Nova Scotia's health care 'crisis' is Canada's crisis too

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Does Nova Scotia have a health-care crisis?

That's the powerful accusation made by a cancer patient in a video that went viral this week.

Wiping away angry tears, Inez Rudderham stared into the camera and challenged the province's premier to admit there was no crisis after she waited two years to be told she has cancer — a delay she attributes to the fact that she had no family doctor and was turned away three times at hospital emergency rooms.

"I dare you to take a meeting with me, and explain to me, and look into my eyes and tell me that there is no health-care crisis in my province of Nova Scotia," said the 33-year-old woman.

Rudderham wasn't the only one talking about a "crisis" in Nova Scotia health care this week.

It's a canary in the coal mine.- Katherine Fierlbeck, professor, Dalhousie University

The "c" word was also used by an emergency room doctor from Kentville, N.S., explaining why he and his colleagues launched a crowdfunding campaign to raise money to pay for more hospital beds at the Annapolis Valley Regional Hospital.

"Front-line emergency physicians, nurses and clerical staff have been pushed to a breaking point," Dr. Robert Miller wrote in a newspaper column published Monday. "Continuing a policy of shooting the messenger while denying a crisis exists is foolhardy."

The $100,000 GoFundMe campaign is part fundraiser, part publicity stunt, Miller wrote, "to draw the public's attention to the need, spur action and put an end to hallway medicine in Nova Scotia."

Meanwhile in Yarmouth, N.S, the regional hospital told pregnant women to call ahead when they go into labour due to a shortage of anesthesiologists. There are supposed to be four on staff, but one moved to another province and two others — a married couple — left the hospital last month.

With only one anesthesiologist left to handle the load, the Nova Scotia Health Authority decided to prepare for a worst-case scenario and warn women that when they go into labour, they might be transferred to another hospital, if necessary.

"We need anesthesia to ensure we have the ability to provide emergency cesarean section when they're required and you can't predict that need," said Dr. Cheryl Pugh, the executive medical director for the health authority's western zone.

'Things are bad'

Added up, it was a challenging week for Nova Scotia's health-care system.

"As a political scientist, I'm very careful about how you bandy about the word 'crisis' because it is politically loaded," said Katherine Fierlbeck, a political science professor at Halifax's Dalhousie University who specializes in health policy and has written a book about the province's health-care system.

"I try to avoid the word 'crisis' — but at the same time, things are bad."

But it's not just Nova Scotia: The same health system pressures are bubbling up all over Canada.

"It's a canary in the coal mine," said Fierlbeck. "It's the same variables that you have elsewhere in the country."

• 'This is the face of the health-care crisis': Woman issues plea to N.S. premier

• N.S. cancer patient shocked and grateful for support following powerful video

Despite Nova Scotia's highly publicized shortage of family doctors, most other provinces have a higher percentage of people without family doctors: Alberta at 18 per cent, B.C. at 16 per cent, and Quebec at 26 per cent.

By comparison Nova Scotia sits at roughly 10 per cent. A provincial patient registry lists almost 52,000 people actively looking for a doctor.

"You have to be careful how you interpret data," said Fierlbeck. "It doesn't really represent what is necessarily happening on the ground."

The statistics don't reveal the combination of forces pitting urban communities versus rural areas, family doctors versus specialists, aging patients with complex needs versus younger doctors choosing to work fewer hours, or the lure of better pay for doctors in some parts of the country and in certain types of practices.

"A lot of the challenge we have here in Nova Scotia is distribution," said Grayson Fulmer, senior director of medical affairs for the Nova Scotia Health Authority.

He's in charge of doctor recruitment. Right now, he has vacancies for about 90 family doctors and 97 specialists.

"Are we having the right physicians in the right places doing the right things? … I think that's the challenge we're having now."

Race to recruit new doctors

Patient demographics are one important factor. Nova Scotia has one of the oldest populations in the country, and older patients make different demands on the health-care system.

"They require more meds, more tests and they come in more often and the visits are going to be longer," said Fierlbeck.

And many younger family doctors are choosing to structure their practice differently, working in teams and sometimes working fewer hours.

"The younger generation of physicians coming out are seeking more of a work-life balance," said Fulmer. "They're working in a different manner and, in certain cases, that does translate into fewer hours."

Fulmer has recruiting agents travelling to medical schools and job fairs across the country, competing with teams from other provinces in what has become a national doctor-recruitment battleground.

• Doctor shortage hits Hay River, N.W.T.

"My recruiters know the recruiters in almost every other province by name, because every single event we go to, it's the same faces talking to the same physicians about the same problem," said Fulmer.

Because family doctors are independent operators running their own small businesses, all any government can do is try to create incentives.

Nova Scotia is offering some tuition debt relief in exchange for a commitment to stay in the job for a defined period of time. But the province is bargaining with less money. Right now, Nova Scotia has the lowest doctor remuneration rates in Canada.

Anesthesia right now is in a situation of a national shortage, so it's not just our centre which is affected. It's across the entire country.- Dr. Cheryl Pugh, Nova Scotia Health Authority

The search isn't limited to Canada. Nova Scotia and other provinces are also recruiting doctors from other countries.

Yarmouth has just hired a new anesthesiologist from South Africa to help with the shortage there, which also highlights another pan-Canadian problem.

"Anesthesia right now is in a situation of a national shortage, so it's not just our centre which is affected. It's across the entire country," said Pugh.

And the long-term bed shortage that prompted the crowdfunding campaign in Kentville is also a shared problem. Every day in Ontario, the province's hospitals have at least 1,000 patients being treated in hallways because of a shortage of beds, according to a recent report.

Fierlbeck said all of those structural issues are also affected by the political climate. Nova Scotia's government has made deficit reduction and balanced budgets a priority, while at the same time restructuring the entire provincial health system into one super-agency.

Ontario is 'déjà vu'

That's a story that will sound familiar to many in Ontario, where the province is also creating a single super-health-care agency and focusing on deficit reduction. This week, headlines reflected the increasing tension between the provincial government and several large municipalities over cuts to public health.

• 'Torontonians will die': City calls on province to end public health cuts

• Provincial cuts will cost Hamilton millions and threaten public health services: city official

"I have this incredible sense of déjà vu when looking at Ontario. What happened here is happening there," said Fierlbeck, adding that without access to public health services and family doctors, patients end up not filling prescriptions or seeking medical care.

"It's all these small choices that people are making that contribute to a worsening of chronic symptoms what will present more extremely down the road."  

Meanwhile, Inez Rudderham's tearful appeal did get the attention of Nova Scotia Premier Stephen McNeil.

"I asked the Nova Scotia Department of Health to contact Ms. Rudderham to offer support," McNeil said in a statement emailed to CBC News.

"As the premier of this province, I want to assure Nova Scotians health care is my single biggest priority. There are challenges in the system — I have always acknowledged that — but we are working hard to make improvements."

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