Cape Breton losing its psychiatric site lead next year
Tom Ayers | CBC News | Posted: October 25, 2018 9:00 AM | Last Updated: October 25, 2018
2017 memo from Dr. Scott Milligan discusses Cape Breton's psychiatrist shortage
Cape Breton is losing another psychiatrist next year, despite financial incentives from the province intended to help retain mental health specialists in rural areas.
Dr. Scott Milligan handed in his letter of resignation Oct. 17 and his last day is Jan. 31, 2019. The psychiatric site lead in Cape Breton declined an interview and wouldn't say if his resignation is tied to ongoing shortages of psychiatrists.
"We have five psychiatrists trying to do the work that was previously done by 14 to 16 people, and that's very difficult," Dr. Margaret Fraser, president of the Cape Breton Medical Staff Association told CBC News a week before Milligan announced his resignation.
"We're supposed to have mental health centres in North Sydney, in Glace Bay, in New Waterford, in Sydney, and it's difficult for five people to run four mental health clinics. You can't do that."
Past comments on psychiatrist shortage
Although he's not speaking to the media about it now, Milligan has talked about psychiatrist shortages on the island before.
On Oct. 30, 2017, Milligan and Dr. Faisal Rahman, chief of the eastern zone's psychiatry department (which includes Cape Breton), signed their names to a Nova Scotia Health Authority memo calling for the problem to be addressed.
"Our typical complement in Cape Breton has been 16; we currently have seven adult psychiatrists and one part-time child psychiatrist," stated the memo, which was released by the provincial NDP.
"By way of perspective, there are approximately 122 psychiatrists working in Halifax. The numbers speak for themselves."
If no one is hired after Milligan leaves, it means there will only be four dedicated psychiatrists on the island. And none of the existing psychiatrists on the island is dedicated full time to children and adolescents.
More incentives to work in Halifax
In April of this year, a psychiatrist at the Cape Breton Regional Hospital told CBC pay inequities could be at the root of challenges in recruiting physicians outside Halifax.
Dr. Yvonne Libbus said psychiatrists in the Halifax region have smaller workloads, yet they receive up to $55,000 per year more than rural colleagues.
Milligan and Rahman's memo also pointed this discrepancy out.
"We have sought help from our colleagues in Halifax and I have had communication with the minister of health outlining our situation and have offered some concrete, specific suggestions which go beyond psychiatry alone," the memo stated.
"We face barriers on several fronts, not least the fact that psychiatrists in Halifax earn more than their rural colleagues and they [practise] in a heavily resourced area. Why come to an under-sourced area only to work harder?"
What the province is doing
In mid-August, the Nova Scotia Department of Health and Wellness came up with several incentives to retain existing psychiatrists in Cape Breton and other rural areas, and to attract new ones.
Those have resulted in a number of psychiatrists from other areas taking on locum, or temporary, postings on the island. But two months later, with the impending departure of one more psychiatrist, the problem doesn't seem to be getting better.
This summer, the province began offering $30,000 a year extra to psychiatrists outside the Halifax region. The additional pay is targeted at recruiting new doctors and keeping existing ones.
The department is also developing a clinical assistant program for Cape Breton and Truro, and is now paying $20 per hour more plus travel and other expenses for psychiatric locums in the Nova Scotia Health Authority's eastern and northern zones.
Fraser said the higher pay and smaller workloads in Halifax have obviously been a factor in the local psychiatrist shortage.
"I was shocked to find out that my psychiatric colleagues in Sydney are getting paid less than the psychiatrists in Halifax," she said.
Fraser said Cape Breton has plenty of psychologists who offer mental health counselling, but they can't prescribe or adjust medication.
In addition, the extra workload is contributing to family physician burnout, she said.
Loss of psychiatrist another blow
Earlier this year, the government began sending Cape Breton's children and adolescents in crisis to the IWK Health Centre in Halifax, because there are no inpatient mental health beds for children in Cape Breton and the only part-time child psychiatrist left this summer.
Dr. Andrew Harris, the province's head of psychiatric services, said Milligan's departure will be another blow to the island. But he said the incentives offered this summer have already begun to have an effect.
Five psychiatrists from the mainland have provided part-time help in Cape Breton over the last two months, he said, and there are signs at least one psychiatrist is considering moving outside the Halifax region.
"We've had a great deal of interest from people within the province who would be interested in locuming," Harris said.
"For example, rather than taking a week's vacation, they might do a week's locum somewhere to earn a bit more money ... and we've got people coming from outside the province who are interested in doing some locums, too, and it's been a big help to have this more competitive remuneration model for attracting locums."
Harris said locums help plug the gaps, but they aren't a long-term solution.
"We need to get people to eventually come move and work full time in Cape Breton, but psychiatrists don't grow on trees, unfortunately, and in order to get someone to come usually is sort of a lengthy process," he said.