Registry Numbers Do Not Tell Us Much About Accessibility Of Primary Care
Posted September 7, 2018
The Nova Scotia Health Authority’s (NSHA) Need a Family Practice registry (NFP) may be a good way to connect people to a physician willing to take more patients, but it does not provide useful information about how many of them there are.
People can identify themselves as seeking a primary care physician on the website or by calling 811. Those who sign up are contacted when a family physician in their area is willing to take new patients.
The registry was initiated 22 months ago, on Nov. 1, 2016. On Feb. 1, 2017, there were 25,000 names on the list, increasing to 42,000 by the end of 2017. Since the start of this year, the increase has been 2,000 per month, bringing the total to nearly 57,000 at the beginning of September.
Survey data by Statistics Canada and others suggest the total number of Nova Scotians who don’t have a doctor is close to 100,000. The registry is unlikely to ever hear from all of them.
Some don’t know about the registry, some don’t believe it will help, and some are not concerned about having a family physician.
On the other hand, the registry will already have names of people who are no longer searching for a doctor. Some will have died, or moved to another province, or found a doctor but neglected to take their name off the registry.
In April of this year, the government announced a $150 bonus from the Department of Health and Wellness (DHW) for each new patient taken on by a doctor.
Strangely, the department does not advise the NSHA when a doctor is being paid this bonus, to make sure that the name is taken off the registry. Nor does it try to track how many patients each doctor has.
Most of Thursday’s Speech from the Throne was a recitation of the things government feels proud of. It used the opportunity to restate its case for collaborative primary care practices.
Like the name of the registry, it tries to emphasize that primary care does not always require a doctor.
We are told of a nurse practitioner who “…cares for approximately 800 patients who were on the Need a Family Practice Registry in that area. Team members at clinics like hers support one another and are able to take on more patients, improving access to health care for Nova Scotians.” Of course, that team must include one or more doctors.
The Liberals have moved on from their ill-considered promise in the 2013 election that every Nova Scotian would have a family physician.
No province comes anywhere close to that. The Statistics Canada study concluded that 14.9% of Canadians aged 12 and over were without a family physician, compared to 10.6% of Nova Scotians.
The number of people on the registry can be expected to continue growing for another year or so, until all the people who are likely to be interested have added their names.
In the meantime, it is ridiculous to treat the monthly increases in the number of names on the registry as a measure of how many more people are looking for a doctor. When the registry opened, it had fewer than 20,000 names that had been collected by some of the former regional health authorities. Did we think that only that small number of people were without a doctor on Nov. 1, 2016?
Rather than a symptom of a crisis, the monthly increase suggests a belief by a growing number of Nova Scotians that the registry is a useful resource.
The registry’s website wrongly tells us that it “…allows us, for the first time, to establish provincial data on how many Nova Scotians do not have regular access to primary care and where they are located.”
This is not to suggest that there are no issues about access to primary care. There are real challenges here and across Canada, although we appear to be better off than most.
There will always be doctors who retire or scale back their practice every year, and the registry could be a useful tool for the affected patients.
But the monthly change in the number of names on the list will never tell us much about how many more, or fewer, Nova Scotians are seeking access to a primary care practice.
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