DIGBY, N.S. – The Digby General Hospital site manager admits challenges exist. However, his primary concern is recruitment – and he’s worried about how negative media could damage those efforts.
“There is a risk of becoming blind to the reality of what we have if you only choose to focus on the negative,” Hubert d’Entremont says. “That goes the same if we only focus on the positive. So from a health authority point of view, yes, we are saying there are some positives happening here. However, we are very, very aware of the other requirements that are not so positive.
“So yes, it’s important to remind the public progress is being made. Are we there? No. We clearly recognize that. We recognize the need for additional health resources, but also it’s important to put into perspective that we have good people here who are working hard and that we want more good people to join us.”
D’Entremont says there is a health-care professional recruiter assigned to the Digby area. However, looking at the NSHA website, that recruiter is also assigned to half the province. What both d’Entremont and Fraser Mooney, public engagement and communications officer for Digby, Shelburne and Yarmouth for the Nova Scotia Health Authority, readily admitted is that communications with the public is an area of focus for improvement.
“Through the restructuring of the former health authority into the NSHA, there have been some things that have been lost and perhaps those include some of our connections with our local communities and with our municipal governments,” Mooney says.
Mooney describes the stakeholder group that meets regularly and while no members of the public are part of that group, Mooney says they are represented through their elected officials.
The stakeholder group includes Digby Mayor Ben Cleveland, Municipal Warden Jimmy MacAlpine, MLA Gordon Wilson, a representative from both Weymouth and Bear River, several NSHA staff and the chair of the Digby and Area Health Services Charitable Foundation, Neil Nichols.
“What we’ve found with that group is that it’s been quite positive in sharing information and, quite frankly, we’re hearing from our stakeholders what some of the concerns are in the community,” Mooney says, adding that NSHA is now taking that Digby-based stakeholder meeting model into other areas, including, as of last week, Shelburne.
Mooney says they’re also now more willing to discuss the challenges they’re facing with the massive transition from regional health authorities to a provincial one and the more specific challenges they’re facing in Digby.
“I think we need to be realistic about the challenges we have,” Mooney says. “And we have challenges – challenges in staffing, physician recruitment, recruitment of others as well – and that creates problems with accessing services. However, I think we also want to help people understand that there are a lot things happening … people are still seeing the challenges from the last number of years, but they also need to know that is all stuff that we’re working on.”
D’Entremont says he is concerned about the negative messages having the potential to harm the recruitment efforts.
“If the overall message is, throughout the community, throughout the province, throughout the country, with this current world of communications, that everything is bad here in Digby, then we will have a major challenge in recruiting anybody to come here, and this has been expressed by our municipal leaders as well,” he says. “Are we denying that we have a lack of resources, not at all. But if the daily grind is negative, our challenge at attracting someone from the outside is going to be monumental.
“The simple fact that we’re recruiting means we need help, but let’s acknowledge that we are making progress . . . basically, since September, we are in a better place. Are we in a great place? Well, we have some areas we are still actively working on, but one of our biggest challenges is that we are swimming against a huge, huge current of negativity.”
The issue, both men say, is in attracting health-care professionals to rural Canada, not just specifically to Digby.
“That is a challenge of rural Nova Scotia, and rural Canada,” Mooney says.
D’Entremont says the issues go beyond the rural nature of the community, however, they come back to the workload that individual doctors have attempted to take on in the past.
“The amount of work for an individual has been a factor identified by previous providers, who, on their departure, have said, ‘This is a beautiful place, (but) the challenge to have a work-life balance is significant,’ and therefore they have taken the opportunity to relocate to an area that offered something different.”
Mooney says he’s excited about the new collaborative team that is already in place and how it addresses that piece of the puzzle.
“Dr. David LaPierre has this enthusiastic energy,” Mooney says. “In the short time he’s been here ... he brings energy and enthusiasm to engaging, not just the members of the team, but he’s also looking to engage the community. I’m really enjoying working with the members of this team, it’s quite a refreshing change.”
Mooney also says there are no barriers in place to recruiting a doctor for Weymouth.
“We took a real hard look at how we were going to best provide service to the community of Weymouth and the people in the area, knowing the difficulties we’ve had in recruiting a single, sole practice doctor, so there was talk about including the Weymouth area as part of the collaborative team that’s being created here in Digby.”
However, Mooney says that after consultations, that idea evolved into the removal of restrictions on a solo practice physician who could choose to operate within the new collaborative practice if so desired. Mooney says that active doctor recruitment for Weymouth is ongoing and that the recruiter looking after the Digby area has also met with Weymouth-based stakeholders.
“We’ve had to look at what we can do differently,” says Mooney. “Just the fact that this team is working together as a collaborative team, that’s a relatively new concept for Nova Scotia … to have that kind of collegiality is really attractive for providers.”
In a previous meeting, Digby’s site lead placed the list of services still available in Digby on the table – it’s a long, comprehensive list created as a hospital tour, and includes the continuation of diagnostic imaging and laboratory services.
Mooney states clearly that he knows of no plan that NSHA has to remove further services from the Digby General hospital and the hospital is to remain open.
“When we’re talking about some surgeries or obstetrics in a smaller rural hospital as opposed to a regional hospital like Yarmouth, there are quality and safety issues that we need to consider when offering those services,” Mooney says. “There is a mix of programs and services that are offered here, as well as visiting consultant clinics available here. Geographically, there is a necessity to maintain a general hospital in this area with a 24/7 emergency department, but of course, as you understand, there are still sometimes challenges in staffing that all the time.”
When he speaks of safety, Mooney says the province’s health service must undergo a regular, national standard, accreditation service.
“Patient safety and safe patient services are a cornerstone of that,” Mooney says. “And it also comes down to a sustainability piece.”
D’Entremont explained further that in the past, for example, obstetrics were provided by family physicians who had back-up from a general surgeon – and that situation no longer meets national criteria for safety – now there must be an obstetrician available as back-up.
“That service is gone because of the safety issue,” d’Entremont says. “The standards have changed.”
Mooney adds that as the national standards change, the NSHA has to prove they are meeting those standards. Mooney also said the province’s investment in a renal dialysis unit points to a significant investment in the hospital and in Digby.
“When the premier was here last year talking about the dialysis unit, that was a point that was made. This is a significant investment in the Digby hospital and an investment in maintaining services here, so I’m inclined to believe that is the case.”
The language NSHA uses about closing that emergency department is “physician availability” and questions have been asked about that language and if it places the blame on the doctors.
Mooney responds: “That language has evolved quite a bit over the years – at one time, we would just say it was closed without giving a real explanation – and I think that wasn’t fair to the providers or to the public either… as opposed to blaming, we really want to thank the physicians and the entire emergency team … I know when there is a closure, Hubert and the other team members are working right up until the last minute to find somebody. We look provincewide to find a locum to come in. Every stone is overturned.”
D’Entremont says one of the outcomes of those emergency department closures has been an increased demand on the 911 system. He has a background in paramedic work and leadership, helped set up the current EHS provincewide system, and he speaks highly of the fully accredited “high-performance model” pre-hospital system Nova Scotia has.
“The community is very fortunate that we have the type of system that we have,” d’Entremont says. “One challenge is, over the past years, the call volume has increased, but the number of vehicles and the number of teams has not.”
D’Entremont calls that pre-hospital emergency system “a safety net” especially helpful if the emergency department is not open – and soon a piece of that system will be integrated into the Digby Hospital emergency department in an interesting response to the longstanding problem with closures due to a lack of available physicians.
“Paramedics will be added to the staff complement at our hospital as well,” d’Entremont says. “We’ve had the interview process and the next step is to do the hire so that paramedics will be in the emergency department. Their role will be to triage but also because the posting was related to advanced care, the paramedics will have a wider scope of practice.”
D’Entremont explained the job description for those roles had been put together by a team of nursing staff and physicians to identify what exactly the scope of that role would be, and he’s hoping that inclusion will allow the emergency department to remain open. D’Entremont says it’s a model that has been used successfully by the QEII in their emergency department.
“For a long time, if you presented at the emergency department at the QEII, the triage person will not be a nurse, it will be a paramedic. I think that’s the way it’s still set up,” he says.
Mooney says the paramedics will work for both EHS and for NSHA, while d’Entremont says because of their shift work, they have availability on their days off, although the hospital site lead was not clear on a start date.
“The paramedics have a very rigorous continuing clinical education program,” says d’Entremont. “They are a great resource, so the community relies on that service especially in emergency situations and now, more and more, in non-emergency situations,” he adds, speaking to the increasing practice local citizens have of calling 911 to have their health situation assessed by a paramedic.
One Digby County resident, who chose not to be identified, has said: “That’s what everyone does now. We just call 911. The paramedics know everything, so they can tell you if you need to go to the hospital or not.”
Mooney says it’s clear that’s not what the system is designed for.
“I’ve not heard that specifically … that’s not the optimal use of the system, but it’s interesting. We’ll have to discuss that with our friends and partners at EHS.”
Mooney also promised communications with the community will be improved, and will include a series of community conversations and possibly a regular newsletter.
“Prior to Christmas, the primary health-care program started a community consultation process … and now in 2018 we’re going to expand that into what we call community conversations, and I know there is one scheduled for Digby,” Mooney says. “We certainly have heard that we’re not doing enough talking with people who are accessing our services and who have a stake in high-quality services so we understand that and we want to do that better.”
Despite the ongoing challenges, both Mooney and d’Entremont remain positive about the future.
“The patient is the centre of the health team and we understand that better now than we ever did, and we have a new breed of health-care providers now and their eagerness and input is helping us to move that idea forward,” Mooney says.
D’Entremont adds a similar sentiment.
“We’re not there yet, but at the same time, there are very great advances, and that is very exciting.”
SEARCHING FOR DOCTORS
There is one current posting for a family physician in Weymouth on the NSHA website listed under the heading Physician Opportunities. However, the list of opportunities contains at least 138 postings, some of those with multiple positions attached to a single advertisement, in communities ranging from Barrington to Truro and right on up to Sydney, with the positions varying from family physicians to psychiatrists, radiologists to anesthesiologists, to name a few.
While both Fraser Mooney and Hubert d’Entremont said physician recruitment is a rural issue, there are also vacancies posted for family physicians or other health-care workers in Halifax, Dartmouth and Truro.
While the new local doctors in Digby have said they could use at least three more doctors to expand their Digby-based team, the NHSA list appears to have only one physician opening specifically for Digby. There are also more than 300 other health-care jobs posted on the NHSA site that include every position from lab technicians to nurse pracitioners.
The list of open positions on the website is not alphabetized or prioritized, contains some grammatical errors, focuses on tourism-based language rather than community specifics or need, and appears to demonstrate an overwhelming need for health-care workers right across the province.