Nova Scotia

Collaborative-care clinics a hit with doctors, but slow rolling out

The province's shift to collaborative health practices is getting good reviews from new doctors, but thousands of patients are still without a family physician - and that has at least one group calling for interim approaches.

Doctors Nova Scotia says more flexibility would help patients in need

The province's deputy minister of health recently said Nova Scotia will need 78 collaborative family clinics. (David Donnelly/CBC)

As the government works to recruit doctors to practise in the province, a director with Doctors Nova Scotia says more flexibility during the changeover to collaborative-care centres could help the thousands of patients who currently don't have a family doctor.

Kevin Chapman says "it's a long haul" getting a family physician for everyone, even though the move toward collaborative centres is happening as fast as it can. 

There are 50 such practices across the province in various stages of readiness, including 14 that are in development and the eight collaborative emergency centres set up by the former NDP government.

But getting to the point where everyone who needs access has it is years away.

'We can't be overly dogmatic'

That's why Chapman would like to see more flexibility in the system to allow doctors to set up in areas where there's patient demand, even if it doesn't fit the health authority's desired long-term structure.

To Chapman, it makes more sense to prioritize getting doctors here now, and then integrating them with the collaborative system later.

With anywhere from 25,000 to 90,000 Nova Scotians still waiting for a doctor, it's a process he said could use multiple approaches.

"We can't be overly dogmatic about this," he said. "I think it's a buyer's market right now for docs."

The health authority has said the collaborative model is meant to bring together a variety of health-care professionals — a family doctor, nurse, nurse practitioner, dietitian, psychologist and others — to provide better care and free up doctors to spend more time with patients who need to see them.

What doctors want

Health-care officials have said working in team-based medical care is what most new doctors want, in part because it's the environment in which they train and because it also gives them a better semblance of work-life balance.

Dr. Pamela Lai, who is about to complete her family medicine residency, said the idea of having colleagues to provide support, especially at the start of one's career, is attractive.

"I think that if you were to poll current residents in family medicine, the majority would rather work in a group than in a solo practice."

Dr. Adam Aleksis is a Dalhousie University grad who devotes part of his time to a clinic at Truro's Colchester East Hants Health Centre that is a prototype of the collaborative family practices Nova Scotia is shifting toward.

'The future of medicine'

Aleksis is also a fan of the approach.

"People assume that physicians are knowledgeable in all areas, and that's not necessarily very true. There are many experts that are good health providers."

Similar to Chapman, Aleksis doesn't want a cookie-cutter approach to collaborative care.

He believes the collaborative model is "the future of medicine," but his one concern would be if there is a push for a one-size-fits-all model.

"It's almost like a treatment for an area," he said. "And you want to tailor the treatment to the people that live there."

Lynn Edwards, the health authority's director of primary health care, said efforts to do just that are happening, with community meetings over the last six months being used to determine the needs of an area that will eventually get a collaborative clinic.

ABOUT THE AUTHOR

Michael Gorman is a reporter in Nova Scotia whose coverage areas include Province House, rural communities, and health care. Contact him with story ideas at michael.gorman@cbc.ca

With files from Angela MacIvor

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