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Shortage of family physicians appears to be getting worse” Schneidereit

Evidence suggests the shortage of family doctors is getting worse.
Evidence suggests the shortage of family doctors is getting worse.

A year and a day after the launch of the province’s wait list for a family doctor, where are we?

On the plus side, the Nova Scotia health authority reportedly says 4,331 people who signed on in the last year had been matched with a family doc by Oct. 1.

On the minus side, despite the above, the wait list has never stopped growing.

Last March, the list contained 25,000 names. By July, it had topped 33,000. The total is now 37,000 people who say they want, but can’t find, a family doctor.

Those numbers don’t include tens of thousands of Nova Scotians who don’t have a family physician but haven’t, for various reasons, bothered to put their name on that wait list.

Nor does it fully reflect the impact of doctors recently retiring or choosing to leave the province — I heard of another two in the latter category just last week — faster than their patient rosters can be absorbed by replacements.

So the evidence suggests the shortage of family doctors is getting worse. In recent weeks, this column has touched on some of the reasons we have too few available family physicians:

• Many doctors trained in family medicine aren’t family doctoring. They’re filling other, more lucrative medical roles, from working in emergency rooms to being hospitalists.

• A previous provincial program that helped foreign-trained doctors to get a Nova Scotia licence was cancelled in spring, 2015. Its replacement has yet to launch.

• Many older family doctors can’t find replacements willing to take on their (traditional) practices. When they retire, their patients are left in the lurch.

• Efforts to produce more family doctors are hamstrung by lack of clinicial training capacity, i.e., the resources, both human and infrastructure, needed to teach family medicine residents.

• Finally, the NSHA’s decision, early on, to tightly control how and where family doctors could practise has greatly frustrated many physicians, who are feeling burned out and disrespected. These same family doctors, however, are mobile and sought after in many other jurisdictions.

What’s being done?

Well, the government, in its September budget, promised $2.4 million for 10 new family medicine residency spots at Dalhousie University’s medical school and 10 spaces in a yet-to-launch program to assist foreign-trained family physicians, whose credentials aren’t automatically recognized here, to obtain licences to practise in Nova Scotia.

The NSHA is also trying to recruit doctors directly from the U.K. and other places considered on par with regards to Canadian medical training and practice.

Bringing in foreign-trained doctors will help, of course.

So will training more family docs. The problem is that since half of those 10 new residency spots won’t open until 2019 — and there’s no timetable yet on when the other five will be offered — it’ll be at least 2021 before those extra spaces produce their first family doctors.

But here’s the rub.

If the environment now contributing to the shortage — including burnout, dissatisfaction, family doctors leaving the province or dropping family practice for many other, more lucrative medical roles — doesn’t markedly improve, why would we expect many of those newly recruited, newly licensed or newly trained family doctors to stay?

Beyond whatever service agreement they might sign, of course.

What’s needed, and urgently, is a bona fide roundtable that includes all stakeholders — genuinely working together — to tackle and solve this deepening crisis.

Nova Scotians are watching.

 

-PAUL SCHNEIDEREIT-

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