Nova Scotia’s doctors ratify new four-year contracts

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The province’s doctors signaled they’re ready for change by approving two new four-year agreements with the provincial government on Nov. 25.

“These contracts begin to recognize the value of Nova Scotia’s doctors and will help to begin stabilizing some of the most vital services in our health-care system so that patients have better access to the care they need, when they need it,” said Dr. Gary Ernest, president of Doctors Nova Scotia.

The new agreements will help address several issues that affect the province’s ability to retain and recruit doctors, including more competitive compensation, physician engagement, physicians’ work environment and physicians’ right to representation.

Doctors Nova Scotia has been advocating for critical improvements in these areas so that Nova Scotia can become a place where doctors want to practise medicine.

The association has been able to make progress on all of the key recommendations it made with Maritime Resident Doctors and Dalhousie Medical Student Society in the 2018 report, Road Map to a Stable Physician Workforce.

Under these contracts, all Nova Scotia doctors will receive a 2 per cent increase in each of the four years of the contracts. In addition, there are targeted investments in five key areas: comprehensive primary care, emergency care, psychiatry, obstetrics and gynecology, and anesthesia.

“While the contracts don’t solve every problem in the system and they don’t make every specialty nationally competitive, we believe the contracts are a step in the right direction and an important investment in the future of our health-care system,” said Ernest.

The targeted investments support specialties that experience tremendous difficulty recruiting much needed physicians because other provinces offer more competitive rates.

Family doctors who provide comprehensive care, such as through office visits, emergency medicine, inpatient care and obstetrics/maternal care, will see a significant increase in pay, bringing their compensation to the top in Atlantic Canada. Community-based hospital inpatient care will be shored up through a new model for family physicians in rural Nova Scotia. As well, there is an investment to pilot a new blended capitation payment model for family doctors.

Specialists who practise emergency medicine, obstetrics and gynecology, psychiatry and anesthesiology will see an increase under these contracts to improve the province’s ability to recruit and retain to these essential services.

The Master Agreement also includes important improvements to physicians’ work environment. Government has made a commitment to support succession planning, allowing retiring and new-to-practise physicians the opportunity to overlap and work together so that there is a seamless handoff for patients and uninterrupted care delivery.

In recognition of the importance of training medical learners in communities around the province, physicians who mentor these learners, who previously were not paid – or were underpaid – for this work, will now receive more appropriate stipends for teaching medical students and residents.

Under this new contract, physician audits in Nova Scotia will become far less punitive and more focused on educating physicians about proper billing technique and documentation.

Through the contract, government has committed to reducing the administrative burden physicians have struggled with. Unnecessarily repetitive or cumbersome paperwork requirements, such as completing paperwork requested by government departments when arranging a locum to fill in for them during maternity leave or sick time, will be streamlined so that physicians can spend more time with their patients.

“We believe the contracts signal a new level of support for physicians from the government and the health authorities. We look forward to working more closely with government to continue making improvements in the system for all Nova Scotians,” said Ernest.

The new four-year contracts come into effect upon signing, which is expected to take place on Nov. 29, 2019, and will replace the 2015 Master Agreement and Clinical/Academic Funding Plan (C/AFP) agreements, which expired on March 31, 2019. The agreements impact 2,944 physicians.