Dear Doctor,

Physicians are on the front lines of Nova Scotia’s COVID-19 response, leading a frightened public through a challenging time. Doctors Nova Scotia (DNS) wants to ensure that you have what you need to look after yourself and your family as you respond to the situation. Please contact us if there is anything we can do to help. We are proud to support you and your dedicated colleagues.

Today, five new cases of COVID-19 were announced, bringing the total in Nova Scotia to 73.

• Most cases are related to travel or close contact, are spread across the province and range in age from under 10 to mid-70s
• One new case cannot be linked to travel or an earlier case. The investigation is ongoing to find the source of the exposure and if other people were exposed. Public health cannot confirm that this case is linked to community spread
• Two individuals are currently in hospital. Two individuals have recovered and their cases are considered resolved
• To date, Nova Scotia has had 3,201 negative test results. Testing has expanded to include anyone screened by 811

Clarification on virtual billing rules for care provided by residents
Doctors Nova Scotia has clarified with the Department of Health and Wellness (DHW) that the new virtual care codes can be used for care provided by residents. During the pandemic, virtual care provided by residents can be billed in the same way as care provided in a face-to-face visit using the fee codes and billing rules communicated in the March 24, 2020 MSI Physicians’ Bulletin. Medical charts should include a note stating the care was provided under the supervision of a physician and the name of the supervising physician. 

Residents are not able to bill the new pandemic virtual care fee code 03.03x, as communicated in the March 18, 2020 MSI Physicians’ Bulletin. This code is only available for physician use.

A bulletin outlining these clarifications will be issued shortly.

Economic measures to support Canadians
Staff at MD Management have created a roundup of the new economic measures, organized by relevance to medical students and residents, practising physicians, retired physicians and family members.

Cross-border restrictions – NEW clarification
The Department of Health and Wellness wishes to clarify what physicians should do if they’ve travelled recently out of province. Like all Nova Scotians, physicians and other health-care workers who have travelled outside of Nova Scotia must self-isolate for 14 days. For physicians, nurse practitioners, allied health professionals and staff in self-isolation, there are opportunities to work from home via telephone and Telehealth, and through secure video.

The only exception applies to health-care workers, including physicians, who cross the Nova Scotia land border on a regular and ongoing basis. For example, someone living in New Brunswick who commutes to Nova Scotia for work. They can continue to travel across the border to work. This exception is included in the order by the office of the chief medical officer of health (OCMOH). Please click here for details.

Exceptions DO NOT apply for:

• Locums or specialists working in more than one province (exceptions to the order may be requested from the OCMOH in very limited circumstances – if you wish to request an exception contact kim.silver@novascotia.ca)
• Physicians who live in Nova Scotia but work in New Brunswick (and vice-versa) if their travel doesn’t occur on a regular and ongoing basis (for example, multiple times per week)
• Physicians who are returning from travel outside of Canada and are self-isolating in another province before returning to Nova Scotia. The order will require a second isolation period upon entering Nova Scotia

New virtual care tool available
Click here for a notice from DHW that outlines the benefits of the Zoom for Healthcare, including supports, custodial responsibilities and how to submit an account request to the Nova Scotia Health Authority (NSHA). Click here for a DNS two-pager on all the virtual care options available. 

Examinations and licensing
The College of Physicians and Surgeons of Nova Scotia has been advised that the Medical Council of Canada, the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada have all postponed their examinations due to the COVID-19 pandemic.

• If you have registered for an examination, rest assured that this will not negatively affect your medical licensure
• If you are provisionally licensed at present, your provisional licensure will be extended
• If you are at the end of training and contemplating independent practice, you will be considered eligible for provisional licensure

If you have any questions, please contact the College’s registration department at registration@cpsns.ns.ca.

COVID-19 webinars now CME accredited
Doctors Nova Scotia hopes to offer regular COVID-19 webinars to keep you informed. The COVID-19 webinar series is co-sponsored by Dalhousie University Continuing Professional Development. Family physicians may claim 2.0 Mainpro+ credits. Specialists may claim 2.0 credit hours. Attendees must complete an evaluation for the series. Please indicate the date of the webinar when providing specific comments. Physicians may submit more than one evaluation, if they wish to provide additional comments as the series is delivered in the future.

COVID-19 recordings and information hub
Find all of the webinar recordings on the DNS COVID-19 information hub. The hub also lists all DNS coronavirus emails and includes a list of frequently asked questions on all aspects of the pandemic, including self-isolation, virtual care, personal protective equipment (PPE), plus much more.

This content is password protected to ensure the public uses the government website for updates. For help logging in, email cat.henderson@doctorsns.com.

Feeling overwhelmed?
During this difficult time, you may be experiencing fatigue, worry and anxiety. If you’re feeling exhausted and anxious—or just want someone to talk to—contact the Professional Support Program. Confidential support is available to you 24-7 and is just a call or email away. Call 902-468-8215 or 1-855-275-8215 (toll-free) or email professionalsupport@doctorsns.com.

Improved virtual care fees
Most physicians can now bill for all non-procedural services that are delivered virtually. Details can be found in the March 24 MSI Physicians’ Bulletin. Doctors Nova Scotia has assurances that all premium fees are also applicable, even though this is not stated in the bulletins. If the 03.03x code is more remunerative than the applicable in-person fee code, physicians may bill the 03.03x as outlined in the March 18, 2020 MSI Physicians’ Bulletin.

Resources on coping with COVID-19
Staff with the NSHA’s mental health and addictions program have developed a one-pager to help Nova Scotians who may be experiencing stress and/or anxiety around COVID-19. Please share it with your family, friends and colleagues.

Resource info

Guidance for employers
For physicians who employ their own staff, the Labour Standards Code will apply, as well as the terms and conditions of the employment contract. See the attached guidance (not legal advice). Advice may change depending on the facts of each case.

Remember:

• Health-care providers in the workplace, including physicians, are exempt from the social distancing rule of two metres and the gathering limit of less than five people
• N-95 masks are only required when doing aerosol generating medical procedures
• As of 11:00 a.m. (EST) on March 26 there are 3,555 confirmed and 24 presumptive cases and 35 deaths of COVID-19 in Canada. The virus continues to spread globally
• Personal protective equipment and ventilators are on order through a national procurement program

Information hubs to watch

• Nova Scotia Health Authority updates and service cancellations
  • New screening protocol for patients with influenza like illness (chart tool)
  • Expressions of interest to serve as the NSHA’s COVID-19 Occupational Health, Safety and Wellness physician
  • Medical assistance in dying (MAID) policy change during COVID-19. Effective immediately, a temporary change to the policy prohibits NSHA staff from acting as an independent witness for MAID requests and consent forms.
  • The NSHA is following up on donations of N-95 respirators and is working to source additional PPE. It will provide information today on how to handle unsolicited offers of N-95 respirators. Health Canada has clarified expectations for hospitals to report medical device incidents and serious adverse drug reactions during the COVID-19 pandemic. Find full details here.
• IWK updates and service cancellations
• Doctor Nova Scotia updates and information

REMINDERS

Repatriating retired physicians
Doctors who have retired in the past three years may be eligible to return to practise. Contact Katrina Philopoulos at Katrina.Philopoulos@nshealth.ca if you are interested.

Reference materials, posters, public education and PPE
The Department of Family Medicine – Family practice recommendations
NSHA COVID-19 quick reference for primary care providers
Self-monitoring vs. self-isolation vs. isolation for COVID-19
How to care for person with COVID-19 at home: advice for caregivers
OMA infographic PPE 

Insurance for lost time
If you have disability coverage other than OMA, please consult your plan providers about things like waiting periods and eligibility for quarantine versus illness.

DNS staff, meetings and events
All DNS meetings and events are cancelled or have moved to a virtual meeting. Employees are working from home until April 8. You may reach staff by email or by calling 902-468-1866 or toll free at 1-800-563-3427.

Additional resources:
Department of Health and Wellness (public)
Nova Scotia Health Authority (physician and provider hub)
811 assessment – when to call (advice for patients)
Government of Canada
Nova Scotia Public Health offices
Canadian Medical Association