Nova Scotia’s health-care crisis continues to crest. A sad path has led us here and it’s exhausting to be negative. So let’s move on to analysis and solutions.

Citizen groups are reporting the dire circumstances people face daily. Local solutions are evolving to meet immediate and short-term needs. Congratulations for these efforts. Margaret Mead’s words come to mind: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

Let’s consider the effects of action and inaction in respect to the plight of family doctors. What problems require immediate attention?

In 2017, 372 Nova Scotia doctors responded to a survey on burnout. Analysis of their answers found physical and psychological symptoms of burnout that interfered with their work. The study concluded the source of their distress was the basic institutional organization of their work, not poor work habits or ignoring self-care.

The “hamster on the wheel” model in which most family doctors practise is the unfortunate result of fee-for-service funding, whether in solo or group practice. Salaried jobs within a collaborative team have been represented as a better alternative. The Nova Scotia health authority and government have assured us this model works, but will need money and time to set up. Money has been earmarked and we are asked to remain patient while change takes place.

What is missing is a service model that can act as a bridge to help us while we wait.

The rate at which doctors are retiring or burning out is outpacing the rate at which they can be replaced or new collaborative centres set up. This has a domino effect on walk-in clinics, emergency rooms and all health services that depend on family doctors. People are stranded, whether they have simple or complex health-care needs.

Consider this: A full-time, fee-for-service doctor who moves to an APP salaried arrangement may be offered around $250,000. (Please remember, the cost of running a clinic, paying staff, retirement, sick time, disability insurance costs, vacation and pension all come out of this.)

However, what they’re offered depends, in part, on whether a doctor is considered full-time or part-time, based on their fee-for-service income for the previous two years, not hours worked or number of patients served. If they billed less than $250,000, they are only offered what they previously made.

But fee-for-service income has been decreasing, year upon year. That’s because, in the last 10 years, family doctors have reported they are unable to look after as many patients as they did in the past. Patients are more complex and require more time. After a visit, much work remains to be done. Burnout has also led to less productivity.

Yet new doctors who join a collaborative practice with no prior billing history are offered $250,000. Young doctors are watching with horror and sorrow as older doctors, who work 15-hour days, caring for older, frail, complex patients, are told they do not qualify as full-time doctors and are denied the salary new doctors are receiving. The inherent unfairness and lack of respect here continues to upset doctors in the province, young and old.

Another ugly truth is that, until recently, doctors retiring from group practices were not permitted to be replaced, leaving large overhead costs to be shouldered by a smaller group of doctors. Many of these are also older doctors, with large practices of older citizens. They can’t squeeze out any more work, which increasingly is not enough to pay for overhead. This is widely seen as a hidden strategy to move them from fee-for-service to salaried positions within collaborative teams.

Another inconvenient reality: doctors who have transferred to salaried positions also have full practices. They are now being pressured to take on patients from growing wait lists. They are already working superhuman hours and recognize they are burning out. They worry they won’t have time for retirement or a family to return to. They are distressed that, when they can no longer work, their patients will be instantly orphaned.

So let’s consider some solutions:

The NSHA, Doctors Nova Scotia (DNS) and Health Department must work out how to relieve stress on doctors, whether in solo practice, group practice or APP salaried positions.

Doctors need to be paid for the work they are doing. Pay should not be based on NSHA statistics.

DNS and the College of Family Physicians of Nova Scotia are in the best position to pull together a task force to connect with each doctor and, with due privacy, sort out what each needs to remain afloat. The next five years depends on it.

For some doctors, there is an urgent need for locum relief to provide one to three months off to recuperate.

For others, there is urgent need of mentorship from experienced doctors to help care for complex patients who have been without a doctor for up to four years.

Imagine a hub of experienced doctors offering mentorship and care — not full time, and not having financial responsibility for running a practice, but available to offer talent and support. This is an essential part of the urgent, five-year transition plan we need.

Meanwhile, we are waiting for the blended-care model that is intended to support office-based family practice. It is more equitable. And it would both recognize and pay family doctors for the hard and gruelling work they do.