Nova Scotia

Nova Scotia's family medicine system needs major changes, say doctors

Nova Scotia doctors say major changes to the family medicine system are needed to ensure a high quality of care is provided.

'We are aging too. We are part of your aging workforce,' says family doctor

Physicians speaking in a forum Thursday night that was organized by CBC's Information Morning identified Nova Scotia's fee-for-service funding model as a barrier to providing effective health care. (Getty Images)

Nova Scotia doctors say major changes to the family medicine system are needed to ensure a high quality of care is provided.

Speaking at a forum that was held on Thursday night and organized by CBC's Information Morning, doctors identified Nova Scotia's fee-for-service funding model as a barrier to providing effective health care.

This special CBC forum discusses the shortage of family doctors and concerns about collaborative care practices in Nova Scotia. 1:30:23

Under that funding model, doctors are paid a set fee by the government for each service provided to a patient. For most family doctors, this usually means an office visit.

Overhead expenses cutting into family doctors' resources

Dr. Tim Matheson is a family doctor with a private practice in Bedford. He also works as a doctor at a hospital in Windsor.

He said that under the current model, the overhead expenses required to run his private practice cut into his resources, meaning his hourly rate in private practice is less than a third of what he makes working in a hospital.

His overhead would be lower if he could share the costs with another doctor, but he said the expenses faced by family doctors have made it hard to attract new doctors into private practice.

Though he now has another doctor working part-time with him, Matheson said he spent the first four years of his practice covering expenses by himself — and he said the situation hasn't improved since then.

"I speak to other family doctors who work in solo practice who find it hard to pay the rent and who are considering closing their practices as a result," said Matheson.

Doctors struggling to meet patients' needs

Dr. Ajantha Jayabarathan said many doctors struggle to meet the needs of their high number of patients.

"I know I will burn out one of these days," she said.

"We are aging too. We are part of your aging workforce."

The province has encouraged doctors to move toward a collaborative care model, a transition Jayabarathan and others initially welcomed.

The collaborative care model usually includes a health-care team made up of a family doctor, nurse, nurse practitioner, dietitian, psychologist and others.

Criticisms of collaborative care

However, doctors have cited flaws in the implementation of the model, including Dr. Amanda MacDonald, who recently opened a collaborative care practice in Windsor.

"We had zero support by and large except for a little bit of advice, and it was really on our own backs that we made that happen," she said. "I did not feel supported in that journey."

Mary Jane Hampton, a health-care consultant, said it's unsurprising the health care system has come to this point.

"It feels that way because we've never had the courage to do the kinds of things we've been talking about for ... probably 25 years," she said.

"The fee-for-service system we have [had] now for three decades was a disaster, in terms of supporting the kind of models of care that we're talking about, that [doctors] want to work in and that patients want to be able to access."

Despite the problems they identified, participants in the forum agreed an honest discussion about the future of family medicine in Nova Scotia is a positive step toward addressing the issues.

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