Doctor forced to reduce patient load
A New Glasgow doctor is being ordered to drop almost 2,500 of his nearly 4,000 patients as new restrictions were put on his license to practise, exacerbating an already short supply of family practitioners in the county.
Dr. Emmanuel Rivera offered no explanation for the change to his practice in letters he started sending out in mid-February to patients he was releasing from his care.
Patients worried about potential misconduct hit the College of Physicians and Surgeons of Nova Scotia with a barrage of questions. It responded by posting a statement on its website on Friday saying Rivera, who started practising in the province in 2014, failed to meet the mandated five-year timeline to attain a full licence.
Pattie LaCroix, director of communications and policy for the regulatory body, said the curbs on Rivera’s practice aren’t the result of a disciplinary decision.
His request for more time sparked an automatic full assessment of his practice that led to restrictions, including the reduction to a maximum of 1,500 patients, a requirement to practise under supervision and no emergency department, intra-partum obstetrical and inpatient hospital care.
Specifics on what warranted those changes, however, won’t be made public.
“Dr. Rivera is owed a measure of privacy, and as such the details of that decision including the reasons remain confidential,” the College of Physicians and Surgeons said.
Rivera, a 2006 graduate of Cagayan State University College of Medicine and Surgery in the Philippines, inherited the large practice with the retirement of long-time GP Dr. J.G. Forbes from the Westville Medical Clinic. After a stint there, Rivera put up his own shingle in the Lawtons Drug Store building across from the Aberdeen Hospital.
Nova Scotia’s 811 service for patients seeking to get on a wait list for a family doctor was already inundated with calls and email registrations from Pictou County before Rivera started notifying more than 2,000 of his patients that they won’t be among the 1,500 he’s allowed to keep.
As of Feb. 1, the most recent statistics available, 4,941 people in Pictou County were waiting to get a family doctor, a jump of 678 from a month earlier.
That means just over 11 per cent of the county’s population is without a family doctor. For New Glasgow, Westville and Stellarton, it’s 13 per cent of the population, with an increase of 535 to 4,311. Pictou is just over six per cent, with 630 people looking for a doctor, up 143.
The figures don’t include people who haven’t added their names to the list, which matches up patients with doctors on a first-come, first-served basis.
Dr. Aaron Smith, who gave up his 2,700-patient practice at the Westville Medical Clinic in January for an executive role with the Nova Scotia Health Authority, says the province has close to enough doctors on a per capita basis. The problem is, outside of Halifax, not enough are primary care doctors setting up family practices, he says.
In the past six months, Pictou County has recruited six new doctors, but only one is practising family medicine.
“Primary care has been a huge challenge,” Smith told The Advocate. “It’s not just specific to Pictou County. It’s generally the case for rural Nova Scotia.”
In Halifax, three per cent of the population is on the doctor waiting list as of Feb. 1. In Dartmouth, it’s only 1.6 per cent. The Annapolis Valley, Colchester and the South Shore were worse off than Pictou County, with each at 13 per cent or more looking for a doctor. But Rivera’s reduced practice is poised to see the percentage here jump.
While wooing family doctors has been tough, Pictou County’s been a trailblazer on the recruitment front.
A physician-led group started a grassroots effort in the spring of 2018 to attract and retain healthcare providers and medical students.
They enlisted public relations pro Nicole LeBlanc as “project navigator” to steer the newly created Healthy Pictou County. Her job is to sell prospective doctor recruits and their families on the county and all it has to offer — and make sure they want to stay.
Smith says the group is a first and is now being emulated elsewhere, with other regions saying, “We need a Nicole LeBlanc.”
Smith and LeBlanc touted Pictou County’s success at a Thursday evening “TUC Talk” hosted by Trinity United Church in New Glasgow.
LeBlanc said in an interview after the event that, oftentimes, recruitment successes can’t be broadcast because of privacy concerns.
“The problem is, when you say a new doctor is here, people say, ‘Great. How can I get on the list?’”
LeBlanc, whose own husband has been looking for a doctor since Smith left his practice, says “it’s not easy for people” who are waiting. “But I think a lot of people aren’t aware of the efforts that are taking place.”
While lots more needs to be done, her ultimate goal is to work herself out of a job, she says.
Smith, who’s now medical executive director for the Northern Zone of Nova Scotia Health, says the days where doctors spent their whole career in a single rural practice have gone.
He’s an example himself. After 12 years at the Westville Medical Clinic, he says he opted for the Nova Scotia Health Authority job, in part because of the potential to have a bigger impact on the community.
“It was very difficult to step away,” he says.
He saw 2,700 patients on a regular basis and had many more “on the books” who’d come in less frequently.
It’s not clear how long Rivera will be working under a restricted licence.
Rivera didn’t respond to an interview request.
Dr. Brad MacDougall, family physician and president of the Aberdeen Medical staff, along with Healthy Pictou County Project Navigator Nicole LeBlanc attending the Dalhousie Family Medicine Residency Job Fair in 2019, speaking with 140 Dalhousie Family Medicine residents about what Pictou County has to offer. (Contributed photo)