N.S. is pursuing more family doctors, but not all want to stick to primary care

Dr. Adrienne Borrie can pinpoint the time when it became clear to her she wanted to focus on family medicine.

Borrie was in her third year of medical school doing clerkship rotations at collaborative family practices in the Nova Scotia towns of Annapolis Royal and Lunenburg where, for the first time, she was given her own roster of patients to oversee.

"That responsibility was really exciting," the family medicine resident said in a recent interview.

"I felt I could go an entire day working and even at the end of the day, I couldn't wait to see the next patient."

Dr. Rebecca Visser had a similar experience when she did her family medicine elective at Dalhousie University's family medicine clinic in Spryfield, the primary site where she's now doing her residency.

"One of the best things about it is that it allows you to build relationships with your patients over their lifetime, which I think is pretty unique," she said in a recent interview.

Need a family practice registry tops 158k

Nova Scotia needs as many Adrienne Borries and Rebecca Vissers as it can get.

The May update for the province's Need a Family Practice registry, which was posted online last week, shows more than 158,000 people are now looking for a family practice provider. That number represents 16 per cent of the province's population, an all-time high.

More than half of the people on the list are in the province's central health zone, which includes the Halifax Regional Municipality. According to the registry, the greatest need provincewide is in Bedford/Hammonds Plains, a fast-growing area of Halifax. But most of the communities with the greatest representation on the list extend beyond HRM to Sydney and area, New Glasgow/Westville/Stellarton, Bridgewater, and Yarmouth.

The provincial government has taken steps to try to cut into this list by increasing recruitment efforts in places such as Australia, the United Kingdom and the United States. The process to recognize the credentials of doctors from some countries has been streamlined in an effort to get more people working here sooner.

But there is an emerging trend in family medicine that further complicates things: an increasing number of doctors trained to do family medicine are working in other parts of the system.

Research shows that shift is motivated by a variety of factors, including a desire for less administrative burden, the opportunity to make more money, a more varied work schedule, and improved life-work balance.

A shifting focus

In March, the Canadian Institute for Health Information (CIHI) published data showing that during the last 10 years, "a growing number of family physicians have been providing services outside of primary care" and that "many newer family physicians are less likely to engage in comprehensive and continuous family practice."

The CIHI report showed that in 2021, the most common focus aside from primary care for family medicine doctors was emergency medicine, psychiatry and general surgery, but there are a variety of other options for doctors who do not want to spend all or any of their time working in an office-based setting with a set roster of patients.

Keys to addressing the changing work patterns in primary care include examining the use of integrated, team-based approaches to care, the role of different pay models, and strategies to improve workforce data collection, according to the CIHI report.

Michelle Thompson, Nova Scotia's health minister, said in an interview last week that her department is attempting to address the system's long-term human resources needs while also ensuring better access for people who do not have a primary care provider.

That has meant creating new ways to access care, such as the expansion of virtual care, mobile clinics and primary care pharmacy clinics.

Thompson said it's difficult to know how every doctor trained in family medicine spends their work hours, but the department is aware that between 450 and 500 physicians are providing care in other ways, such as mental health and addictions, palliative care, emergency department shifts and obstetrics.

The reason for that alternative focus is less important because, in most cases, the services being provided are as vital to the system as seeing patients in a primary care setting, said Thompson.

"In a rural community, in order to keep emergency rooms open on a more regular basis, or in fact permanently, we do need family physicians who have an interest in [emergency] medicine," she said.

"Addictions and mental health, a family practice physician that's contributing that way is essential for us in terms of delivery model."

While there is a strong emphasis on recruitment, there is also the reality that competition for doctors and other health-care professionals is fierce across the country and beyond.

The number of family medicine residency spots at Dalhousie University has been expanding in recent years and will expand further in 2025 with the opening of a satellite school at Cape Breton University, but there are inherent limitations with that, too.

"We have to grow our own base," said Thompson. "[But] it takes 10 years to get a family physician. So it's going to take us some time."

The government is also hoping that a recently negotiated contract with doctors that created premiums for primary care to increase pay should help with recruitment and retention, as well as efforts to reduce administrative workloads.

Although the Tories have touted an expansion of collaborative care, it's been a process slowed by recruiting challenges for doctors and other would-be team members.

Borrie and Visser both envisage careers as family doctors, seeing patients and following them through the milestones of life. They also have an eye toward a varied practice.

For Borrie, that could include some work as a general practitioner oncologist along with rural family medicine, while Visser envisages a clinic-based primary care practice with variety built in.

"So it might be one day of, for example, a prenatal clinic," said Visser.

"Another day where you're doing some minor procedures and then just other primary health-care and prevention."