“Oversight” left Halifax out in the cold without enough docs

Health authority came to the rescue

The family doctor crisis in Metro Halifax occurred because government assumed that the capital city didn’t require its attention as it set about managing the MD supply in rural Nova Scotia.

Wendy Walters, Senior Communications Advisor, Physician Relations for the NSHA, describes it as a bureaucratic “oversight”. I can think of less charitable words, but people do make mistakes (I may have made a mistake once, but the details have grown fuzzy.)

Political interference, on the other hand, would have been be unacceptable. Walters says it didn’t occur: “(The direction was) a policy decision from the Department of Health and Wellness which at the time hosted the New MD approval committee. It was in response to perceived challenges in recruiting to rural areas and came from a reasonable place with the data available at the time.”

In fact, the information was there, but you had to dig for it.

The family doctor issue acquired a public profile sometime around 2009, but was assumed to be a strictly rural issue until 2016, when the Nova Scotia Health Authority brought Halifax in from the cold.

The deliverance of Metro Halifax (along with the rest of the Central Zone) began in 2011, when the Department of Health and Wellness created the “New MD” committee.

Halifax remained off the committee’s radar until 2016, when the freshly minted NSHA joined the group. The NSHA was handed “accountability” for the province-wide physician supply problem. (See Turpin’s Law, Section 33 subsection 9(a),(1),(ii),(ab), which states “Woe unto whosoever is last to join a committee, for surely he will be assigned the heavy lifting.”)

Walters wouldn’t say so, but I think the NSHA is the hero of the piece, leaning into the task to discover there was a problem in Metro Halifax, too. So, in fiscal 2017, Metro and the rest of the Central Zone received a physician recruiter and incentives matching those enjoyed by the other zones.

The beleaguered Western Zone got a recruiter, too.

Bottom line, Metro was left twisting in the wind for five years or so while government was busy implementing policy for the rest of the province. Today we have 23,709 people who cannot find a doctor.

I combed DHW publications for the origin of the “oversight” and I believe I have found it.

DHW had reports noting “… almost 60 per cent of physicians (are) located in Halifax.” True, but that number included specialists, and NS had 30 per cent more specialists than the Canadian average (see Physician Supply, Environmental Scan, Page 14, and Shaping our Physician Workforce, Page 4). I’m guessing that no one thought to ask how many of those doctors in Halifax were specialists and how many were family MDs.

If I may borrow a medical term, we had an “occult” family doctor shortage in Halifax, i.e., hidden by all the specialists and clouded by the exhaust from their Porsches.

I am Halifax-centric, but I do not minimize the effect all this has had outside Metro; it’s just that the worst problem is here in the middle of the Central Zone. For example, an acquaintance in Musquodoboit with a life-threatening disease has no family doctor to tell him whether a new symptom is benign or possibly something more dangerous.

Note to insiders: The NSHA’s Walters says the accreditation and privileging system was never used to control the number of doctors. That was accomplished simply by managing the number of available positions. However, the NSHA took over physician supply management at about the same time it got responsibility for accreditation and privileging, and I think the two activities became associated in the public mind.

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