Doctor shortage forces Halifax clinic to cut STI testing despite growing need
Elizabeth Chiu | CBC News | Posted: September 27, 2018 9:10 PM | Last Updated: September 27, 2018
Non-profit Halifax Sexual Health Centre says it needs more staff and more funding
A doctor shortage is being blamed for a significant drop in testing for sexually transmitted infections at a Halifax clinic in a year that has seen a jump in new cases of HIV and gonorrhea in Nova Scotia.
The Halifax Sexual Health Clinic is the only place in mainland Nova Scotia that offers anonymous testing for STIs. Since February, the non-profit centre has lost five family doctors, four of whom left the province entirely and another who relocated within Nova Scotia.
The result is longer wait times and fewer opportunities for patients hoping to get tested. The shortage of doctors has also caused the centre to shut its doors on Fridays and it's having challenges staffing its evening clinics.
Kate Calnan, the centre's executive director, said patients are squeezed in for timely treatment if an STI test comes back with positive results.
But she estimated more than 100 patients are left unseen every week because no doctor is available.
The service reduction is "hugely frustrating," said Calnan.
"That's been one of the most significant challenges we've been facing here at the centre."
Cuts to testing and longer wait times
The staffing crunch has also hurt the facility's bottom line.
The centre charges physicians overhead on their MSI billings to help cover salaries for nurses and staff. That overhead accounts for approximately 60 per cent of the centre's $650,000 operating budget, said Calnan.
With fewer physicians working, the budget has taken a direct hit.
Back in April, the centre could afford to hire two full-time nurses and one part-time nurse, said Calnan. Now it takes three weeks to see the clinic's sole nurse, up from one week.
Nurse-run tests for blood-borne infections such as HIV, syphilis, and hepatitis C and B are now offered just one day a week instead of three.
A drop-in blood-testing clinic, a weekly service popular among people who get tested regularly, has been suspended.
And access to a doctor is limited for testing of bacterial STIs, such as gonorrhea or chlamydia.
It can take four weeks to be seen by a doctor at the centre, which, in any given year, usually provides testing for blood-borne STIs for 1,000 clients. Calnan said it's on track to provide testing to only one-third of its clients this year.
HIV, gonorrhea rates could be highest in 5 years
According to the Nova Scotia Health Authority, as of the end of August, there were 16 confirmed cases of HIV in the province and two suspected cases. In the same period last year, there were just eight confirmed cases. By the year's end, there were 15.
Gonorrhea rates also rose faster this year. In the first eight months, there have been 224 cases, compared to 152 in the same period last year. For all of 2017, there were 233 cases.
Dr. Trevor Arnason, the medical officer of health for the central region, said the spread of the two STIs "could be the highest level" in the past four or five years. He said they're both on track to post 25 to 50 per cent higher rates.
'Another barrier to proper testing'
While STI testing is available through primary care providers in settings other than the Halifax Sexual Health Clinic, some at-risk patients aren't willing to ask.
Matthew Numer, an assistant professor of health promotion at Dalhousie University, studies the sexual health of gay men. He said he's very worried about the loss of the drop-in blood-testing clinic, calling it "another barrier to proper testing."
He said "many gay men do not have family doctors and even if they do, they may not be willing to discuss their sexual practices or history of them."
Stress on hospital STI clinic
Clients who can't be seen by the Halifax Sexual Health Clinic are now being referred to the Nova Scotia Health Authority's STI clinic at the Victoria General site in Halifax.
The hospital's first-come, first-served clinic is supposed to run twice a week from 5 p.m. to 6:30 p.m. — an end-of-day shift for the nurses and doctors who work there. Instead, some nights, they're working until 9 p.m.
The clinic's co-director, Dr. Todd Hatchette, said there's a risk of burnout among clinic staff and they're now considering capping the number of patients that can be tested at 30.
Funding request for a nurse
Calnan said her centre needs an extra $60,000 in funding to pay for a second sexual health nurse.
She said the centre does not receive funds from the Nova Scotia Health Authority, but applied for funding for a nurse anyway earlier this year.
Calnan said she was rejected, and then turned to the Department of Health and Wellness to boost the centre's annual grant to $149,000 to help cover nursing salaries. The centre received its annual amount of around $117,000, but no additional money, she said.
Health Minister Randy Delorey said Wednesday he was unaware of the centre's funding proposal and that nobody in his office could track it down.
On Thursday, however, a department spokesperson confirmed in an email to CBC News that staff received the proposal in March for an additional $32,000. Tracy Barron said the request came in too late to be considered for the 2018-19 budget.
"Staff are in contact with the centre to discuss its current situation and possible options," Barron wrote. She also noted the department provides $250,000 a year to six centres that fall under Sexual Health Nova Scotia, including the Halifax clinic.
Calnan said she's also putting work into fundraising. Last weekend, an event at Grafton Street Dinner Theatre raised between $3,000 to $4,000.
Calnan plans to use the money to reinstate the drop-in blood collection clinic, but instead of it being held weekly, it will likely be monthly to stretch the money as long as possible.