Offering doctors financial incentives to take on additional patients was right prescription, Thompson says

Nova Scotia’s health minister lauds as successful the province’s plan to offer family physicians monetary incentives to take on additional patients.

“We have about 59 physicians who have signed up and that has resulted in 4,700 patients and their families coming off the list, and it’s important to note that these are patients who particularly have complex needs,” Michelle Thompson told reporters after a cabinet meeting Thursday.

In late June, the Health Department announced the program to help match people with a primary-care provider.

Eligible physicians who accepted 50 patients with higher needs from the Need a Family Practice Registry, the list that Thompson referenced, were to receive $10,000 from the province. Every additional patient accepted beyond the initial 50 would land the physician an additional $200.

Physicians had from July 1 to Oct. 31 to apply to participate.

The 50 patients with some of the most complex care needs were to be selected by Nova Scotia Health and the participating doctors still have until Dec. 31 to ensure that the new patients have joined their practice.

“We’ve updated the ability of people to tell us a bit more about their health conditions so there have been 4,700 people taken off the list as the result of that initiative,” Thompson said “They (physicians) do have until the end of the year in order to make sure folks are on board and into their practice. So we do have some more to tell you in January.”

Registry upgrade

To facilitate the transition of patients waiting care on the registry to the new incentive program, the Need a Family Practice Registry went through an upgrade at the time of the June announcement.

Anyone who joined the registry after that point could fill out a health-status questionnaire that became part of their registry profile. Those already on the list were contacted to add their health status but they could also voluntarily update their status online or by phone.

Patients on the wait list were strongly encouraged to update their information but it remained completely voluntary.

The profile allowed the department to share health information so patients could access the care they needed in their community while they waited to be matched with a provider, the minister said in June.

It also helped determine what patients would be attached to doctors to take advantage of the new incentive program.

In introducing the incentive program, the department said it would not change how people on the registry are matched with a primary-care provider outside of the incentive plan. The registry continues to be organized by community and people are listed in chronological order based on when they registered.

“We are really pleased, and to have 4,700 people come off the list (now) attached to physicians, those with the most complex need, I think is very successful,” Thompson said. “It’s one lever, it’s one thing that we’re trying so I’m very grateful to the physicians who stepped up to be able to help us.”

As of early June, there were 148,431 people on the need primary care registry, which fell to 146,451 by Nov. 1, according to the province’s Action for Health website.

The early November number, however, represented 14.8 per cent of the province’s population who were not attached to a primary-care provider. The 146,451 November number was up 1,984 people or 1.4 per cent from Oct. 1.

Wait times

The good result Thompson trumpeted was offset by an annual Fraser Institute report published Thursday, a survey of physicians across 12 specialties and the 10 provinces that documents the queues for visits to specialists and for diagnostic and surgical procedures in Canada. 

In 2023, the physicians reported a median wait time of 27.7 weeks between a referral from a general practitioner and receipt of treatment, representing the longest delay in the survey’s history. The delay is 198 per cent longer than the 9.3 weeks Canadian patients could expect to wait in 1993.

Overall, Nova Scotia reported the longest wait in the country at 56.7 weeks while Ontario reported the shortest wait at 21.6 weeks.

The 27.7-week total wait time that patients face included a 14.6-week wait from a referral by a general practitioner to consultation with a specialist and a 13.1-week wait from the specialist consultation to treatment.  

Thompson was not too concerned about the survey.

“The data that we would use to inform our decision making would be the data we actually have in our system,” Thompson said. “That survey was simply that. It was a survey of a cross-section of physicians from across the country but we actually use the data we collect through Action for Health and it’s available on the website. We know that we’ve seen some really good progress. As an example, our surgical waitlists and coming down. We’ve done an additional thousand surgeries this year over our baseline year in 2019.”

The minister said an additional 400 endoscopies were done in Nova Scotia this year and there’s been an infrastructure upgrade at the Dartmouth General Hospital.

“There is more to do but we’re pleased with what we’ve seen,” she said.