On May 9, 2012, the Department of Health and Wellness (DHW) released Shaping our Physician Workforce, a planning tool to manage physician resources and reshape the workforce over time. Working with partners such as Dalhousie University, Doctors Nova Scotia as well as the Nova Scotia Health Authority (NSHA) and the IWK Health Centre, this comprehensive planning tool provides a model to manage physician resources over a ten year timeframe.The goal of physician resource planning is to have the number, mix and distribution of physicians to meet Nova Scotia’s health care needs including those who have historically experienced barriers or disadvantages in receiving care.
The workforce data and forecasts that formed part of the report (Physician Resource Planning: A Recommended Model and Implementation Framework - Final Report) were based on positions that existed in 2009/10. Data and forecasts were updated in 2011/12 and the forecast is being updated based on 2013/14 data. This information will continue to help determine the appropriate complement of physicians needed across the province.
While Nova Scotia does have more physicians per capita than the national average, there are many areas of the province that are lacking physician resources. It’s one of the reasons the Physician Resource Planning tool was created, and why the Recruitment and Retention Action Team was formed. The team included community and health system stakeholders who made a series of recommendations to improve the recruitment and retention of physicians to communities where they are needed. One of their recommendations—the tuition rebate program--has been implemented, while others are under consideration.
The principles guiding physician resource planning are:
Population Health needs
The foundation of all health human resource planning is a provincial health service delivery plan. Therefore, physician resource planning is intimately linked to and dependent upon provincial health service planning. As Nova Scotia is home to the Dalhousie Medical School, planning must also consider academic and research streams.
A variety of other processes are underway within the DHW, NSHA and the IWK Health Center, including an innovative New M.D. Appointment Process, the reorganization of the Diagnostic Imaging Pathology and Lab Medicine services, and the ongoing work of the provincial Perioperative Advisory Committee, among others. It is also important that technology in the provision of care be enabled.
Of course, health service planning isn’t just about numbers of physicians and their locations. Planning must include the development of models of care to make optimal use of all health professionals in improving health outcomes. Key areas of work on inter-professional models of care include primary health care, mental health and addictions, palliative care and dementia care.
The Department Of Health and Wellness is working with the Nova Scotia Health Authority and the IWK Health Centre to create a collaborative interdisciplinary team approach to primary health care. The provincial Collaborative Care Framework for Interdisciplinary Primary Healthcare Teams aims to clearly define the roles and expectations between and among the DHW, NSHA and IWK, and collaborative teams, so that people are engaged in the management of their own health and the contributions of all providers and staff are maximized.
Interdisciplinary primary health care teams work together and share responsibility for comprehensive and continuous primary health care for a group of patients. The team consists of family physician(s) and at least one other provider type. Early work involved the addition of new teams in communities of high need and extra resources for other teams to improve access to primary health care. In addition, the introduction of the Collaborative Emergency Centres (CEC) model enhanced access to primary health care as demonstrated in the evaluation.
A population-based planning approach using a metric calculation assists in determining the number and mix of team members needed to support community clusters. The DHW has a population-based planning framework and tool to support this work by providing data regarding the social determinants of health, social connections, and community-based resources. The planning metric continues to evolve. This will inform the need for family physicians as interdisciplinary teams are implemented or enhanced with other team members such as nurse practitioners, family practice nurses, social workers, etc.
Family physicians are the largest single group of physicians in the province making this work particularly valuable.
Postgraduate medical education produces specialized physicians who become part of a mobile national workforce. Nova Scotia recruits both new postgraduate trainees from Dalhousie Faculty of Medicine and specialist physicians in practice across the country.
The Medical Education Working Group makes annual recommendations for the number and mix of entry opportunities into postgraduate medical education in the Canadian Resident Matching Services (CaRMS) match based on forecasts of Nova Scotia’s needs over a ten-year period.
The Medical Education Working Group recommended the establishment of an additional community-based training site for family medicine in the Southwest area to bring the training of family physicians closer to anticipated d needs.
Work will continue on distributed medical education to make optimal use of community-based training and bridge community needs.
Physician Resource Planning has evolved from its initial stages and has been guided by the principles of population health needs, sustainability, quality, equity and system priorities.n It has now evolved to a stage where health service delivery planning will shape our future health human resource needs. As witnessed through primary health care planning, this system-wide, evidence based approach aids in forecasting needs across health professions, particularly in a team based environment. In turn, this helps our educational partners ensure they are training to meet the needs of communities today and into the future.