Is Halifax the real victim in Nova Scotia’s doctor shortage?

Walkin Clinics in Nova Scotia

In a series of posts at Turpin Labs, my favorite Nova Scotia blog, Bill Turpin has been throwing contrarian shade on the widespread assumption that Nova Scotia’s doctor shortage is worst in rural precincts. According to Turpin, the real problem is in Halifax.

Now you have to admire anyone who will promote the proposition that Halifax, with 43% of Nova Scotia’s population, is the true victim of  the doctor shortage, despite having 60% of the province’s doctors. To make this case, Turpin leans heavily on the Nova Scotia Health Authority’s March Accountability Report showing 44,158 residents of HRM who are without a family physician, compared to 41,877 in January. (The April report, just out, shows a further increase to 45,555.) Turpin says the problem is focused in Metro Halifax. He attributes it to, “the rural favouritism baked into our politics.”

I remain skeptical, and offer the following points to consider:

  • Halifax is rarely a victim of anything vis-a-vis the rest of the province. By virtually any measure—tax base, percentage of government spending, percentage of government-funded institutions, level of municipal services, per capita income, percentage of government employees, centralization of services—it is the lap of luxury when viewed from Dingwall or Diligent River. So expect push-back on the claim that, in this respect, Haligonians are victims of a cruel conspiracy.
  • “Halifax” covers a lot of territory, everything from the Waegwoltic Club to Ecum Secum. When Turpin cites unjust allocation of medical resources to a resident of Musquodoboit, he is highlighting an injustice in rural Nova Scotia.
  • What proportion of NS docs are specialists? What percentage of  specialists practice in Halifax? On an over/under at 78%, I’ll take the over.  When we most urgently need to see a doctor, chances are it’s a specialist, and chances are she’s in Halifax.
  • When we hear any statistic, we should always ask, “compared to what?” This is especially true when we hear a claim that NS has a “shortage” of something that, according to rigorous stats, we have more of, per capita, than any province in Canada. Here’s an essay question for extra points: “NS has more doctors per capita than any other province or territory, yet a shortage of doctors is said to be a crisis here. Explain.”
  • When I hear talk of a doctor shortage, I am reminded of the Halifax left’s obsession with pedestrian safety. We constantly hear that Halifax is uniquely perilous for pedestrians, that our drivers are rude and reckless. To anyone who has lived, walked, or driven in Boston or Montreal, this proposition is risible. For years I have joked with fellow come-from-aways about NS motorists’ habit of screeching to a halt the moment anyone on a sidewalk even glances at a crosswalk. So, again, “compared to what?” Tim Bousquet rigorously catalogs every unfortunate vehicle-pedestrian encounter in NS, but never provides comparative stats to other cities. Are we worse than average? Better than average? Who knows? Same for docs. Some comparative stats are in order.
  • Economists who track unemployment know zero joblessness is not a realistic goal. Sometimes people may be temporarily without jobs for worthwhile reasons. Likewise, the ideal doctor supply may not provide every Nova Scotian with a family doctor. Some people may choose not to have a family doc. Maybe they fear, or otherwise dislike, physicians. Maybe they find other ways to access medical care. Maybe they have never been seriously ill. How many people are without a family doctor in Ontario or BC or Saskatchewan? How many are without a doctor by choice or inertia? What would be a normal, non-concerning level of family-doctorlessness in NS? The answer is non-zero.
  • If you have no family doctor, what alternatives are there for accessing service? Answer in Metro Halifax: Cadillac services include 18 seven-day-a-week walk-in clinics and multiple emergency rooms. Answer in Rural NS: Bupkis mit kaduchas, mainly long drives to emergency rooms that are likely closed on many weekends and some weeknights. See the map at the top of this post.

There’s a reason rural eyes roll when Halifax whines.

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