Doctors Nova Scotia president says inpatient service reduction a long time coming

The president of Doctors Nova Scotia says the decision by some doctors in Cape Breton to withdraw inpatient services has been a long time coming.

Dr. Tim Holland said the move by about 30 general practitioners at hospitals in Glace Bay and North Sydneyis a reflection of the change in how doctors practise and the increased demands they face to fulfil as many obligations to patients as possible.

"They're stretched so thin that they're faced with the really difficult decision of, 'Where is the best area for me to dedicate my efforts?'" Holland said in an interview Tuesday.

But money is also a factor.

Glace Bay and North Sydney, along with Strait Richmond Hospital, are the only sitesin the province where doctors are not compensated for on-call inpatient coverage.

Agreements have been reached through the years betweengroups of doctors at individual hospitals and the former district health authorities, and then provincial health authority, but the lack of consistency has also resulted in hard feelings.

Those hard feelings were exacerbated in 2017, when the Health Department increased funding for hospitalists doctors who focus on inpatient care by $3.2 million.

That move reduced strain hospitalists faced, but increased the pay disparity between them and family doctors doing similar work.

Holland said that was a tipping point for many doctors as they weighed increasing workloads and demands on their time and tried to find a way to shoulder the load.

"Demand is currently outstripping patient supply and, as a result, physicians need to dedicate themselves in certain areas."

A decision with consequences

For most general practitioners, that's meant an increased focus on office work and, in some cases, emergency department coverage or nursing home visits, while moving away from inpatient care, said Holland.

"It's quite difficult for them to be able to mix with the rest of their life," he said. "It's a really onerous part of their practice."

That decision has created further pressures on the health-care system in Cape Breton, where the Cape Breton Regional Hospital has, at times, faced a bed shortage while beds at Glace Bay and Northside General remain empty.

Without doctors to handle inpatient care, fewer patients can be admitted to the community hospitals, which, in turn, increases pressure on the emergency department at Cape Breton Regional.

Holland said he wouldn't classify the move as work action by the doctors who have pulled inpatient services, noting the change has been happening for some time.

"They're doing so based on decisions in their own life. They aren't doing so as a strike, they aren't doing so in a way that is a work action," he said.

"This is a conversation that's happened for a long time and so it's one that has to continue."

A proposal from the province

In an attempt to acknowledge that difficulty in Cape Breton and recognize those doctors who have continued with the work, the provincial government recently offered an additional $51,000 per year to ninedoctors in Glace Bay who havecontinued to provide patient care.

Government officials say the doctors can claim the increase as along as there are enough to continue providing sufficient inpatient coverage at Glace Bay.

While a statement from the province said the offer was made via a proposal sent to Doctors Nova Scotia, Holland said he hasn't seen it yet.

He said it seems like "quite a generous raise and I would be surprised if any physician would say no to it," but he said he's still trying to get more information.

Targeting 10 hospitals

The Glace Bay offer is part of a more generalproposal from the province to Doctors Nova Scotia intended to address compensation concerns for inpatient work at 10community hospitals across the province. According to documents shared by Doctors Nova Scotia, the community hospital inpatient model would be available at sites in:

• Inverness
• Cleveland
• Glace Bay
• North Sydney
• New Waterford
• Lunenburg
• Middleton
• Liverpool
• Windsor
• Shelburne

The model would see doctors providing inpatient care receive daily stipends and on-call pay. The stipend amount would vary based on a site's number of beds and activity level and is, according to the Doctors Nova Scotia, "a significant improvement from the current payment levels."

Master agreement talks continue

While the government is meeting with doctors in communities about the model, Doctors Nova Scotia is not endorsing it for reasons including restrictions on how and when rates are revisited and a requirement that all doctors at a site agree to the model for it to be used.

But government officials say that while they initially had a rigid view on doctor participation levels their stance changed last month.

Now they would only require approval from enough doctors to provide consistent inpatient coverage at a site in order to sign off on the new model. The switch could happen as soon as enough doctors agree to the formula.

All of this comes as Doctors Nova Scotia and the government continue protracted talks to get a new master agreement in place.

Pay issues, particularly for family doctorswho are seeking a new payment model that would include rates that would bring them in line with their Atlantic counterparts, are a key matter in the talks.

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