Doubling the number of residencies for medical school graduates in Nova Scotia is the only way to have enough locally educated physicians in order to reduce the province’s long wait times for health care, says the president of Doctors Nova Scotia, which represents over 3,500 physicians.
In recent weeks, two women died after spending hours waiting for care in Nova Scotia emergency rooms.
“Knowing that we probably need about 100 new family doctors per year over the next 10 years—if you wanted to have all of your family doctors locally grown and trained, which is the ideal because then they’ve been trained in the health-care system in which they’re working and they’re a little quicker to transition into the practice—then you would have to double the number of residency spots,” Dr. Leisha Hawker told The Epoch Times.
But there’s a snag.
Every medical school graduate accepted into a residency program has to be supervised for a while by a more experienced physician, called a preceptor, who sets out expectations, provides feedback about the resident’s performance, and provides learning opportunities.
If there are no preceptors, there are no residency programs, and the shortage of physicians in Nova Scotia makes getting those preceptors tricky.
“It’s a bit of a chicken-and-egg situation we’re in, unfortunately,” says Hawker.
“Every time we increase residency spots, we need more preceptors of family medicine to be able to train them, and training those residents of family medicine takes them away a little bit away from their practices. You need a certain number of physicians to be able to train the future physicians.”
Nova Scotia, much like other provinces, is trying desperately to cope with a serious shortage of physicians and nurses.
The province has the second-longest wait times for health care in Canada, behind only Prince Edward Island, reports the Fraser Institute.
In its “Waiting Your Turn: Wait Times for Health Care in Canada, 2022 Report,” the think tank revealed that last year in Nova Scotia the median wait time was 58.2 weeks from referral by a general practitioner to receipt of treatment by a specialist.
That’s more than twice the median wait time of 27.4 weeks nationally and almost three times longer than in Ontario, where that wait is only 20.3 weeks.
The 58.2 weeks’ total wait time in Nova Scotia represents two consecutive periods of time: a wait of 37.3 weeks to see a specialist after being referred by a family doctor, followed by a wait of another 21 weeks to finally receive treatment after consultation with the specialist.
The shortage of physicians is having a ripple effect in the province’s emergency rooms.
Charlene Snow, 67, waited seven hours in an emergency room on Dec. 30 before leaving to go home, figuring she would go to an outpatient clinic in the morning. She had a heart attack and died about an hour after returning home that night.
The following day, 37-year-old Allison Holthoff died in the emergency department of the Cumberland Regional Health Care Centre after waiting for some seven hours while in severe pain.
Government Action Plan
Nova Scotia Premier Tim Houston has vowed to improve health care in the province.
“I just stepped out of a meeting with healthcare partners, including associations, service providers, education institutions, regulatory colleges, unions and senior leadership,” he tweeted on Jan. 17.
“My message to them is crystal clear – go like hell.”
Since then, Nova Scotia has unveiled an action plan to “improve emergency care to ensure that people with the most urgent needs receive care first.” The plan aims to improve ambulance response times and offer more places for people to receive care, so as to ease the pressure on emergency departments, said the news release issued Jan. 18.
Among the various action items, doctor-led teams will focus on getting patients out of ambulances faster, physician assistants and nurse practitioners will be assigned to give care in emergency departments, and care providers and patient advocates will be added to support patients in waiting rooms. The province is also going to make virtual care available to more patients with less urgent needs, and enable out-of-province doctors who are licensed in Nova Scotia to provide some of that online health care.
There will be a $11,500 tuition rebate for paramedics who agree to work in the province for at lest three years, and the province is increasing funding to train medical first responders. It is also adding a second air ambulance to handle routine transfers for tests and treatment between Sydney and Halifax and between Yarmouth and Halifax, letting ground ambulances stay in communities more often.
The plan will expand services in more pharmacies, add virtual care hours, increase support for family medicine practices, and provide more mobile primary care, mobile respiratory clinics, and urgent treatment centres.
“The healthcare system was built during a different era, and aside from technological advances, it has barely changed since,” Nova Scotia Health president and CEO Karen Oldfield said in the news release.
“That is not our future. No one person can move this mountain by themselves. We can do it if we all pull together with a common goal: a system that is ready, responsive and reliable.”
Shortage of Residency Spots
All of that is a good first step, but much more needs to be done, and the wait times in Nova Scotia could actually get worse before they get better, says Dr. Hawker.
There just aren’t enough physicians and nurses to handle the current workload, and the residency spots needed for medical school grads to go into practice aren’t there either, she said.
The medical school at Halifax-based Dalhousie University had 48 residency spots in family medicine across the province last year and is increasing that to 58 in 2023, according to a December 2022 provincial government news release.
The news release also said the province has added 10 residency positions to the previously available six seats designated for international medical graduates studying outside Canada, with priority given to those with a connection to Nova Scotia.
But Hawker says this is nowhere near enough residencies for the province in its effort to bring young doctors to the workforce as quickly as their baby boomer colleagues are retiring.
“A quarter of our family doctors are actually over the age of 60, and unless there is significant recruitment over the next few years, we could potentially see the health-care human resources challenge get worse,” she said.
Despite the current shortage of physicians, however, she is optimistic about the future, one reason being that foreign-trained doctors will help lighten the load. Immigration, Refugees and Citizenship Canada has several worker immigration programs to fast-track their immigration to Canada.
“Wait times will significantly improve in Nova Scotia in the next few years,” Hawker predicts.