Doctors and Nova Scotia government reach new contract agreement

The provincial government and Nova Scotia's doctors have reached a new contract agreement that the president of Doctors Nova Scotia believes will bolster recruitment and retention.

The contract, which includes an eight per cent raise over four years and moves family doctors and some specialists to the top of their pay scales in Atlantic Canada, was approved by the membership of Doctors Nova Scotia this week and released Wednesday. About 69 per cent of eligible members voted on the deal, which received 95 per cent support.

Dr. Gary Ernest, president of Doctors Nova Scotia, said having doctors at or near the top of pay scales in Atlantic Canada will help keep doctors in the province and bring back those with ties to here who left for greener financial pastures.

"It going to either equalize us or get us close enough to what people are earning in other provinces that it's going to make people say, 'You know, it's close enough or I'm ahead, I'll come to Nova Scotia,'" he said in an interview.

"The spinoff of that is access for the public."

In total, doctors will get $135 million more by the final year of the deal.

Beyond the eight per cent increase, there is an additional $42 million for family and emergency doctors, anesthesiologists, psychiatrists and obstetricians and gynecologists.

Although there have been a variety of shortages in Nova Scotia, psychiatry and anesthesia have been a particular problem for this province and the rest of Canada.

The rural retention bonus will double to $16,000 by the end of the contract, something Ernest, a family doctor in Liverpool, said is particularly significant.

"A lot of the rural specialists are holding together services by their fingernails because of difficulties with resources and they really deserve a lot of credit for working long hours, spending a lot of time on call," he said.

Premier Stephen McNeil said the deal is affordable, leaves room to hire more people if recruitment does increase and should make it easier now to deal with other issues, such as maximizing the use of health-care teams.

"This contract [negotiation] was preventing, in my view, for us to have other conversations," he told reporters in Halifax.

That includes how to have doctors who retire early work on a periodic basis in areas that need extra help, or continue to cover long-term care homes even after closing the rest of their practice.

"Those are the kind of innovative conversations we'll start having now with Doctors Nova Scotia," McNeil said.

He said it was clear more needed to be done for certain doctors because of how competitive recrutiment has become. He noted the overall raise to all doctors is generally in keeping with what's being offered to public servants, while allowing for the fact doctors don't have access to government benefits or pensions.

Other incentives in the deal

The deal includes support for succession planning, which would see a new doctor and retiring doctor be allowed to overlap and work together as they make the transition without interrupting service to patients.

There is a promise to reduce the paperwork burden for things such as securing a locum and there will be increased stipends for doctors mentoring medical students in communities. Those programs have been particularly successful in rural communities and Ernest said the stipend, while only $450 a week, is important.

Family doctors have also secured a pilot program for a new blended capitation payment model, a system in which doctors receive a combination of salary and a fee for services. The model is used in New Brunswick with some success.

Getting to this point has not always been smooth, with doctors in some parts of the province refusing to provide certain services in protest of what they viewed as unfair wage disparities with counterparts in other regions of Nova Scotia. Things become particular tense in Cape Breton when the government gave a raise to hospitalists who focus only on inpatient care.

McNeil and Ernest said they hope terms in the contract intended to address that disparity will be enough to get doctors back to providing all services.

Premier steps in

The nearly year-long negotiations seemed to stall several times and McNeil said he ultimately decided to become directly involved, contacting Ernest so he could get a sense of exactly what challenges doctors were facing.

"He has a very good understanding, quite frankly, of his membership and the concerns that were faced by specialists and how we needed to address those," McNeil said. "And there was give and take, and we landed and we arrived at this point."

Ernest said signing the deal is a positive step toward better relations and collaboration between the two sides.

"The tide has turned. Things are more positive now [and] they will become more positive," he said. "There's a lot of work to do yet, but this is the start; this is the start of a new era, if you will."

McNeil seemed to agree.

"My hope is that this puts us back on solid ground," he said. "My hope is that they recognize we have a fiscal responsibility to the entire province. At the same time, we've recognized and listened to some of the challenges they say were in the system and that this deal is fair to them and fair to taxpayers and addresses some of the issues that the system was ailed by."

The contract comes into effect upon signing, which is expected to happen later this week, and is retroactive to April 1, 2019.