When a healthcare crisis is an opportunity… for an “important milestone” moment photo-op

While our healthcare crises multiply, our leaders stage photo opportunities that resemble trying to slap Band-Aids on the backsides of rampaging elephants. Whatever happened to political leadership?

So last week, 10 out of 37 hospital emergency departments in Nova Scotia were closed for at least some part of the week. The Musquodoboit Valley Memorial Hospital won in the best-in-worst category; its emergency department was scheduled to be closed for a total of five days last week, only finally reopening its doors on Saturday.

There are differing but ultimately similar and familiar explanations for why this should be so.

“Vacations,” Nova Scotia Healthy Authority spokesperson Kristen Lipscombe explained simply and seemingly logically to News 95.7. “The people that work for us are entitled to vacations and time away from work, and that does include during the summer months, which tend to be busier for vacation time.”

Doctors Nova Scotia president Gary Ernest did not so much disagree with that as he added a layer of nuance to the vacation rationale. Back in the day, he explained, local family doctors used to volunteer to take on extra shifts at their rural hospital emergency departments to keep the services running while others were on vacation.

“Now what’s happened over the years is these same family docs — because of getting more fatigued, getting burnt out — they’ve had to say look we’ve gotta draw the line here, our own physical and mental health is at risk.”

Both of those explanations, of course, meander their way backward to the same root cause — a lack of doctors, particularly family doctors, particularly family doctors willing to ply their trade beyond the usual urban amenities.

The latest head-less count from the province’s doctors-wanted helpline shows almost 52,000 Nova Scotians — about five per cent of our population — would like to have a family doctor but can’t find one.

That’s a lot of Nova Scotians. It might even be called a healthcare crisis if our political leaders used words like crisis to describe the many and various healthcare crises facing us.

They don’t. Instead, they stage photo opportunities that resemble trying to slap a Band-Aid on the backside of a rampaging elephant. They call them “important milestone” moments.

I give you Premier Stephen McNeil, speaking two weeks ago at just such an important-milestone photo-op moment: an announcement the province will fund 16 new seats in Dalhousie University’s School of Medicine. These spaces are specifically designated for wannabe doctors from rural, Mi’kmaq and African Nova Scotian communities.

That may seem like modestly good news. And it is. But there are catches.

Of course, there are catches.

For starters, 16 new doctors will not a solution make.

Worse, the province won’t actually even be funding the $75,000 per-student cost of all 16 new students immediately. In 2019-20, the government is only ponying up $300,000 for four student spots. The other 12 won’t open up until 2020-21, just in time for the Liberals to claim bragging rights during the next provincial election. That, of course, will still be well before what a government press release says will be an annual price tag of $4.8-million shows up on the books, beginning in 2023-24.

And here’s another catch, which becomes a Catch-22. While the government will fund Dalhousie to add those additional seats in its school of medicine, covering its cost and adding to the overall number of students it can admit each year, there was no indication in the news release the government will also fully fund those rural, Indigenous and African Nova Scotian students who want to attend Dalhousie for their medical education.

  • According to the Association of Faculties of Medicine of Canada, newly minted doctors report an average debt of close to $165,000 for medical school costs and living expenses during their education.
  • According to a Statistics Canada survey, medical school tuition in Nova Scotia is currently about $5,000 more per year more than the Canadian average.
  • Nova Scotia family doctors, who are in contract negotiations with the provincial government, are now the lowest paid in the country.

Do we see the makings of a… well, if not crisis, what then?

Those individual issues become knock-ons. Would-be medical students from Nova Scotia communities that are under-represented are often under-represented for a reason. Money. Many simply can’t afford to take on the huge debt needed to become doctors without some guarantee their expenses will be fully covered.

But even many of those who decide to take that plunge will, not surprisingly, ultimately choose medical specialties that offer the fastest and biggest returns so they can pay down that debt more quickly.

Family medicine is not one of those fastest/biggest specialties. But it is the specialty 52,000 Nova Scotians are self-reporting they need. There is no guarantee — or requirement — those under-represented students who do take up the new seats at the Dal medical school will ultimately choose to go home again.  As Dr. David Anderson, the dean of Dal’s medical school, told the province’s standing committee on health last week, too few medical graduates still choose to specialize in family medicine.

And so the situation spirals, the crisis deepens, the photo-ops proliferate.

Is there a solution?

Consider Fidel Castro.

No, seriously.

In the immediate aftermath of the triumph of his 1959 revolution, fully half of Cuba’s 6,000 doctors decamped to Miami. Castro, whose new government had optimistically guaranteed every citizen the “right to health protection and care” clearly understood he had a crisis on his hands. He launched “a national project” to fix Cuba’s crumbling healthcare infrastructure, including promoting medical education.

Within 25 years, Cuba had trained enough new physicians that every neighbourhood had its own doctor and nurse. Today, Cuba’s world-class healthcare outcomes— in what is economically still a third-world country — attest to Castro’s success.

Castro not your cup of rum?

Consider the Marshall Plan, the US post-World War II initiative to help resuscitate European economies ravaged by war. American money helped goose four years of the fastest-ever growth in those Western European countries and then spawned another two decades of never-before economic expansion.

My point here is not that we should ape Fidel Castro or George Marshall. Both have their detractors. But the larger reality is that they were both leaders who understood a crisis when it smacked them in the face, and who rose to the occasion.

Nova Scotia? We still have our own version of “crisis actors” instead of crisis leaders, busily slapping their Band-Aids on the elephant’s departing backside instead of confronting the real crisis elephant in the room.

This column first appeared in the Halifax Examiner August 19, 2019.

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