent on seeing patients — or a different method of payment to family doctors.
QUESTION: WHAT’S THE MOST SURPRISING THING YOU LEARNED?
The lack of proper communication and overall information sharing in this day and age among doctors and specialists, and health-care authorities and governments.
QUESTION: WHAT STUCK WITH YOU AFTER YOU FILED YOUR ARTICLE?
If you don’t have a family doctor and efforts to find one fail to meet with success, you are disadvantaged in society in terms of your health care. There is no continuity in your health care and issues can go untreated for long periods of time, or missed.
QUESTION: WHAT IS/WAS A STANDOUT SUCCESS IN THIS SERIES?
Highlighting the issue throughout the region is the standout success! It has gotten the conversation going, and readers got to see that the issue is not localized to their area or province, who some the people most affected are, and who some of the main players are working on finding solutions to this major issue.
QUESTION: WHAT HOLDS THE MOST PROMISE IN TERMS OF CHANGING THE TIDE/ POSITIVELY IMPACTING THE SHORTAGE?
The medical schools designating seats specifically for family medicine and programs that have medical students live, work and be exposed to family medicine, particularly in rural areas.
LAY IT OUT FOR ME
THE NEXT GENERATION OF DOCTORS ARE UP FOR THE CHALLENGE, BUT FEWER ARE CHOOSING RURAL:
192 students admitted into Dalhousie University (112) and Memorial University medical schools in 2018. Students are exposed to training in rural regions and recruitment efforts are focused on encouraging teens from rural communities to consider a career in health care.
WE HAVE AN AGING WORKFORCE
According to Canadian Medical Association (CMA) data from 2018, practising doctors 65 and older in Atlantic Canada: 40 in P.E.I., 172 in N.L., 235 in N.B. and 387 in N.S.
BURNOUT IS REAL
47.4 per cent of Nova Scotia GPs or specialists in the 2017 CMA survey felt overworked in their discipline. In N.L. that number was 39.3 per cent, 34.3 per cent for P.E.I. and 34.1 per cent for N.B.
THE PAY STRUCTURES NEED HELP
New Brunswick’s blended pay model is helping New Brunswick keep more local doctors. Meanwhile, physicians in N.L. and N.S. say the current fee-for-service payment model is a double-edged sword that encourages volume (that’s good and bad) but it doesn’t encourage collaboration or place focus on preventative care.