By Dr. Rick Gibson and Dr. Lynne Harrigan
The concern over access to primary care in our province is top of mind for Nova Scotians. Addressing that problem is the key priority for us at the Nova Scotia Health Authority.
Those who are without a primary care provider, such as a doctor or nurse practitioner, and those who do have a family practice but wait too long to be seen are understandably worried.
So are we. It’s a problem we’ve been working to solve from day one of our organization. The approach has evolved in that time but we’d like to speak about the key pieces.
1. Determining the scale of the problem
While there have always been people who need primary care but can’t find a doctor or nurse practitioner in their area, we have never had a good sense of how many people or where they were located until now. Today, based on the data added to the year-old Need a Family Practice registry, we are aware of more than 42,000 Nova Scotians seeking a family practice and we continue to encourage others in need to add their names to the registry.
Having that information enables NSHA to plan and prioritize work to expand and enhance collaborative family practice teams around the province. The registry is also a resource that allows us to provide doctors and nurse practitioners who are accepting new patients with a list of people in need in their areas. Almost 3,500 people have been matched to family practices that way so far. At the same time, practices decide the way they accept patients. Family doctors choose when, how, and from where to accept new patients into their practice. We know from validating registry information that almost 3,000 more Nova Scotians have found a family practice through other routes.
A limitation of the registry is that we don’t have a way to prioritize people who are the sickest. For those people who do not currently have a family practice, we recognize the need for access to care now. We are working with the Department of Health and Wellness on options to respond to that need and will share an update on these plans in the New Year.
2. Recruiting Family Doctors
Every day, NSHA staff, along with community groups and practicing family doctors, is working hard to recruit more family doctors to the province. Since NSHA took responsibility for doctor recruitment in April 2016, 69 family doctors have been recruited along with another 11 who have accepted offers and are planning to start practice. We’ve made significant investments in working with our partners and communities to promote Nova Scotia as a place to practice medicine and live a great life.
We’ve established a provincial recruitment advisory group to make sure we are maximizing opportunities to bring doctors to Nova Scotia. It takes all of us—the health authority, government, physicians, community leaders, and Nova Scotians—to create the warm and welcoming culture that our province is known for and that is vital to recruit and retain health professionals.
We are also working with our partner organizations to establish a new assessment program for qualified doctors who have been trained outside Canada, which will result in additional family doctors who are able to practice here.
NSHA is approving the replacement of every Nova Scotia family doctor who retires or leaves practice for any other reason. Many retiring family doctors have a large number of patients in their practice. Upon retiring, they may need to be replaced with more than one doctor. And this is happening.
We know there are currently more than 60 vacancies, and we’re working to add more doctors on top of simply filling vacancies. Initially, we were asking doctors setting up new practices to do so in the communities where they were needed most, based on doctors having left the community. That has changed based on feedback from doctors and communities. While we continue to recruit for those communities, we recognize that some family doctors wish to establish practice in other communities. NSHA does not restrict where family doctors establish their practice. Any family doctor with a Nova Scotia license to practice can work in our province.
3. Increasing access to primary care
All family doctors provide an important and valued service in our province. The way doctors are trained and practice is changing. New doctors are trained in team-based care. Many of our current doctors provide care in emergency departments, nursing homes, and inpatient units, in addition to their office-based practices. Some prefer to work part time, and we all value work-life balance.
While we continue to recruit family doctors in a competitive landscape, we are also expanding access to primary care in other ways. Team-based care is an investment in better access for patients and better supports for family doctors. Other regions that have built strong primary health care systems based on collaborative family practices have healthier populations and lower rates of hospitalization, reducing health care costs and improving the whole health system.
We are not starting from scratch. There are already 50 collaborative family practice teams in various stages of development across the province. We are continuing to strengthen and support these existing teams and to work with new providers to add more.
It is important to note that family doctors are independent health professionals who are compensated by the Department of Health and Wellness and run their own practices. Our role at NSHA is to support family doctors and collaborative family practice teams to provide comprehensive care for Nova Scotians. We understand the importance of strong relationships with family doctors and other health professionals and are committed to strengthening those relationships.
NSHA will continue to evaluate and improve our processes and plans. We want to work with providers and other Nova Scotians to learn and to do things better.
It can be challenging to think about the future when you are worried about the present. We want to assure you we are working to meet immediate needs, still with a vision for a healthier Nova Scotia that is built on a strong foundation of primary health care.
Dr. Rick Gibson is the senior medical director of primary health care and Department of Family Practice and Dr. Lynne Harrigan is vice-president, medicine and integrated health services with the Nova Scotia Health Authority