A rural obstetrician is worried a jump in the fees she and her colleagues pay could negatively impact the health of women in Nova Scotia, especially those in rural areas.

Obstetricians found out late last year there would be a jump in their dues to the Canadian Medical Protective Association of more than $30,000. On Wednesday, the physicians found out in an email that the province will not be footing the bill for the increase.

Losing one or two obstetricians in a rural area would mean patients "are going to have to travel further and further distances" to get care, said obstetrician Robyn MacQuarrie.

The decision could also impact physician retention. It is going to be a disproportionately large financial burden for obstetricians who provide care during labour and delivery, MacQuarrie said.

"Many of my colleagues that I've spoken to today are concerned that they're not going to be able to continue delivering care in Nova Scotia," said MacQuarrie, who practices part-time in Amherst and fears the fee jump could mean reduced services for women in rural Nova Scotia. 

In MacQuarrie's area there's only one other obstetrician, so each doctor is on call every other night. Losing one doctor could be extremely detrimental.

"I don't think there's any person who could reasonably deliver 100 per cent of call," she said. "So it would significantly change the delivery of obstetrical care. Women aren't going to necessarily be able to have children in the regional centres if there's no obstetrician back up."

One of the services the Canadian Medical Protective Association (CMPA) provides is legal representation for its members. All physicians are required to be members.

The fee for obstetricians in the same category as MacQuarrie in the region that includes Nova Scotia went up from $20,304 last year to $51,252 for 2015.

"Providing obstetrical care is a challenging time. We, of course, want the very best care for our patients and their children but when things go wrong the lawsuits tend to be significant," said MacQuarrie, who adds the fee increase for her section is likely the result of some large payouts.

Financial pressure

MacQuarrie says when the group learned of the fee increase in December last year they were reassured they would be compensated.

The email from Doctors Nova Scotia to physicians said the increase in CMPA fees for all doctors "created a new $7.5 million financial pressure. Government officials say they did not foresee or budget for this increase and therefore they are not in a position to cover this added cost."
Compensation for doctors is negotiated with the province. The current agreement between the province and physicians expired Tuesday.

The email sent by Doctors Nova Scotia said the expired contract will be in place for 90 days, with the exception of the program that pays physicians back for their CMPA fees. Instead, only the 2014 amount would be eligible, the email states.

While many of the physician categories saw increases of a couple of thousand dollars and none had fees as high as obstetricians to begin with — many categories doubled, but the fees started at around $1,000 to $8,000.

MacQuarrie says she believes the obstetrics fee increase will affect about 50 to 55 physicians. The next highest increase in the province is for neurosurgeons, which spiked from $17,736 to $32,388.    

"It's very problematic to me that it's women's health care that continues to be targeted," she said. "We already know that the surgical specialities that deal with obstetrics and gynecology or women's health care exclusively are of the lowest paid of the surgical specialties."

Physician retention 

MacQuarrie said she has heard "a lot of shock and surprise and dismay" from her colleagues since the email was sent about the viability of working as an obstetrician in the province.

MacQuarrie is a recent medical school graduate who says many of her friends wanted to work in Nova Scotia as family physicians when they graduated but the incentives weren't there to stay in the province.

"Now we've got people who are in the province who have set up their practices and their lifestyles here who are looking to go elsewhere because these rebates are available elsewhere," she said. "It's not as though Nova Scotia is a unique province in offering this rebate. CMPA dues are rebated as a matter of practice, so now, seeing this significant cut to the rebate people are looking elsewhere for jobs."  

Health Minister Leo Glavine responded Thursday.

"When the general tariff agreement expires ... there is concern about a whole range of fees and insurance coverage, and so forth, for clinicians. I am expecting a reasonable proposal that will come forward to deal with the general tariff agreement. That will be one of those negotiating areas."

If these fees become "an area of extreme contention" then the province will take a look at it during negotiations, which are happening now, he said.