Big jump in number of patients seeking doctors in central N.S. over last 2 years, figures show

The need for family doctors in Nova Scotia's central region, which includes the Halifax Regional Municipality, has shot up in the last two years, outpacing rural areas of the province.

According to October data from Nova Scotia Health, more than 116,000 people across the province are on a waiting list for a doctor and, of that, more than 47,000 are in the central region.

In October 2020, however, the number of people on the list across Nova Scotia was less than 49,000 — and in the central region, only 6,641 residents were on the list. The change represents a six-fold increase in two years.

Dr. Leisha Hawker, president of Doctors Nova Scotia, said in an interview it's only recently the need for family doctors has spread to more populous areas of the province. 

"In previous years, we generally had a hard time recruiting to the rural areas and that's where most of our shortages are," she said. "Now, we're seeing shortages of family doctors across the province, both in central zones and in our more rural areas."

The increase in need in the province's most populous region is partly due to doctors leaving for other jurisdictions, she added. Another factor is the province's population that's risen nearly nine per cent since 2015 and sits at more than one million residents, according to provincial estimates. 

"Also, we have that aging population for family doctors in Nova Scotia. About one-quarter of the family doctors are over the age of 60," she added, "so we're already set to see a lot of retirements."

Currently, there are about 99 vacant positions for family medicine across the province "equally distributed ... in both rural and urban areas," said Health Department spokesperson Khalehla Perrault in an email. Also equally distributed across the province are 65 vacant positions for specialists in areas including emergency medicine, internal medicine, psychiatry and gynecology.

Some forecasts suggest the province needs to recruit about 100 family doctors a year over the next 10 years, plus more to account for future retirements, to meet demand.

Tackling the family doctor shortage 

Addressing the shortfall is more complicated than just filling vacant roles, Hawker said.

"Once we recruit, the job isn't done. The job is really just beginning," she explained. "We need to make sure that the physician feels well-supported and, also, that their family members are supported."

To keep more doctors within the province, Hawker said Doctors Nova Scotia has used a strategy that pairs young doctors with more senior family doctors who are on their way to retirement. It allows the younger physicians to be mentored by the older physicians, while they build relationships with the older doctors' patients.

Patients "see both physicians for a short period and then, instead of having a brand-new physician who doesn't know anything about you, you have good continuity," once the older doctor retires, Hawker said.

Doctors Nova Scotia also runs a mentorship program for international medical graduates.

"It's important to help them settle into the province both socially and as a physician so that they have some peer support in how to navigate the system," Hawker said.

Recruitment and beyond

Getting support, both professionally and personally, is key to doctor retention, said Elena Neiterman, a professor at the University of Waterloo in Ontario.

Neiterman, who studies health worker retention, said in an interview it's not enough just to hire a new doctor.

"You have to work on creating the environment in which they want to stay," she said. "A lot of times, people recruit a physician, but there are no support services, there are no other people they can rely on," which can include diagnostic staff or another physician to replace them in case of vacation or other types of leave.

"It's not just about doctors, right?" Neiterman said. "It's also about supporting personnel, … the working conditions, … how many other health-care providers are around, [what] opportunities they have for their social life, for their education."

For Nova Scotia, Neiterman suggested a long-term plan that ensures doctors don't burn out, which is another factor in doctor retention in areas where health-care professionals are in short supply. In her opinion, that involves having enough staff to allow for breaks.

Current provincial strategy

Nova Scotia's current recruitment strategy says that after physicians are identified and recruited, efforts are made to help them "put down roots" in Nova Scotian communities and provide a "robust package" for professional development and career advancement. 

Perrault said a "record number" of doctors were recruited in the last year, with more than 160 physicians added to the province's roster between April 2021 and March 2022. The current retention strategy is focused on all Nova Scotia's doctors, Perrault added.