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David ZitnerThe latest missive from the Nova Scotia Health Authority (NSHA) – sent to some doctors but not to the community at large – acknowledges the responsibility of the health authority for the sad state of primary care.

In an April Department of Family Practice Update we see a development that imposes a costly and inefficient administrative burden on all Nova Scotians.

An objective of the Department of Family Practice is to ensure access to primary care.  The health authority writes, “The department’s purpose is to understand and co-ordinate the activities of the more than 1,000 family physicians practising within the health system, ensuring that Nova Scotians have access to the primary care.”

One imagines that co-ordination ought to be about maximizing access instead of curtailing it. Unfortunately, the Department of Family Practice follows with proposals that will decrease the already-limited access Nova Scotians have to primary care physicians.

The health authority’s proposal is consistent with previous harmful actions that continually make care and access to care worse for patients.

The NSHA seems to have the inexplicable belief that increasing the administrative burden on clinicians won’t decrease the time available for care.

The specific proposal from the health authority is to create 14 network councils with representation from every community. The authority notes that “serving as a council member is an excellent opportunity [for physicians] to connect with colleagues.” No loss of income is contemplated because “time and travel costs are reimbursed for participating.”

Instead, the already burdened system and the frustrated public will be the losers.

There’s already a shortage of doctors available to see Nova Scotia patients. Now, the time these doctors spend connecting with colleagues and travelling will take them away from patient contact and care.

The health authority essentially places an additional burden on communities by proposing regular Department of Family Practice network meetings across the province.

The authority, with no seeming oversight from the N.S. Department of Health, has hired 12 physicians as “network leads” in paid positions, asking each to take half day a week of clinical time from communities that are suffering. And two more physicians are sought to add to these 12.

The N.S. government, as regulator and evaluator of care, is silent. The government has said it would reduce the administrative costs, which it identified as a burden on healthcare. Yet the NSHA has been empowered to take valuable clinical time from communities and develop 14 physician networks. Did the NSHA and provincial government mean to develop 14 networks to replace or compensate for the former nine districts in the province?

The public needs better solutions. Health care represents 45 percent of the provincial budget and education gets 14 percent. The government divides the remaining money between 19 other departments. Nova Scotia elections have recently focused on healthcare and who will run health insurance.

Nova Scotians expect better solutions. We expect the government to comment on the state of health services management, to indicate when it will accept its responsibility for healthcare governance and oversight, and to indicate its plan to reduce the continuing decline.

David Zitner is a retired family physician and is senior health policy fellow at the Atlantic Institute for Market Studies (

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