Background

In late 2017 and early 2018, DNS representatives met with academic physicians and the C/AFP Department Heads to learn more about their perspectives on the issues that academic physicians are facing in their practice environment.

This report synthesises their feedback and makes recommendations for ways to improve the tertiary and quaternary health-care system in Nova Scotia.

As we expected, Nova Scotia’s academic physicians share many of the same frustrations as their colleagues with fee-for-service, hourly or alternative payment plan (APP) contracts. However, while academic physicians share many of the challenges experienced by their colleagues in primary and secondary care, some of their concerns are unique. This report focuses on these unique issues, continuing the conversation between physicians and key health-system leaders, including those within the Department of Health and Wellness, the Nova Scotia Health Authority, the IWK Health Centre and the Faculty of Medicine at Dalhousie University, that began with the publication of Healing Nova Scotia.

Doctors Nova Scotia believes it is critical that all stakeholders come together to address the issues that affect physicians, and invites all partners to work together to create a better future for our health-care system, for the sake of all Nova Scotians.

Priority issues

The priority issues identified by academic physicians in Nova Scotia fall into the following themes:

1. Access to primary care
2. Support for the clinical/academic mandate
3. Decision-making and engagement
4. Relationships and professional satisfaction
5. Resources and work environment
6. Retention and recruitment

Doctors Nova Scotia has identified several recommendations to address these concerns and improve the practice environment for academic physicians and health care for Nova Scotians. They include:

1. Improve access to primary care for both patients and physicians.
2. Provide greater support for the clinical/academic mandate by creating an environment conducive to innovation and ensuring enough funding is available to support academic and clinical work.
3. Clarify and streamline decision-making and reinstate meaningful physician engagement in health-system decision-making.
4. Rebuild and reinforce collaborative relationships with health-system stakeholders, and ensure physicians are treated as part of the solution, not part of the problem.
5. Provide the necessary financial, human, infrastructural and technological resources so that physicians have what they need to accomplish their clinical/academic mandate and meet patient needs.
6. Improve academic physicians’ professional practice environment by working with health-system stakeholders to make Nova Scotia’s academic health science centres appealing workplaces.

Acknowledgments

Doctors Nova Scotia thanks academic physicians from the following departments and divisions for their input:

Anesthesia
Critical care
Diagnostic imaging (IWK)
Diagnostic radiology
Emergency medicine
Family medicine
Gynecologic oncology
Medicine
Obstetrics and gynecology
Ophthalmology
Pathology
Pediatrics
Psychiatry
Radiation oncology
Surgery
Urology