March Madness
Posted April 14, 2023
We are not winning the battle to find enough family physicians. First some background.
In March 2020, like jurisdictions all over the planet, Nova Scotia’s Liberal government was rushing its response to the rapidly growing pandemic. It was clear that programs were needed to assist individuals and businesses adversely affected by COVID.
The government asked Dalhousie University to administer some of those programs. Their work was judged to have been done competently in a subsequent review by the Auditor General.
It would have been normal for the funding to have been provided as needed from budgets approved by the legislature. Instead the government sent $100 million to Dalhousie on March 31st. This had the purely political motivation of including the cost in the fiscal year ending that day, so the costs would not show up in the 2022-2023 budget.
As it happened, less than half that amount was needed for the programs, so the balance, together with interest, is still under Dalhousie’s control. It has agreed to be guided by “advice” from the province about where to send the money before the agreement concludes in 2027. Unsurprisingly the Auditor General has taken a dim view of this process.
Fast forward to March 2023. On consecutive days in early March there were three health care related funding announcements:
- $58.9 million to develop a new campus at Cape Breton University (CBU Medical Campus), with cohorts of 30 new doctors, in collaboration with Dalhousie University’s faculty of medicine. It includes collaborative care clinic and expand CBU’s health and counselling centre.
- $25 million for Saint Mary’s University to develop a diploma program in healthcare analytics, and a business administration program for healthcare administrators, office directors and family doctors.
- $37.4 million for an Institute at St. Francis Xavier University to improve health promotion and mental health and wellness in rural communities
The entire amounts for each of these were transferred by the end of March for the same purely political reasons that applied in 2020.
Each of the three 2023 arrangements will have been documented by a letter, but none of these documents has been made public. As the Auditor General has observed, Nova Scotia is the only province that lets cabinet make spending decisions without legislative approval.
It is bad enough that the three university spending decisions were made without legislation. Even worse is that the publicly available information is restricted to the self-congratulatory press releases.
Whatever their merit, it will be several years before any of these initiatives has a discernable impact. The announcements distract attention from what is happening now.
Dealing with the shortage of family physicians is urgent. Population is growing fast, and there has been a surge in retirements in the past two years.
The Action for Health plan states that the goal is to have 135 Family Physicians per 100,000 Nova Scotians, and that it was at 125 as of March 31, 2022. That would suggest a shortage of 100 doctors,
The Department of Health and Wellness reports 142,000 people waiting for a family practice. Given its goal to have 135 family doctors per 100,000 Nova Scotians, that would indicate a shortage of 190 doctors.
Part of the difference would relate to the unprecedented growth in population in 2022. The rest is because of retirements. The number of licensed family physicians dropped sharply:
| January | Physicians Licensed | Family Medicine Specialists Licensed | Other Specialists Licenced |
| 2020 | 2,706 | 1,204 | 1,528 |
| 2021 | 2,865 | 1,231 | 1,634 |
| 2022 | 2,961 | 1,320 | 1,641 |
| 2023 | 2,923 | 1,140 | 1,783 |
Readers will understandably find some of these numbers confusing and inconsistent. That is because the sources are different and sometimes incomplete. They do not distinguish between full-time doctors and those spending some of their time teaching or in emergency rooms. Some measurements are over calendar years while others are over April 1 to March 31 fiscal years.
The province is showing progress in alternative sources of primary care. Enrolments for virtual care visits have grown to 61,000. In March there were 4,000 primary care clinic visits by those on the registry.
It is nevertheless clear that those plus the current array of recruiting initiatives will take far too long to close the gap. To make the job tougher, the data show medical students having a waning interest in family medicine residencies.
This problem is not unique to Nova Scotia or Canada. We are competing against the other provinces and countries to attract new doctors and retain the ones we have.
The province and Doctors Nova Scotia, the bargaining agent for physicians, are currently in negotiations. It will help if there is agreement on the severity of the problem.
It is going to cost serious money to move the dial. Fortunately there is more than $50 million stored at Dalhousie waiting for “advice” on how it should be deployed.
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