In this pandemic year, the number of Nova Scotians waiting for a family doctor has grown

In a year when the COVID-19 pandemic has thrown a wrench in so many systems, it should come as no surprise that Nova Scotia has been finding it more difficult to match prospective patients to primary care practices.

As 2020 comes to a close, Nova Scotia Health's registry of people looking for a family practice has once again topped 50,000, almost entirely eliminating gains made in 2019.

The year started with 46,991 people on the wait-list — the lowest it had been in about 20 months. For the first few months of 2020, the number of people being matched with primary care physicians and nurse practitioners was on the rise, while the number of names being added to the list was shrinking.

But things changed after March.

The number of people finding family practices each month started trending downward, and by mid-year, it dipped below the number of new additions to the registry, and has stayed there each month since.

As of Dec. 1, there were 51,735 Nova Scotians on the list.

What's causing those trends is uncertain, according to the man in charge of the registry.

Matt Holland, Nova Scotia Health's manager of planning and development for primary health care, said given that things started changing around March — the month COVID-19 arrived in the province — the pandemic seems to be at least partly to blame. 

March is also the month when a provincial incentive program, which offered doctors $150 for each patient removed from the wait-list, ended.

"Both of those could very well have had an impact over the last nine months. But it's kind of hard to tell to what extent each one is having an impact," Holland said.

It's hard to tell, right now, but Holland said if the trends continue into 2021, the health authority would be searching for answers.

"Trying to figure out where some of those pressures might be coming from is really important. And I think, hopefully, going into the next year if we start to see the trend stick the way it is it will help us determine where we need to focus our efforts," he said.

In the meantime, Holland said the health authority is also trying to make sure people on the wait-list have access to primary care when they need it. He pointed to a list of 16 clinics across the province designated for people on the list.

Greater focus on health in 2020 

The head of Doctors Nova Scotia said the growth in the provincial wait-list underscores the importance of primary care.

"I think people are also much more focused on their health this year. And so people who up until now have sort of been like, 'Oh, I can get by with visiting a walk-in [clinic] here, there,' realize that they probably want to have a family doctor. And so they're recognizing the need and identifying it and seeking it out," Dr. Robyn MacQuarrie said.

She wasn't surprised that fewer people have succeeded in finding practitioners this year.

MacQuarrie, a practising obstetrician/gynecologist, is a proponent of virtual medicine — something the province adopted early in the pandemic and could maintain after — but she said added efficiency is not one of its benefits.

"My experience of virtual care would not be that I can go any faster. I think it's probably faster for the patient because they don't have to travel to my office, et cetera, but all the things that I'm responsible for when I see a patient [in person], I'm still responsible for in virtual care."

The shift to virtual care, she added, may even have limited the ability of doctors to take on new patients.

"I think adding somebody to your roster would be a pretty difficult thing to do, virtually, because so much of that initial review is listening to their heart, listening to their lungs, listening to see if that patient has a murmur," said MacQuarrie. 

"These are all things that family doctors would have documented in their chart. And so I think it would definitely be a challenge for them to onboard new patients virtually."

Doctor recruitment seemingly on track 

Despite 2020's travel restrictions, the number of physicians recruited to Nova Scotia does not seem to have taken a huge blow so far this year. 

The health authority reports doctor recruitment numbers following the fiscal year, Apr. 1 to Mar. 31, so numbers for the 2020-2021 reporting period are incomplete. But a snapshot of a little more than half the year, Apr. 1 to Oct. 31, shows the total number of family doctors recruited — 31 — is exactly half the total number from the previous 12 months.

It isn't clear how many of those doctors have actually started practising in Nova Scotia, and MacQuarrie said she's aware of some new recruits who've had to postpone their moves to the province.

Plus, typical recruitment efforts have been stymied in many ways.  

As MacQuarrie put it, the pandemic "limited things like site visits and social gatherings that we would normally do with recruiting people to meet the medical community."

Those limitations may not be borne out in the numbers, yet.