Cape Breton doctors say medical system is ailing under one health authority

Three Cape Breton doctors say the move to one provincial health authority and the resulting Physician Resource Plan is limiting the ability to recruit and retain doctors.

Dr. Margaret Fraser has been a family and emergency room doctor in Sydney for almost a decade. Plastic surgeon Dr. Abdul Atiyah came to Sydney 19 years ago and Dr. Stacy MacDonald set up a family practice in North Sydney a few years ago and works in the emergency room.

They say doctors who want to come to the area are being refused because of the province's resource plan. It uses metrics to determine the number, mix and distribution of physicians needed across the province.

MacDonald said when interning in Cape Breton under the former health authority, she was invited to several recruitment events. After the districts were amalgamated into the Nova Scotia Health Authority in April 2015, she said, "quotas of physicians in specific areas were introduced and you would only be able to apply for jobs in pre-approved locations."

She said New Brunswick tried a similar plan a few years ago and lost a lot of doctors.

Doctors told there are no jobs

Fraser said messages coming from the health authority don't always reflect the reality of the situation.

"We have seen a number of physicians come to the area who have wanted to work in the area and have been told that there are no jobs here despite the fact that we have manifestly large number of patients who have no family doctor and despite the fact that we have long wait times and large gaps in service," she said.

Statistics show that from April 2015 to the present, 13 family medicine doctors and 16 specialists were hired in the province's eastern zone (Cape Breton, Guysborough, Antigonish). Currently there are vacancies for 30 family doctors and 17 specialists.

Janet Knox, president and CEO of the Nova Scotia Health Authority, said she knows that access to health services is a primary concern for residents.

"We're working very hard with local physicians and a recruiting team to really be focused on how we fill those vacancies," she said. 

"We know we have challenges there and are bringing the full force of our provincial resource to how we support that."

Knox said seven potential recruits will be doing site visits in the upcoming weeks, including three specialists.

Specialists needed

The doctors said as specialists leave, it increases the likelihood other specialists will follow.

"As a surgeon, I can't work without internal medicine," said Atiyah. "And the loss of an infectious disease specialist in our area is a huge loss.

"One of the big losses we have is the loss of full vascular surgery. For most of the years of my service, we had two full-time vascular surgeons. [Now] we have the ability to do minor procedures and consults. That's about it."

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He said the health authority's resource plan doesn't recognize that Sydney is 450 kilometres from Halifax.

"In bad weather without surgical specialties, a helicopter can't help us," Atiyah said.

Making decisions locally

Fraser said concerns at the local level are going unanswered.

"At Cape Breton District Health Authority you could go down the hallway and knock on a door and say, 'We have a problem. What are we doing to address this?'" she said.

"Now we ask a question and we get no answer — except if we ask the question very loudly at a rally."

Knox said the health authority has a structure that allows for local knowledge to be taken into consideration. The authority has community health boards across the province as well as four geographical zones and local managers.

"The purpose of the zones ... is to make sure that we have local implementation and truly understand the needs of the local population," she said.

"We are working really hard to make sure that decisions are made locally and supported by an overall organization that can help move resources around. We are very committed to understanding the experience of people living in their local communities."

Nova Scotia moves to collaborative care 

The doctors said collaborative care may help some communities, but is not a provincewide solution to many problems. 

"Collaborative care is slow to implement," said Fraser. "We've been told anywhere from four to 10 years. And collaborative care is a very expensive model of care."

Ontario's auditor general found it was much more expensive than conventional care delivery models, Fraser said.

In the past, doctors rarely spoke out, said MacDonald. Now, "we are all seeing the need to expand services, to recruit locally and to make changes to our health-care system for the future."