Nicole Stewart is eagerly anticipating meeting her third baby in August. But a letter sent to at least 65 expecting mothers in southwest Nova Scotia this week has her concerned about her upcoming birth.
“It’s definitely stressful,” said the mother to two daughters and a step-son.
The letter says due to a shortage of anesthesiologists “there may be times over the next few months when it will not be possible to deliver babies or perform some surgeries at the Yarmouth Regional Hospital.”
“Pregnant women who feel they need care are asked to CALL the Women and Children’s Health Unit before coming to the hospital.”
The letter goes on to say that women may be directed to a hospital for care. But the only options are in Kentville, N.S., — a drive of nearly two-and-a-half hours — Bridgewater, N.S. — a more than two-hour drive — or Halifax — more than three hours.
“Babies will not be delivered here without anesthesia present, except in cases where transfer to another hospital is unsafe or unfeasible,” according to the memo.
Stewart used to live in the small rural community of Advocate Harbour, N.S. and says she was just over two hours from the nearest hospital when both her daughters were born. She was excited to be about 10 minutes away from the hospital this time.
“My first pregnancy I didn’t really know what to expect, so I drove to the hospital in labour — a two-hour drive to the hospital in labour,” she said. “The second time around I had a little bit more support and I knew what to expect, so I camped out in Truro so I was a lot closer to the hospital.”
The 28-year-old says she’ll likely head to Halifax the week of her due date this time around, just to be safe.
“But that’s wrong, what if you can’t afford that?” she said.
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The Yarmouth Regional Hospital usually has a complement of four anesthesiologists. One left in the fall, and two more in January.
As a result, the Nova Scotia Health Authority (NSHA) immediately cut back operating room time for visiting physicians, cancelling more than 100 surgeries between January and March. These are elective procedures, things like dental surgeries and vascular, urological and orthopedic cases. The NSHA says urgent cases are a priority.
But with only one full-time anesthetist to deal with the most urgent cases and locum anesthetist covering emergency cases, it’s impossible to say how many patients have been affected. On top of the 100-plus cancellations are dozens of surgeries that were simply never scheduled, and physicians say it means the wait lists for those elective surgeries will continue to grow.
“If somebody’s been waiting for their hernia repair for a while, and you know, off work for it, that’s the type of patient who’s really being affected right now,” said Dr. Joe Gillis.
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Gillis is a family physician who’s been practicing in Yarmouth for three years. He also works as a hospitalist in the Yarmouth Regional and covers labour and delivery. For now, he says he’s trying to reassure his pregnant patients as best he can.
“If we are to lose that service for any period of time, be it a day or a week or whatever, you need to look at other options for some of the patients and that becomes difficult,” he said.
The health minister says he was “caught off guard and surprised” by the memo the NSHA sent to patients.
“The intent seems to be, to be proactive for potential risks,” he said. “But I want to be clear, the information I’m receiving is that the coverage is there and sustained for the next month.”
Longer-term solutions are in the works, NSHA says
The NSHA says it is working on solutions to the problem.
One anesthetist it has been recruiting for Yarmouth is working through the immigration process and is scheduled to take exams in Canada at the end of April. It’s not clear when he could actually begin work.
According to the NSHA, there is anesthetist coverage for emergencies until the end of May. Those locum physicians are coming from other parts of the province or other parts of the country.
The shortage is not limited to Yarmouth. The NSHA acknowledges there is at least 16 full-time equivalent (FTE) vacancies in anesthesia across the province, although a spokesperson said the situation is fluid and it’s impossible to say how many physicians it needs to hire. There are about 130 FTEs provincewide.
“We’re actually substantially short in Yarmouth, and in basically every other regional hospital we have at least one other vacancy,” said Grayson Fulmer, the NSHA’s senior director of medical affairs.
“The QEII, the tertiary care facility, they cover multiple hospitals and they actually have a shortage in the academic centre of anesthetists as well.”
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Dr. Gillis says moving locum coverage around the province is “like robbing Peter to pay Paul.”
“Taking an anesthesiologist out of their facility to come to ours, you know we really appreciate it but we also understand the difficulties that they face in terms of maintaining their surgical wait lists and things like that,” he said.
“So it’s really not a great situation for anybody in the province.”
The health minister says he’s in discussions about allowing family physicians with advanced training to work as family practice anesthetists, something that is done in other provinces.
The NSHA is working to develop a program to streamline the immigration process. Fulmer says they and the Nova Scotia College of Physicians and Surgeons are finalizing details and funding for a “practice-ready assessment” program for international medical graduates who are not from a jurisdiction where their training is recognized by Canadian licensing bodies.
“The way that practice-ready assessment program works is we bring in international medical graduates, they’ll work in the Canadian context for three months and be evaluated on their skills,” Fulmer said.
But funding has not been secured from the province yet, and there’s no indication of when it may begin.
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Frustration with the NSHA’s recruitment process
Dr. Gillis says since the creation of the NSHA, there has been an erosion of local recruitment processes. There’s a sense that communities used to have some autonomy in recruiting physicians to their area, and that has fallen off with the merger of the health authorities.
“I was recruited very quickly as soon as the local recruiter realized that there was a local girl who was dating a med school student,” he said.
“And you know I can rhyme off five or six docs who are here now because of the localized recruitment that used to be.”
Fulmer calls it a “bit of a growing pain” for the health authority.
“We took the feedback to heart, from our physicians, from our community members, and we made changes to try to address and better respond to their concerns going forward,” he said.
“There’s still a lot more work to be done in ensuring that we’re functioning well and working collaboratively.“
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