Survey looks at challenges getting doctors to community emergency departments
Unplanned closures in Nova Scotia have increased 4 years in a row
A questionnaire is circulating among some doctors in Nova Scotia asking them what would be required to get them to pick up shifts at community emergency departments.
Nova Scotia has struggled with a rising number of unplanned closures at community emergency departments and collaborative emergency centres in recent years. While regional sites are required to provide 24/7 coverage, community sites are not.
Dr. Rob Bush is a family doctor in Tatamagouche and one of two local doctors who also do emergency shifts at the local Lillian Fraser Memorial Hospital.
He speculated the survey, conducted by the emergency medicine section of Doctors Nova Scotia, could be related to the pay gap between working shifts at a regional site and a community site. According to a recent survey of emergency medicine doctors, the former carries a rate of $232.51 an hour, and the latter a day rate of $154.96 an hour and $178.71 an hour for evening shifts.
The rate for collaborative emergency centres, which is what Tatamagouche has, is the same as the day rate for community hospitals with emergency departments.
"That's a pretty big discrepancy," said Bush.
The different rates are intended to reflect the fact that the types of care and patient volumes vary at emergency departments in the province.
The recently signed master agreement saw fee increases for emergency department coverage, but it wasn't across the board, meaning the gap has grown enough that it has potentially contributed to people not being as interested in picking up shifts or travelling to do locums at community emergency departments.
Scheduling change helps
Bush said in his community's case, they've benefited from a recent change related to scheduling at the regional hospital in Truro. In the face of more competition for emergency shifts there, doctors are now required to do at least some shifts during less desirable hours.
As a result, five or six doctors regularly travel to pick up shifts in Tatamagouche, meaning that after averaging two uncovered days per week for some time, staffing levels at the emergency department have shot up.
"We're probably one or two shifts a month that's uncovered," said Bush. "So there's been a big improvement."
Pay not the only factor
A similar survey by the emergency medicine section recently asked doctors who practise emergency medicine about the various pay rates and their effect on recruitment and retention.
Dr. Robyn MacQuarrie, president of Doctors Nova Scotia, said all information gathered helps when it comes to tackling issues because it comes from a broad group of people.
"That's really powerful and compelling information to then use in our conversations with government," she said.
Attracting and retaining doctors is an ongoing challenge, but MacQuarrie said pay is only part of the equation.
"The type of work and the supports that you have, the environment in which you're working, that is all an important part of the work that we do because we like to not feel like an island."
While there has been a shift through the years of people working in more urban sites, MacQuarrie wonders if that could start to change.
Benefits of an open emergency department
COVID-19 has changed some people's outlook in terms of where they want to be and rural areas are benefiting from programs that take new doctors out of cities and train them in smaller communities, she said.
"They're learning that they love those communities and we're having really great retention rates," said MacQuarrie.
Bush said having the help necessary to keep emergency departments open as scheduled means patients are getting care when they need it, as opposed to potentially hanging on to concerns until they can get in to see their family doctor.
"We're having a hard time actually managing family practices efficiently and helpfully when the [emergency department] is closed," he said.
"When the emerg is open, it allows the family practice to work better and to provide better primary care."
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