Nova Scotia doctors have been asked what they want in their upcoming funding contract with the provincial government and the survey responses are blunt and even bruising.
The province's doctors are asking for everything from a new "adversarial approach" to government, new fees and a pension plan.
"We did hear it peppered throughout our travels, no question," Nancy MacCready-Williams, the CEO of Doctors Nova Scotia, said of the consistent desire for a pension program or retirement support.
The formal funding contract between physicians and the government of Nova Scotia for the majority of physician services is known as the Master Agreement. The current agreement expires on March 31, 2015, prompting Doctors Nova Scotia to create a negotiations committee and organize meetings to seek input from physicians.
MacCready-Williams and Dr. Mike Fleming, the president of Doctors Nova Scotia, visited 10 communities across the province to solicit input on the multi-year agreement.
They had discussions with 250 doctors — about 10 per cent of the province's practising physicians.
MacCready-Williams said the desire for a pension was not a top priority when compared, for example, to compensation for non-face-to-face encounters.
"They could probably be more patient friendly in the way they deliver their care if they were incented to make that phone call, to send that email, to perhaps see the patient in their home," MacCready-Williams told CBC News.
The top priority was that fees recognize the complexity of the care delivered. An overall increase is also sought.
Doctors Nova Scotia seems unlikely to abandon its current co-operative relationship with the provincial government.
"I hear as many physicians say taking a collaborative working approach is the right way to go," said MacCready-Williams.
"We get lots done in a small province when we can influence based on positive working relationships."
Doctors question 811, nurse practitioners
Physicians' survey results released internally — and obtained by CBC News — also reveal skepticism about the value of Nova Scotia's $6.2-million 811 phone service that connects patients to nurses.
"Physicians being accessible by phone will be more cost effective than 811 and provide better patient care as the physician has patient history," the survey reports.
"Will save more visits to emergency room and office visits as often recommended by 811."
MacCready-Williams said the 811 service should be reviewed.
"811 likely needs a bit of an evaluation to see what the impact has been on patient care and is it the most effective way to deliver service," she said.
Doctors raised similar concerns when it came to nurse practitioners. The survey found their role and benefit to the health-care system was widely recognized by doctors but still raised questions rarely expressed in public.
"Concern that training and scope of practice does not support them in the role of investigating and diagnosing," the survey says of nurse practitioners.
The survey went on to say: "The role often results in higher costs as unnecessary tests are ordered and referrals made. Specialists worry about the quality of care. Many examples were provided where they were hesitant to refer patients back to nurse practitioners."
"Specialists also noted a difference in the quality of referrals from nurse practitioners versus family physicians — the quality often resulted in the specialist spending more time educating the nurse practitioner or seeking clarity on the request."
Doctors complained that nurse practitioners are not held to the same standard of accountability as physicians so they "don't really replace the need for the family physician in communities," the survey reported.
MacCready-Williams says given that nurse practitioners are fairly new to the system, it's appropriate to look at their role.
The survey results do not reflect Doctors Nova Scotia's negotiating position. That will be developed by a newly constituted steering committee and presented to the association's board by May.