Several Nova Scotia physicians have spoken out recently about the problems in the health system, but the senior medical director for primary health care at the province's health authority says fixes are underway and more are coming.
"As I listened to those interviews last week, I was struck by the fact that they're basically describing the work we've been doing all along," Rick Gibson, the Nova Scotia Health Authority's head of the department of family medicine, told CBC's Information Morning Tuesday.
"They're criticizing the health authority and yet those are exactly the problems we're aware of and we're working to address."
Telephone appointments underway
Last week, Halifax emergency room doctor John Ross said the health authority must embrace an "engineering" solution to delays in health care by better using nurses, paramedics and physiotherapists.
"If you start adding things like video and even still images, you can get a lot done remotely," he said.
Gibson, who is a working family doctor, agreed family doctors should work in interdisciplinary teams and be paid appropriately. He said the health authority regularly sends newsletters with updates, but thinks many doctors don't read them to stay abreast.
Gibson said Nova Scotia doctors can now bill for some phone consultation in certain cases.
"There was significant concerns from the Department of Health about the runaway costs of that. But it actually makes telehealth, or consultation with a patient who's not physically in front of you, an insured service in Nova Scotia," he said.
He said that challenges the claims of Maple, a company that's started providing a "chat with a doctor in your pyjamas" in the province via paid online consultation. Maple says such remote care is not covered by health care and therefore can be charged for, like access to a dentist.
"I'm not sure I buy the argument that they're providing an uninsured service and therefore can bill for it," Gibson said. "I was also very concerned by their statement that they could provide an orthopedic exam over a video link, because there are parts of it that require hands-on."
Wait-list a 'serious problem'
Dr. Al Doucet, a retired physician who recruits doctors for the Liverpool area, is the chair of the Queen's General Hospital Foundation. Last week, he told CBC he had taken his concerns to the health authority, but got no feedback. He said a shortage of doctors was a big problem in his area.
Nova Scotia has 37,000 people on a wait-list for a family doctor.
"It's a serious problem when somebody doesn't have a family doctor. We are very concerned about that," Doucet said. "It was somewhat predictable several years ago that we would at some point find ourselves short of family doctors."
He said the health authority is "adjusting course" to bridge that gap.
Gibson said city dwellers without a family doctor can still access primary health care at walk-in clinics and at emergency rooms.
"I think the thing that falls apart is their chronic disease management, their renewal of prescriptions, the monitoring of their conditions," Gibson said.
Getting family doctors involved
Gibson said the health authority created a Department of Family Practice to give family doctors a voice in the organization. He said that's part of a 15-year trend to reduce the isolation of family doctors.
The health authority is spending millions investing in teams to work at collaborative-care clinics, which Gibson said allows practices to take on many more patients. The authority is looking at better ways to prioritize wait-lists so those most in need of help get it first.
It may also hire nurses to help patients on the wait-list navigate the system and open short-term clinics just for those patients.