Environmental Scan - Government of Nova Scotia

Physician Resource PlanningAn Environmental Scan• Adult Endocrinology and Metabolism has a significant workforce shortage which makes it difficult toprovide provincial leadership to diabetes management. In the last year Endocrinology and Metabolismhas sent the message that they can no longer accept referrals (except new diabetes or persistent HbA1C > 10 level). The leadership will need to be in a particular area since the general overall programmanagement is going very well through the Provincial Diabetes Centre Management Model. TheProgram is regularly invited to speak across Canada.• Adult Endocrinology and Metabolism – none of the six remaining subspecialists are sub-specializing indiabetes• Alternative Funding Plan – there is a perception that productivity may have declined by Endocrinologyand Metabolism• GPs are well aware of guidelines and good knowledge. Best local knowledge is with GPs and GIM17.7 Cardiovascular HealthProgram Director InterviewPOPULATION NEED• Need for dialogue between GNS, medical leadership, DHAs on CV health resource planning• Market forces drive current availability/distribution of CVH specialists, both FFS outside Halifax and AFPin Halifax i.e. echocardiography.• CV Health service delivery planning and provision is patchy across the province.• Access to Services:−−−−−PHYSICIAN SUPPLYElectrophysiology (EP) ablation (atrial especially) wait list is very long.Follow up needed re- Implantation (pacemaker, ICDs) – 50% cardiac surgeons, 50% InterventionalCardiologists, catheterization, angiograms, angioplasty (PTCA/PCI), and stenting wait times.Echo/Telemetry/Holter - majority of general cardiology consultation is channelled through QEII butFFS doesn't not allow echo testing or treadmill testing in a private office i.e., must be performed inhospital. Hence no one is setting up a private office, as it is not economically viable. Routineconsultation to Halifax residents has to happen with QEII and Dartmouth consequently theechocardiography wait is 4-6 months. Treadmill and holter monitoring waits are 2-3 months.General consultations – access is a challenge i.e., FFS remuneration considered to be inadequate fortime and intensityGeneral Comment – It is often easier to see a specialist but then have to wait for a diagnostic test(e.g., echo, treadmill, holter). Suggested need to grant access in private offices to includeappropriateness criteria to 'govern/manage' volume.• In Halifax− General Cardiology – 26 full-time who also provide majority of echocardiography services− Interventional Cardiology – 7 full-time with plans to go to 8− Electrophysiology (EP) – 5 full-time− Cardiac Surgery is an evolving specialty with rapidly developing less invasive techniques. Dialogue isneeded with this group to contemplate the possible excess physician resources145 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011