Nova Scotia’s doctors ratify new four-year contracts

On Nov. 25, the province’s doctors signalled they’re ready for change by approving two new four-year agreements with the provincial government.

“These contracts begin to recognize the value of Nova Scotia’s doctors and will help to begin stabilizing some of the most vital services in our health-care system so that patients have better access to the care they need, when they need it,” said Dr. Gary Ernest, President of Doctors Nova Scotia.

The new agreements will help address several issues that affect the province’s ability to retain and recruit doctors, including more competitive compensation, physician engagement, physicians’ work environment and physicians’ right to representation.

Doctors Nova Scotia has been advocating for critical improvements in these areas so that Nova Scotia can become a place where doctors want to practise medicine.

The association has been able to make progress on all of the key recommendations it made with Maritime Resident Doctors and Dalhousie Medical Student Society in the 2018 report, Road Map to a Stable Physician Workforce.

Under these contracts, all Nova Scotia doctors will receive a 2% increase in each of the four years of the contracts. In addition, there are targeted investments in five key areas: comprehensive primary care, emergency care, psychiatry, obstetrics and gynecology, and anesthesia.

“While the contracts don’t solve every problem in the system and they don’t make every speciality nationally competitive, we believe the contracts are a step in the right direction and an important investment in the future of our health-care system,” said Dr. Ernest.

The targeted investments support specialities that experience tremendous difficulty recruiting much needed physicians because other provinces offer more competitive rates.

Family doctors who provide comprehensive care, such as through office visits, emergency medicine, inpatient care and obstetrics/maternal care, will see a significant increase in pay, bringing their compensation to the top in Atlantic Canada. Community-based hospital inpatient care will be shored up through a new model for family physicians in rural Nova Scotia. As well, there is an investment to pilot a new blended capitation payment model for family doctors.

Specialists who practise emergency medicine, obstetrics and gynecology, psychiatry and anaesthesiology will see an increase under these contracts to improve the province’s ability to recruit and retain to these essential services.

The Master Agreement also includes important improvements to physicians’ work environment. Government has made a commitment to support succession planning, allowing retiring and new-to-practise physicians the opportunity to overlap and work together so that there is a seamless handoff for patients and uninterrupted care delivery.

In recognition of the importance of training medical learners in communities around the province, physicians who mentor these learners, who previously were not paid – or were underpaid – for this work, will now receive more appropriate stipends for teaching medical students and residents.

Under this new contract, physician audits in Nova Scotia will become far less punitive and more focused on educating physicians about proper billing technique and documentation.

Through the contract, government has committed to reducing the administrative burden physicians have struggled with. Unnecessarily repetitive or cumbersome paperwork requirements, such as completing paperwork requested by government departments when arranging a locum to fill in for them during maternity leave or sick time, will be streamlined so that physicians can spend more time with their patients.

“We believe the contracts signal a new level of support for physicians from the government and the health authorities. We look forward to working more closely with government to continue making improvements in the system for all Nova Scotians,” said Dr. Ernest.

The new four-year contracts come into effect upon signing, which is expected to take place on Nov. 29, 2019, and will replace the 2015 Master Agreement and Clinical/Academic Funding Plan (C/AFP) agreements, which expired on March 31, 2019. The agreements impact 2,944 physicians.

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Doctors Nova Scotia represents over 3,500 members. Membership includes practising and retired physicians, medical students and residents. Incorporated in 1861, it’s the oldest medical association in Canada.

Contact:

Barb Johnson, Doctors Nova Scotia
Telephone 902-483-6462 or email barb.johnson@doctorsns.com

Contract backgrounder

Term:

The four-year contracts will come into effect shortly after ratification, retroactive to April 1, 2019, and will expire on March 31, 2023.

Two contracts:

• Master Agreement (1,836 physicians paid by fee for service and alternate payment plans, 408 retirees, and an additional 700 clinical/academic physicians voted on this contract)
• Clinical/Academic Funding Plan (approximately 700 physicians in 12 departments who teach and/or do research in addition to clinical care voted on this contract)

Voting results:

The Master Agreement was ratified by 94% of voting members and the C/AFP contract was ratified by 96% of voting C/AFP physicians and 12 of 12 departments. In total, 68.9% of eligible members voted.

Total investment:

$135 million increase to the annual Physician Services spend by the final year of the contract

Overall increase:

2% per year, in each of the four years of the contract, for every physician practising in Nova Scotia

Repair funding:

The contracts also include repair funding, also known as targeted investments. There is $42 million of repair funding invested in the Master Agreement, which will increase compensation for physicians in five key areas to aid recruitment and retention.

• Family physicians, anesthetists and emergency physicians will be the top paid in Atlantic Canada
• Psychiatry and obstetrics/gynecology will come very close to being top paid in Atlantic Canada

There is $13.5 million of repair funding invested in the C/AFP contract. The Committee of C/AFP Department Heads has used a formula to allocate the funding to those departments that are furthest away from their national peers.

Additional investments:

• The Rural Specialist Retention Incentive Program will double to $16,000 by the end of the contract
• NewMD funding of $9.05 million to fund new physicians to N.S.
• APP specialists now can bill fee-for-service while on call
• Fee Committee will have a budget of $1.5 million in Year 3 of the contract for new and revised fee codes
• Funding for preceptors (physicians who train medical learners) will be available to preceptors who currently aren’t paid, or are underpaid, for this work. A stipend is available for these physicians, valued at $450/week for students and $250/week for resident electives.
• Parental leave benefit improvements
• Health and dental plan wait time will reduce from six months to three months for new plan members

Work environment:

Some investments will improve the physicians’ work environment, which is critical to improving doctor retention and recruitment.

• First-time audit focused on education – The first instance that a physician is audited on a particular fee code, the audit will be for education purposes only unless in the rare event of intentional abuse.
• Transition into practice and transition out of practice program – The government has instituted a program to better support patient care transition and to allow retiring physicians to transition out of practice more slowly and to mentor new physicians should they wish to do so.
• Administrative burden review – The Office of Regulatory Affairs and Service Effectiveness, working with partners and physicians, launched a two-year pilot project designed to identify and implement measures to reduce administrative burden on physicians and their patients.
• Physician engagement – The Department of Health and Wellness (DHW), Nova Scotia Health Authority (NSHA) and IWK commit to engage physicians in any decisions that may impact physicians and their delivery of services. The DHW, NSHA and IWK will meaningfully consult with DNS, ensuring that the concerns and input of physicians as represented by DNS are considered in health-system decision-making.
• Doctors Nova Scotia’s role restored – Doctors Nova Scotia has secured physicians’ right to representation in all aspects of contract negotiations, including not only compensation but also the services that can be required of physicians in exchange for that compensation, through a Memorandum of Agreement (MOA) between DNS, the DHW, the NSHA and the IWK.
  CHIP – The agreement includes a new in-patient care funding model for larger community hospitals, which offers a daily stipend to cover all day-time in-patient work. It also includes Level 1 on-call and care provided when called back to hospital between 1700h and 0800h can be billed fee-for-service. This model includes care for both a physicians’ own patients and orphaned patients.
• Blended Capitation Payment Model – The agreement includes funding to pilot a new blended capitation payment model for family doctors. This model supports team-based and virtual care delivery, making it easier for family doctors to provide the care their patients need, when and where they need it. The model will be developed over the next year and begin to roll out April 1, 2021. Details are still in development.