Nova Scotia’s health-care system relies on the passion and commitment of a robust and extensive workforce. Physicians are a critical component of that workforce. Unfortunately, there are not enough physicians to meet the health-care needs of Nova Scotians.

The physicians we do have are carrying the burden of this shortage and are suffering from burnout, low morale and disengagement. The impact of this is being felt at all levels of the system and in all corners of the province, including primary and specialty care, rural and urban care, physicians in all career stages, and potential new physician recruits.

There are several key issues that have contributed to the fragility of the physician workforce in Nova Scotia. These include Nova Scotia offering among the lowest compensation rates in the country, and the challenging work environment in the province. Immediate action is needed to stabilize Nova Scotia’s physician workforce.  

Doctors Nova Scotia believes a stable physician workforce cannot exist without these key ingredients:

• Competitive pay for physicians
• Meaningful physician engagement and leadership opportunities
• Appropriate resources and practice supports
• Mutual trust and respect between physicians and government and health-system leaders

After surveying the state of the physician workforce in Nova Scotia and investigating the issues doctors are facing, Doctors Nova Scotia, Maritime Resident Doctors and the Dalhousie Medical Students’ Society released a position paper titled Road Map to a Stable Physician Workforce. In it, the three organizations that represent the interests of physicians across the continuum of their career in Nova Scotia put forward six recommendations to help stabilize the province’s physician workforce.

Recommendations:

1. Pay physicians competitively. Nova Scotia must become a leader for physician compensation in Atlantic Canada, with an established path to becoming nationally competitive. This will not only support the recruitment of new physicians to the province but also help retain the physicians currently practising here.
    
2. Introduce a new blended payment model. Adding a blended payment model for family physicians, similar to what’s offered in New Brunswick, the province’s major recruitment competitor, would make working in Nova Scotia more enticing to physicians.

3. Invest in succession planning. The province should implement a Transition into Practice/Transition out of Practice (TIP/TOP) model for all specialties. In this model, new-to-practice physicians are paired with retiring physicians; the physicians overlap in the same practice for a set period of time, as one prepares to retire and the other gradually assumes the duties of a full practice.
    
4. Improve physician engagement. The Health Authorities and the Department of Health and Wellness (DHW) must actively seek the input of appropriate physicians when making decisions that impact the delivery of health services. This must involve engagement of the organizations that represent physicians, including DNS, MarDocs and the DMSS, as appropriate.
    
5. Change the focus of billing audits. The primary focus of auditing and claims monitoring must be education. The first time a physician is audited on a particular fee code, the audit should be for education purposes only. Only in the rare circumstance of fraud or intentional abuse, or if a physician is found to have repeated the error after attempts to educate, should punitive measures be taken.
    
6. Create a “Red Tape Reduction Task Force” for physicians. The mandate of this task force would be to identify opportunities to remove unnecessary administrative burden for physicians, and to ensure physicians are paid for the work they do, which in turn will increase the capacity of the physician workforce and increase trust between physicians and the government.