Nova Scotia Health Minister Michelle Thompson sat down with Global News as part of our series called Code Critical, which examines the issues impacting the health-care system. Read Part 1: How a N.S. woman without a family doctor prays her family ‘doesn’t get sick’ and Part 2: Family doctors, walk-in clinics and how stretched the N.S. system is.
The interview has been edited for length and clarity.
Global News: The most recent numbers for the doctor wait-list indicate that just over 156,000 Nova Scotians are now on that wait-list. Names are coming off the list, but it seems more are being added. So for those who are on the list and might be feeling frustrated, what is your message to them?
Thompson: You’re right. There are people coming off the list. So we know that in the past year, since around April, we’ve had about 45,000 people come off of the list and we’ve had about 60, 64,000 go on.
But what I do want to just draw attention to as well is that the list is really a Need a Family Practice Registry. A doctor for Nova Scotia has a very different promise than we are offering. And I think it’s really important for people to understand that through the work we’ve done, and professions have done with scope of practice, that people can expect a health home now.
The days of only seeing a physician, when you go through an office door, really are not the future. Perhaps the practice will have a nurse practitioner or family practice nurse, or perhaps there will be a pharmacist. So what we really are doing is creating a health home environment where people can have their needs met by a variety of different health-care practitioners. And in many ways, it immunizes us against being afraid that we would lose a doctor or lose a nurse practitioner because our health home will be where we go to get care.
Global News: In the first instalment of Code Critical, we spoke to a mom of two young boys who is without a family doctor. She is most concerned for her youngest son, who has a lung disease. So with a family like that, how does she navigate the system? How does she ensure that her little guy gets the care that he needs and doesn’t end up in the ER with pneumonia?
Thompson: When people live with chronic disease, first of all, I know it’s it is very stressful. There’s just so many variables. So the emergency room, when you live with chronic disease, should actually be part of your plan if you feel that you can’t manage your symptoms. What we want to do is create a community environment where you have access to, in this case, pediatricians, where there are nurses that can support you, pharmacists, family physicians.
We’re in the middle of a test-and-try right now where people in a number of practices across the province actually have access to some of their health record on the YourHealthNS app. That’s also very empowering so that in the event you need to go to the emergency room, or you need to seek care from a different clinician than you see typically, you have access to that information in the palm of your hand.
Global News: A concern we’ve heard from those without a family doctor is “falling through the cracks.” How do you make sure that with the different diagnoses that you could have as you age, nothing’s getting missed? That you are making sure the checkups are happening and your health does not fall through the cracks?
Thompson: If you’re not on a family practice registry, certainly if you feel that you need a checkup, those are things that can happen. We also have a number of screening programs throughout the province. We have the colorectal cancer screening program for those who are 50 years of age and older, that comes directly to us through the mail. We have women’s clinics, as an example, mammography services, many of those are self-referral. And so it’s really important that we do continue to keep our health at the forefront.
You can put that in the (YourHealthNS app). It will direct you there because it has location services. There’s a number of programs offered through Nova Scotia Health around supporting wellness, supporting healthy eating, supporting movement, supporting mental well-being programs that can be delivered virtually and you can register right within the app.
To your point around wellness, there’s so many pressures on on all of us, but certainly on families. I think that app is an incredible tool to navigate the system and see what’s available, because it’s one-stop shopping, more or less so for individuals who are wondering how they maintain that prevention.
Global News: In the second part of our series, we interviewed a family doctor who is concerned that a quarter of her colleagues will retire over the next 10 years. How is the province preparing right now to address that, especially as the population is set to continue to grow?
Thompson: There’s not one strategy that’s going to support that, and I think we see this across the country. There were changes made to education in the ’90s that certainly have echoed through those decades to bring us to where we are today.
We have competitive incentives for physicians across the province. We’re also very progressive in terms of our approach. So these health homes are really an essential part, endorsed by the Canadian Medical Association, certainly Doctors Nova Scotia. There are things that are within a physician’s scope of practice that are very essential. And we want those people who need that physician service to go there.
Physicians now want to work in a team. And we hear that new physicians don’t work as hard as the old physicians. And I always temper that by saying they work differently. And I think our more senior physicians would say that the environment in which our newer physicians are working is just a very different environment.
We’re looking at ways to support them in their practice, particularly around things like red tape reduction. So we’ve committed to taking 450,000 hours of red tape out of the system, one, for obviously the well-being of the physicians, but also to ensure that they are patient-facing as much as they possibly can be and not tied up with administrative tasks.
Global News: Now that we’ve talked about concerns and resources that are available, I’m just wondering about this idea of fear. Do Nova Scotians who are on the wait-list have the right to feel fear when it comes to their health if they don’t have a family doctor?
Thompson: I think what what people really need to know is that there are a variety of access points and I think our language really matters. As an example, for primary care appointments in this province, there are over 60,000 new appointments available to Nova Scotians. So often fear comes when we don’t fully understand or have line of sight of what the options are.
The past is really not the present, and it’s not the future. So, you know, pharmacists do so much more now. Nurse practitioners are so involved in the system. We have physician assistants who are working in our emergency rooms, and we’re training them to work in the primary care environment in the emergency room. So it really is around understanding the app can help you navigate; urgent treatment centres are throughout this province. So if something comes up unexpectedly, you can go and access the care there.
I don’t want people to be fearful. I think all of us have to be advocates for our own health, whether we’re preventing illness or we’re managing an ongoing illness, and we are creating more tools for that. And so there’s never been this amount of investment in my career as a registered nurse in health care. There’s never been this change. It’s not perfect.
I want people to feel encouraged and I want people to know we’re working very, very hard to create a different system than the one we are used to. And I know that’s hard, but we are getting there.
Global News: (The Nova Scotia PC Party campaigned on fixing the province’s health-care system in 2021.) So, the big question to add to that as we check in on the pulse of health care: has it been fixed?
Thompson: It’s being fixed is what I would say.
We’ve seen a reduction of 27 per cent in our surgical wait-list — that’s towards fixing it. We have seen through the investments in EHS with the clinical transport operators, there have been thousands of hours of ground ambulance support put back in the system. We have incredible investments where we now have physicians, nurses and paramedics working in our communication centre providing support in the field. Four out of 10 calls now don’t actually have to be transported because of the supports that we’ve offered.
We’re looking at investing in our clinicians and we’ve settled some really competitive contracts in order to make us a magnet for health-care workers. We’re more transparent than we’ve ever been showing people where we’re doing well and where there are areas to improve.
I do want people to feel encouraged. We are fixing it. I certainly can’t say that it’s fixed, but I feel hopeful as a clinician.
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