Environmental Scan - Government of Nova Scotia

−Physician Resource PlanningAn Environmental ScanInterventional cardiologists shadow-bill well above AFP incomes with the shift to twice the volumeof stenting procedures to coronary artery bypass procedures. Cardiac Surgery average billings arewell below Surgical AFP values. Primary provider of pacemakers and ICD device procedures remainscontentious between cardiac surgery and EP groups. EP is now doing 50% of pacemakers and ICDswith C/S the balance.• Outside Halifax−3 Cardiologists in Kentville, 1 in Bridgewater, 2 in Sydney (just lost 1), 2 at Dartmouth General (FFSmodel not under AFP). None in Truro and Antigonish where GIM covers the cardiology service.• Infrastructure−−−EP Studies - major expansion with 2 new EP labs in last year. Do not have funding to staff full-timefor skilled nursing and x-ray staff. 1 of new EP labs will only open 1 day/week.Realities of infrastructure constraints impact access to services, i.e., access to booking rooms, examrooms, and secretarial support.Cardiac catheterization laboratories are appropriate and of sound quality.• Interventional Radiology−Have an active Interventional radiology group but cardiology has very little interaction. They do verylittle carotid stenting. Surgical intervention is performed by cardiology. Peripheral vascular work isdone by interventional radiology along with vascular surgeons.• AFP and Innovation−−−Does not see AFP as funding innovation.Multiple other ways could utilize allied health professionals but 'shadow-billing' constrainsinnovation e.g. CDHA has set up a heart function clinic for complex CHF but is seen by a nurse andnot seen by Cardiologist.Recently set up a Nurse Practitioner run clinic where a specialist briefly sees the patient; preliminaryfeedback is very positive at QEII• The Future−−−−Expect specialists to be hybrid trained e.g., vascular surgeons with catheter skills; need hybridtrained specialists for heart procedures including percutaneous valve and percutaneous implant ofaortic valves i.e., teams of Cardiac Surgeons and Interventional CardiologistsFewer conventional cardiac surgeons and more with hybrid skills (no current Canadian Fellowshipfor hybrid skills for IVC).Stenting is starting to plateau nationally however diabetes, obesity and aging will continue to driveinvasive procedures.Need to fix patchy access to cardiology consultation with better distribution across province.17.8 Emergency Health ServicesMedical Director InterviewPROGRAM OVERVIEW• Builds on a natural partnership between physicians and paramedics146 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011