Code Critical: Family doctors, walk-in clinics and how stretched the N.S. system is

This is the second instalment in a Global News series called Code Critical, which examines the issues impacting the health-care system in Nova Scotia. Read Part 1: How a N.S. woman without a family doctor prays her family ‘doesn’t get sick.’

As a family doctor in Halifax, Dr. Leisha Hawker is well aware of the demands and burnout she and her colleagues face daily.

The former president of Doctors Nova Scotia believes the province’s health-care system is stretched thin — but what’s even more daunting is the fact it will worsen.

“The biggest concern I have is we just don’t have enough bodies,” she said.

“We know about a quarter of our family doctors are probably going to retire in the next five to 10 years.”

Hawker said she and so many other physicians are not just family doctors but “fill some other gaps in the health-care system.”

“We often work in emergency departments and do prenatal care and deliveries and long-term care, sexual health clinics,” she said.

“Right now, today, I’m working on addiction clinics. So a lot of times, on top of our family practice, we’re usually working in at least one other setting as well. And so it’s the struggle trying to balance a family practice with other jobs that you might have as well.”

She pointed out that family doctors tend to have a “really broad scope” in training, so will take on roles within the community whenever they see a need.

For Hawker, who started a practice in north-end Halifax, she devotes much of her practice to addiction medicine. As well, she co-founded a newcomer clinic that serves refugees who are new to Nova Scotia.

That clinic was designed to be a temporary landing space, but that hasn’t been the case.

“The ideal model is that they stay with us for about two years and then they transition to a permanent family doctor. But with our primary care crisis, I’ve had some patients I think I’ve had for six or seven years,” she said.

According to the province’s data dashboard, there are 155,373 people on the Need a Family Practice Registry as of Feb. 1, which represents 15.5 per cent of the population.

Since Jan. 1, the registry has increased by 2.2 per cent — or just over 3,300 people.

Hawker said it’s evident Nova Scotians are feeling the weight of an overburdened system.

“We get questions from like your hairdresser, your contractor, anyone that you happen to be in line with at the grocery store,” she said.

“If they find out that you’re a family doctor, there’s always somebody they know that needs a family doctor.”

She said it’s hard to say no to all the requests.

“Because you want to be able to have a family doctor for every Nova Scotian. But you also need to be able to have reasonable access for your current roster of patients.”

Walk-in clinics become a resort

So, what happens when a family doctor is stretched too thin for their current roster of patients?

There were about 20 people lined up outside a walk-in clinic in Halifax’s Clayton Park neighbourhood at around 8 a.m. Tuesday — half an hour before it opened.

Wafa Ali, who arrived just after 7 a.m., was near the front of the line. She has a family doctor but it’s usually a two-week wait to see him, which isn’t feasible for certain illnesses.

She has resorted to waiting for the walk-in clinic more than once, and knows the drill.

“I got a very late appointment from my family doctor and I need to see a family doctor immediately. So I came here to this clinic. The point is we have to come as early as we can, so we can reserve our spot,” she said.

“As you see, it’s windy. It’s -5 (C) and there is a long queue to wait … to see the doctor. But this is the situation here.”

Despite arriving early — before the clinic even opens — some patients were turned away.

“I have to come back another day. It’s super disappointing but honestly, I’m not really surprised,” said Lola Kirincich, who also has a family doctor but said appointments are booking three weeks ahead.

“They said it’s the max people they can take and they’re really sorry. There’s nothing else they can do.”

The only other option, she conceded, would be an ER visit or to come back the next morning.

“Maybe I’ll come another hour early,” she said.

‘Recruiting as aggressively as possible’

Katrina Philopoulos, the director of physician recruitment with Nova Scotia Health, told Global News that the province is “recruiting as aggressively as possible” and “not leaving any stone unturned.”

“What I can tell you is that our wait-list, every month, we are taking patients off that list,” she said.

She admitted “no one thing” is going to solve the doctor and recruitment situation, but said the province is dedicated to several strategies.

At the forefront is a focus on “medical learners” — those who are about to enter the medical field and can be enticed to start their career in Nova Scotia.

In some cases, that means recruiting students from other Canadian universities. Most recently, Philopoulos says, she’s travelled abroad to bring Nova Scotians home.

“Our Nova Scotia kids — sons and daughters — are training in the U.K., are training in Ireland, are training in Australia and the Caribbean,” she said.

“We have gone and met with those medical schools, and we’ve met with those students to let them know that there are pathways for them to come back.”

Philopoulos said 20 to 30 per cent of the province’s recruits are international medical graduates and calls the situation a “global competition.”

Nova Scotia Health has been working with the Department of Labour, Skills and Immigration to make it easier for physicians and families to “establish roots in Nova Scotia,” she explained.

Hand in hand with those initiatives, the College of Physicians and Surgeons of Nova Scotia has made changes to licensing, which includes removing the requirement for a certification exam for doctors trained in the United States.

Just this week, the province has put out several news releases on funding for recruitment and retention initiatives as part of the Office of Healthcare Professionals Recruitment (OHPR) Community Fund.

Thirty non-profits and charities will be receiving money for websites, a podcast, a TV series, welcome kits and social events — all in a bid to support newcomers in the health-care field as they settle in Nova Scotia communities.

“We know that when we bring physicians here, communities are the ones that wrap their arms around them and help them identify and find and build roots in the community,” Philopoulos said.

Planning for succession

Meanwhile, Hawker worries for the future.

In light of the fact a quarter of her colleagues are over the age of 60 and nearing retirement, she believes there should be a focus on how to help them wind down their practices.

“There’s going to be a lot of retirements in the next decade. We’ll need to really plan for that succession,” she said.

“Support them if they want to slowly wind down their practice … while a newer physician can receive mentorship from them and have a gradual transition of practice, which would be great for the patients too because they get good continuity of care instead of losing a doctor.”

Nova Scotia Health Minister Michelle Thompson sat down with Global News to talk about some of the concerns raised in this series and to discuss what steps government has taken to improve the health-care system.