Disagreements lead to N.S. docs missing out on anesthesiology training

Nova Scotia recently missed out on two training opportunities that could have helped bolster anesthesiology services in the province because a health-care group tasked with overseeing the issue couldn't agree on the offers.

Documents received in response to an access-to-information request show the province was offered a family practice anesthetist training spot for this past July at both the University of Toronto and McMaster University in Hamilton, but missed the deadline to have doctors accept either offer because health officials here still cannot agree on whether the role should be used in Nova Scotia.

A family practice anesthetist (FPA) is a family doctor who has an additional year of training focused on anesthesiology. The training allows the doctor to provide local and general anesthetics in cases except for those that are highly specialized, such as heart and brain surgeries.

While the role is commonly used in Ontario and Western Canada, it isn't east of Ontario. Resident training programs exist at 11 medical schools in Canada, although Dalhousie University is not one of them.

Problems at regional hospitals

At a time when the provincial health authority has six vacancies for anesthesiologists and the specialty is in demand across the country, some officials, including doctors at regional hospitals in Antigonish and New Glasgow, have called for FPAs to be used here to ensure service levels remain stable outside the Halifax area.

The most pressing need recently has been in Yarmouth, where at one point this spring the regional hospital was down to just one anesthesiologist, forcing a reduction in surgical services and the possibility of pregnant women needing to leave the community to deliver babies.

Although that never happened, and the site has since brought on a second anesthesiologist and also has locum support, things remain precarious; elective surgeries have been reduced for the last six months.

Such uncertainty is what's driving the push to allow FPAs in Nova Scotia.

"I see this as one of several solutions, and perhaps a minor solution, but one that N.S. has not allowed itself to use," Dr. Rod Wilson wrote in an email to Nova Scotia Health Authority officials in January.

"Other provinces have been training and educating FPA[s] for decades."

'We came so close'

Wilson, the former executive director of the North End Community Health Centre in Halifax, is a physician adviser for the Health Department, and the documents CBC News received show his efforts to bring the FPA role to the province have faced pushback from some sectors, including anesthesiologists.

"The program at the moment would have limited success given the lack of support from [the perioperative group] and primary health care members," the health authority's vice-president of medicine, Dr. Nicole Boutiller — who at the time was the NSHA interim co-vice-president of medicine — wrote in an email to Wilson in February.

The health authority's perioperative group eventually reviewed the idea, and although its March decision is redacted in the documents, subsequent emails from Wilson to health authority officials and staff at the University of Toronto and McMaster University make clear the group did not endorse using FPAs.

"We came so close to [getting] an extra anesthesia resource for communities," Wilson wrote to health authority officials.

"Anesthesia leaders not supportive or accepting [of the] FPA practice," he wrote to the chair of the University of Toronto's department of anesthesia.

In an interview, Tim Guest, vice-president of health services for the health authority, said some of the concerns from the perioperative group were based on a lack of information about the role. Although the group initially rejected the idea, the health authority's medical advisory committee went back to them with research on FPAs and asked the group to provide options to be considered for how to enhance the anesthesiology system.

That was months ago, and the group has yet to provide those options.

Health Minister Randy Delorey, who was made aware of the role a year ago by an out-of-province doctor who wanted to know why FPAs aren't used here, has been waiting on a report about the issue since the spring. Guest said he's hoping for those recommendations soon. He said his primary concern is maintaining access to care as close as possible to where people live.

"It behooves us to look at every option that we can to stabilize and ensure that we maintain those services," said Guest.

'We need to look into this more'

Although FPAs are sometimes dismissed as an option used only in rural and remote communities, the documents received by CBC show that is not the case. A jurisdictional scan shows there are FPAs based in Ottawa, Kingston, Ont., Mississauga, Ont., Winnipeg, Edmonton, Vancouver and Victoria.

While the health authority awaits the recommendations from the perioperative group, other doctors have expressed interest in the idea.

Dr. Mark Taylor, the executive director of medicine for the central zone, noted in a May email to colleagues that an Accreditation Canada survey he was part of for the Southern Regional Health Authority in Manitoba showed five hospitals with surgical services, all within an hour-and-a-half of Winnipeg, exclusively used FPAs.

"There is not one fellowship anaesthetist in the entire region. Everyone seemed satisfied with services and there was no indication of poor outcomes that I could find," he wrote.

"Very interesting," Dr. Drew Bethune, medical director of Nova Scotia's cancer care program, wrote in response.

"Obviously we need to look into this more."

Dr. Greg Hirsch, the chief of cardiac surgery at the QEII Health Sciences Centre in Halifax, responded by saying he is "keen to learn more about the potential role of [family practice] anaesthetists and how it might buttress the critical shortage of anaesthetists in the province."

With the College of Physicians and Surgeons of Nova Scotia having agreed to licence the role, the president of Doctors Nova Scotia is encouraging officials to keep working on a solution.

Dr. Gary Ernest said the organization is supportive of a collaborative model that would see FPAs working in appropriate situations with appropriate support, at certain locations that still include board-certified anesthesiologists.

"That seems reasonable and indeed, from a Doctors Nova Scotia perspective, it is reasonable to have them working in a collaborative manner," the Liverpool-based doctor said in a telephone interview.

Ernest said that although he understands it might be ideal to have a full complement of board-certified anesthesiologists in the province, the reality of the shortage is that's simply not possible. Even if salaries for the specialty were more competitive on a national level, Ernest said he doubts it would lead to a windfall for Nova Scotia.

That reality is part of the basis for Doctors Nova Scotia's position, he said.

"We have to really look at this situation in a proactive, open-minded way and really look at the potential that exists for a collaborative model."