The strain on family doctors in Nova Scotia is expected to increase as a growing number of physicians plan to retire, according to Doctors Nova Scotia.
The association representing the province’s doctors says there are 57 vacancies or pending vacancies for family physicians in the Halifax-area alone. Thirty of those positions are already open. In the remaining 27 cases, physicians have given notice that they will retire or leave their practice, but haven’t left yet.
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The cases in the health authority’s central zone are part of a larger cohort of doctors that are retiring. Across Nova Scotia, between 300 and 400 family doctors are expected to retire within a decade, Chapman said.
In the short term, the number of people who don’t have a family doctor will “absolutely go up,” he added. Dartmouth is a hot spot in the capital, according to Chapman. In that community, there are 12 vacancies, with 12 more expected.
The most recent information from Statistics Canada shows that in 2014, 89 per cent of Nova Scotians had a family doctor while in Halifax it was 86 per cent.
Months-long search for a replacement
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Dr. Graeme Bethune has been searching for a replacement doctor at his clinic in Halifax’s North End since June. With less than three months before he retires, he has yet to find a doctor who will take over his practice.
In an interview at his clinic, he told Global News he has “serious concerns” about what will happen to his patients, especially those with more complex health problems. He sees more than 2,000 patients at his clinic.
READ MORE: Nova Scotia doctor calls family doctor shortage a ‘crisis’
“I don’t know how it’s going to play out, I really don’t. I don’t look forward to it at all,” Bethune said.
If new physicians aren’t found he said the impact will be felt throughout the health care system, with more pressure likely placed on hospital emergency rooms.
“I have many, many patients who really must be properly cared for by one physician – or a small group of physicians in a family practice – and they cannot manage going to walk-in clinics, their care is too complex.”
Health authority can’t guarantee all gaps will be filled
Due to the “fluid” nature of the process, not all positions will be filled, said Dr. Lynne Harrigan, vice-president for medicine and integrated health services at the Nova Scotia Health Authority (NSHA).
“There will always be some minor gaps,” she said in an emailed statement.
Pointing to the planned transition to collaborative practices, Harrigan said the health authority is making the job of family doctors more appealing by allowing doctors to work in “a team-based environment that has administrative supports and mentorship.”
“We are actively recruiting to fill all open positions. Recruiting is complex and challenging,” she said. “We have to manage the number of positions but also balance that with the types of positions and the areas required.”
Health authority policies won’t cover ‘shortfall’: Doctors Nova Scotia
Chapman says Doctors Nova Scotia supports the health authority’s long-term plans but it doesn’t believe the transition to collaborative care will be fast enough to address the immediate needs.
“They won’t cover the shortfall,” Chapman said. “It just takes a long time to implement these primary care teams.”
Changing the payment model, allowing for overlap between incoming physicians and retiring physicians, increasing the number of family medicine residency positions and adding more flexibility to the system are all measures the association thinks could be taken to increase the appeal of working as a family doctor.
For example, Doctors Nova Scotia is recommending the province move away from a fee-for-service payment model where doctors are paid based on the number of patient visits. Instead Chapman suggests a payment model based on the total number of patients that a doctor has in their clinic, or a blended model.
He said the goal would be for new doctors to be able to spend more time with their patients.
A spokesperson for the health department said in an emailed statement that the department is “always open to conversations with Doctors Nova Scotia, NSHA and the IWK Health Centre about payment models for family physicians in primary care.”
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