There’s a perverse pleasure that comes from discovering that we can’t solve our problems because there are rules against solutions.
It’s no fun for the victim of the rules, but for those of us predisposed to disdain rules anyway, an uneasy sense of validation accompanies the discovery of another bizarre contortion that results in the rule-keeper’s head impossibly lodged elsewhere in his anatomy.
One such victim is a medical school graduate who wants to be a family doctor in rural Nova Scotia, in a place that needs doctors, very near to where she came of age. It seems like an obvious and easy win in the effort to re-doctor Nova Scotia, particularly considering she is has unqualified support from folks who want her there, future patients and a bevy of practicing physicians who see in her great potential.
She’s a long-serving nurse and was a licenced nurse practitioner but always dreamed of being a doctor. So, she reset her career and personal life, incurred a mountain of debt and devoted four years of her life to the successful pursuit of a medical degree.
Now, she needs to complete a family practice residency before she can hang out a shingle in an underserved area of Nova Scotia. But, she didn’t make the cut for a residency in Nova Scotia, so chances are good she’s off to the USA or Ontario where she did make the cut, and once moved there for two years of residency, she is unlikely to return here to set up a practice.
You will have noticed that her name is missing, a too-common deficiency these days in stories about what seems like the steady erosion of ground under the foundations of what’s erroneously called health care.
Her story rocks the boat she still hopes to board, and the ship’s senior officers are known to metaphorically keelhaul dissenters, so the discouraging words are whispered below decks.
The current provincial government didn’t create this situation and worked with Dalhousie Medical School to create additional family doctor residencies in Nova Scotia, but the rules still won’t let the province pick off the low-hanging fruit – that being, Nova Scotian med school grads who want to stay and work in their home province.
This story reaches beyond the unlit, straight and narrow halls of decision-making power in Nova Scotia’s health system, and crosses into the labyrinthine corridors of academia, where one might expect greater flexibility in the enforcement of rules. One would be dead wrong.
Here’s where it gets a little complicated, but let’s forge ahead and in the interest of attention-span (mine) simplify things at the risk of characterizing the rules as totally counterproductive when in fact they are only mostly counterproductive.
There are more medical students applying for residencies than available spaces. Regardless of how many doctors we need, the rules limit the number of residencies to a precious few.
So, those tasked with determining who is eligible for residency need an empirical formula to decide who’s in and who’s out. This is basically an academic decision and that means exam scores become the standard.
As a wise doctor once schooled me, “some docs, despite being smart (on paper) are morons in the art of real life.” That is not so say the docs who get the residency placements are real life morons, but they are smart on paper and that’s what gets them their spots.
There is something appealing about family doctors who are skilled in the art of real life, so perhaps factors other than exam grades could play a more prominent and productive role in determining family practice residency placements, factors like the certainty that the resident will stay in the province permanently.
Today, family practice residents commit to stay in a certain part of Nova Scotia for a pre-determined number of years after their residency, but they can buy back that required service. Some of these docs stay the required time and then leave. Others buy back their service and go, and still other do in fact stay in Nova Scotia.
But our doctor is a Nova Scotian with family and roots in the province, who’s dream is to practice family medicine among the people she knows and loves. She’s a sure bet to stay. Too bad the rules won’t let us bet on her.
Jim Vibert, a journalist and writer for longer than he cares to admit, consulted or worked for five Nova Scotia governments. He now keeps a close and critical eye on provincial and regional powers.