The 2013 election was a high point for Stephen McNeil – riding to power on a Liberal majority that swept much of urban and rural Nova Scotia. But one promise that got him there has been dogging the Liberals ever since — “a doctor for every Nova Scotian.”
While the NDP and Progressive Conservatives attack the Liberals for failing to make good on the promise — neither party is repeating it. Tory Leader Jamie Baillie has called it an “irresponsible promise” that McNeil had no idea how to keep.
The latest numbers from Statistics Canada show that 91,800 Nova Scotians over the age of 12 don’t have access to a regular health care provider — usually a family doctor. When asked why his promise wasn’t realised over the last three and a half years, McNeil has previously said it was because there was no physician resource plan when he came to office.
“We took down nine different district health authorities into one, during that process we realised there was no physician resource plan, we created one,” McNeil told reporters in the first week of the election campaign. “There was also a belief in the system that doctors were retiring based on age, that has not been the case. Doctors — at different stages of their professional life — are choosing either to retire or reduce practicing so there was a tremendous amount of pressure in the system in places where we weren’t expecting that.”
READ MORE: Our complete Nova Scotia election coverage
But, the province has an active physician resource plan that is updated regularly, and was introduced in 2012.
It looks at the province’s population and the supply and demand of physicians to predict how many doctors the province needs on a ten-year timeline.
Asked later about the discrepancy, McNeil told reporters on May 12 that the plan wasn’t specific enough.
“When we came in across the province we couldn’t tell where the shortages were, we had no idea who was retiring because what happened was plan had been built on… but the retirements were based on age when in actual fact we were finding that wasn’t the case,” said McNeil. “Some people were leaving profession, leaving the province at a younger age when we thought and the former health authorities thought they would be practicing in those communities for a very long time. That wasn’t the case.”
Physician resource plan works, but short term plan needed: Doctors Nova Scotia
Doctors Nova Scotia says the province’s physician resource plan is one of the most detailed in Canada.
“I don’t think it was ever intended to solve today’s immediate problems, it really was intended to ensure that structurally we have a good foundation into the future,” said Kevin Chapman, partnership and finance director of Doctors Nova Scotia.
However, Chapman said changes under the new Nova Scotia Health Authority have made tracking retirements easier. He said that it has helped show where gaps are going to be.
But the association says what’s needed to address the immediate shortage is collaboration between all parties — including the IWK, the health authority, Dalhousie University’s medical school, the health department and Doctors Nova Scotia.
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Chapman said in the short-term a mentoring program, more flexibility for new doctors, and a new payment model are needed to fill the immediate gap in the availability in doctors.
“None of its happened to date,” he said.
However, Chapman said terms of reference are in development for a payment model working group with Doctors Nova Scotia, the health authority and the health department.
Amalgamating the health authorities trumped doctors promise: professor
Because the physician resource plan is a planning document, made with predictions, political science professor Katherine Fierlbeck said it’s possible that the plan’s retirement projections didn’t completely hit the mark. But she said that’s why the plan is updated every few years.
Fierlbeck studies health policy and governance in Nova Scotia and has put a focus on the administrative and governance changes in the province’s health care over the last several years.
She said the Liberals “shot themselves in the foot” by campaigning on a doctor for every Nova Scotian at the same time as they campaigned on amalgamating the health authorities.
READ MORE: Nova Scotia Election: Tracking party promises on health care
The amalgamation required a huge amount of time, and resources, and focus.
“They were able to achieve this but in the meantime, there wasn’t a lot of emphasis put on the development of new primary health care models,” she said. “Everything was put on hold until the structuring of the health authorities was complete and then the year after that the restructuring of the department of health was completed.”
In order to tackle the gaps in primary care in Nova Scotia, she said whoever forms government will need to focus on rebuilding trust with front line health care workers and broaden the focus from doctors to all health care professionals.
“Not having a doctor is a huge issue for Nova Scotians right now.” Fierlbeck said. “It’s almost impossible I find, to talk to friends or family without somebody saying I don’t have access to primary health care.”
Parties promises on primary care
Over four years the Liberals say they will roll out $116.7 million to establish more collaborative care clinics and recruit more doctors.
$78 million will go towards expanding and creating 70 collaborative care teams. However, McNeil has said doctors will not be forced into collaborative care teams if they still want to work solo.
In addition to keeping many of the Liberal’s promises for more collaborative Progressive Conservative (PC) Leader Jamie Baillie said that if his party were to form government, they would spend $19.5 million over four years to address the shortage of family doctors and specialists.
Baillie said much of the extra money would be spent in the first year for doctor recruitment.
The NDP say they plan to spend $120 million over four years to build new primary care clinics and to hire more doctors, nurses and nurse practitioners.
Gary Burrill said an NDP government will work collaboratively with family doctors to determine what resources are needed in various communities. The party also says it would accept all the recommendations in a recent Doctors Nova Scotia position paper.
-With files from The Canadian Press.
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