Sydney doctor switches to collaborative practice, takes on new patients

A longtime doctor in Sydney, N.S., is accepting as many as 40 new patients a month from the provincial doctor wait list after switching his practice to a collaborative model.

Dr. Steven MacDougall has added four new family doctors to Island Family Health Care in the last 18 months, and added a nurse practitioner and a social worker. He also plans to hire a family practice nurse.

MacDougall said patients are directed to the person within the practice that is best able to help them, and that's freed him up to see more patients. 

"For instance, if the nurse practitioner is more able to manage chronic disease than me, then why doesn't she do that?" said MacDougall. "Maybe I can do certain things that I'm better at. Everybody does the tasks that they're best trained to do."

According to the Nova Scotia Department of Health and Wellness, there are about 50 collaborative practices across the province in various stages of development.

MacDougall said the collaborative approach generally means patients don't have to wait as long to get an appointment, and doctors can spell one another off and can share an on-call schedule.

That's much better for a patient's continuity of care, he said, rather than forcing them to go to a walk-in clinic or the emergency department.

The newest member of the collaborative team is Pam Lappin, a social worker. She joined the practice about two months ago after 20 years in other health and community social work jobs.

Lappin said she tries to examine "the big picture" of a patient's wellness by looking at such things as housing, employment and food security, and directing them to the appropriate resource.

One example would be helping a patient who's been prescribed an expensive drug treatment.

"They may need a medication and then we find out they don't have drug coverage," said Lappin. "So we help support them and navigate a system to get them appropriate coverage."

Nurse practitioner Dena Edwards-Wadden is able to diagnose patients, order lab tests and refer to specialists. 

She also does home visits, and said the doctors will refer patients to her when they feel the patients could benefit from a longer visit or need someone to go through their medication.

"You're really just laying more eyes on the patient," said Edwards-Wadden. "We're all coming from different areas of care, really just providing holistic, patient-centred care."

'Allows me to do more doctor-type things'

MacDougall said he knows of several collaborative practices in Cape Breton. They can be an important tool in trying to recruit new doctors, he said, by offering them a practice where they feel supported.

"A lot of times, they're just out of residency, and it is helpful to have someone that they can run something by," said MacDougall.

The collaboration means that, for the first time in 15 years, he has the luxury of opening up his practice.

"Me personally, I take about 40 patients a month, and I know that doesn't sound like a lot, but add that up. And that's added to my already full practice," said MacDougall.

"The people we're collaborating with are doing a lot of the things, most of the time better than I would have done it, and it allows me to do more doctor-type things."