Fifteen percent of Nova Scotians are officially waiting for a family doctor or nurse practitioner—the highest tally the province has seen since Nova Scotia Health launched its Need a Family Practice Registry in 2018. As of June 1, 2023, there are 148,431 people on the province’s primary care waitlist. That’s an uptick of more than 3,400 since last month, and a jump of 53,500 from this time a year ago.
“We know there is plenty more to do,” Nova Scotia’s health and wellness minister Michelle Thompson said in a statement earlier in June, adding the province has “a plan” to solve Nova Scotia’s primary care shortage and is “implementing it.”
And while Nova Scotia’s government says its physician recruitment efforts are “starting to see results,” the new head of the association representing Nova Scotia’s roughly 3,500 doctors, residents and medical students says burnout remains a concern for those working throughout the health-care system—and that fixing work-life balance issues in a new collective agreement will be key in shoring the province’s talent gap.
Waitlist by the numbers
From the beginning of his premiership campaign, Tim Houston pledged to fix a provincial health-care system he described as suffering from “years of neglect.” At the time of his August 2021 election, Nova Scotia’s primary care waitlist stood at just over 75,000—or roughly 7.5% of the province’s then-992,000 residents. Emergency departments across the province were seeing a surge of patients amid a third wave of COVID-19. Houston promised $430 million within his party’s first year in power to give the province’s health-care system a shot in the arm. It propelled his PC Party of Nova Scotia to a majority government.
Change, however, has come slowly. Nova Scotia’s primary care waitlist has nearly doubled since August 2021. As of June 13, 2023, Nova Scotia’s acute care units were at 96.3% capacity—with some units operating at as high as 130% to 140% capacity. A February review of wait times for walk-in clinics across the country found Nova Scotians waited 39 minutes longer to see a doctor in 2022 than they did the year before.
In response, Houston presented the latest facet of his health-care plans in April. The premier introduced a four-year Action for Health plan to “transform” the province’s flailing health-care system, promising better public reporting, faster emergency care, progress on waitlists and “accountability at every level.” (To date, the province’s public reporting has fallen short of its promises.)
“The message we’ve heard over and over again is clear,” Houston said in a news release at the time. “Change is needed to provide better health and better healthcare for Nova Scotians and to support and respect the people who work in the system.”
Roughly one in seven people living in the HRM is on the province’s waitlist for a family doctor or nurse practitioner.
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As of June, waitlists are up across the board in Nova Scotia. Each of the 14 so-called regional “networks” the province’s health authority tracks saw an increase in its primary care waitlist compared to a month ago. Nowhere was that more significant than across the HRM, where a net of 1,951 Haligonians joined the list of those awaiting a family doctor or nurse practitioner. Today, that list has grown to more than 66,300 Haligonians—or roughly one in seven people living in the HRM.
Provincewide, the story looks much the same: From May 1 to June 1, 2023, Nova Scotia Health says it matched 1,795 people with a primary care provider, but 5,222 more people joined the province’s Need a Family Practice Registry. In short, for every patient the province managed to match with a clinic, nearly three more people took their place.
‘Much to do,’ health minister says
The province is hiring more doctors—the trouble is, it just hasn’t been fast enough. From April 2022 to March 2023, Nova Scotia Health and IWK Health hired a combined 168 doctors. In the same span, 82 doctors left the province, retired or closed their practice.
“We know that there is still much to do, but our hard work is starting to see results,” health minister Thompson, herself a former nurse, said in May.
In the past year, the province has cut red tape for American-licensed doctors to practice in Nova Scotia and made it easier for doctors from other Maritime provinces to practice without further licensing issues. The province has also been recruiting medical students in Ireland and the Caribbean who might have ties to Nova Scotia or an interest in practising in the province.
Doctors, province working on new contract
If change is to come within Nova Scotia’s primary care system, it might well begin with a new contract between Nova Scotia Health and the province’s physicians. Doctors across Nova Scotia have been working without a contract since April. The last collective agreement between the province and Doctors Nova Scotia—the bargaining unit that represents Nova Scotia’s roughly 3,500 doctors, residents and medical students—expired on March 31, 2023.
While discussions on a new deal have been “very positive,” according to Doctors Nova Scotia’s new president, Dr. Colin Audain, there are still concerns to address. Burnout remains an issue.
Speaking by phone with The Coast, Audain says the province’s health-care system was “stretched to its maximum” before COVID-19—and the pandemic prompted the early retirement of some nurses and doctors who might have otherwise continued working.
“We don’t really have the same pool of nurses or physicians or other health-care workers in general that we’re used to,” Audain tells The Coast. “So it means everybody’s working a little bit harder—and that’s not helping with the burnout.”
Work-life balance forms a central part of negotiations with the province, Audain says—along with bringing compensation in line with the rest of Canada. A 2019 Canadian Institute for Health Information report found Nova Scotia’s family doctors earned among the lowest gross incomes of any province or territory—and $55,000 less than the national average.
“That doesn’t necessarily mean it has to be competitive with Alberta or Ontario,” Audain says, “but if you fall too far behind, it’s going to be hard to get people to stay in the province.”
