Along with the registry of more than 50,000 Nova Scotians looking for a family doctor, the province has another growing list to tackle: the 70.5 family physician job openings it needs to fill.
The current job openings are only a fraction of the hires that will need to be made in the coming years. The most recent physician resource plan says more than 500 physicians are needed in the next 10 years.
The Nova Scotia Health Authority says it’s tackling this challenge by changing recruitment. A provincial strategy was created last year, and the province is focusing on improving its presence at job fairs.
The NSHA’s senior director of medical affairs, Grayson Fulmer, says his team is also working with the Department of Health and Wellness to overhaul physician incentive programs.
“We collaboratively worked to expand that opportunity, so that we can use those incentives in more situations that are more akin to how physicians are now entering practice and locating themselves,” Fulmer said.
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The data suggests those programs have been severely underutilized.
Between 2015-16 and 2017-18, $4.71 million was budgeted for the three main incentive programs: the tuition relief program, the family medicine bursary, and the debt assistance program.
Tuition relief offers up to $12,000 of medical school tuition in exchange for five years of practice in the province. The family medicine bursary offers up to $60,000 toward startup costs in exchange for a three-year commitment, and the debt assistance plan offers $20,000 to $45,000 to doctors who choose to practice in Nova Scotia.
But only 57 per cent of the funding for those programs was paid out in the last three years; just over $2.69 million total.
“We kept hearing back from the physicians we were trying to recruit that there wasn’t a whole lot of flexibility in some of the incentives as they were administered,” Fulmer said.
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In April, changes were made to remove some of the restrictions, beginning by allowing doctors in urban areas to access the programs. Fulmer says he’s not able to say why the changes were so long in coming, but the Department of Health is hopeful that more physicians will access incentives.
But even newly-created incentive programs have restrictions. A $6.4 million trust fund has recently been established to encourage doctors to take patients off of the wait list. Each time a new patient is added to a physician’s roster, they can bill for $150.
Dr. Barb O’Neil and her colleagues in Kennetcook, N.S., have used the incentive a handful of times already.
“But for us it’s not a huge incentive because we are closer to our capacity of patients, having practiced here for a number of years,” Dr. O’Neil said.
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She believes it would be better suited to newer physicians, but those doctors are shut out. The province says only those who have been in a practice for at least two years or have more than 1,350 patients can use the new billing code. Dr. O’Neil says that doesn’t make sense.
She says the province needs to consider paying physicians better. Nova Scotia family doctors make less than the national average, and less than their counterparts in neighbouring provinces, according to the Canadian Institute for Health Information.
Beyond money, Dr. O’Neil says community involvement is one of the strongest recruitment tools the province has at its disposal – and it’s one she says is being underutilized.
“I was recruited to a rural community from residency, and the things that swayed me and made that decision for me were the physicians in that community,” she said.
The NSHA says it’s working on that, too.
“We’re undertaking a couple of different projects to reach out, to talk directly to municipalities, directly to the local physicians and physician leaders, to get a more active sort of mechanism and process working with our recruiters and working with us to make sure that the candidate experience when we actually do have someone who’s interested in practicing here, is seamless and effective,” Fulmer said.
Fulmer admits that is a return to something that had been happening before the NSHA’s creation.
“Some of those linkages broke down a little bit and there was a little bit of odd messaging coming forward that we were solely responsible for.”