Environmental Scan - Government of Nova Scotia

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27 APPENDIXPhysician Resource PlanningAn Environmental Scan27.1 Table of FiguresFigure 1 Nova Scotia Actual and Adjusted Population Forecast, 2010-2021 ................................................................................................ 12Figure 2 Relative #Physician Services Utilized by Age, Nova Scotia 2010 ..................................................................................................... 12Figure 3 Nova Scotia - Future of Primary Health Care .................................................................................................................................. 13Figure 4 Provinces - Population per Physician FTE, 2008/09 (Source: CIHI) ................................................................................................. 15Figure 5 National Growth (Number and %) in Postgraduate Positions (2000/01-2009/10) - Generalist & Non-Generalist Disciplines ....... 16Figure 6 Percentage of Canadian-trained physicians practising in the jurisdiction where they graduated from Medical School, 2009(Source: CIHI) ................................................................................................................................................................................................ 17Figure 7 National Ratio: cumulative growth of #M.D. graduates compared to cumulative growth in population - Actual 1990 to 2009,Estimate 2010-2021...................................................................................................................................................................................... 18Figure 8 Estimated Net Difference Nationally between Annual Physician Need and Supply ....................................................................... 19Figure 10 Population and (demand-based) Physician FTE Change, 2010 to 2022 ........................................................................................ 19Figure 9 Physicians by Province paid partially and mainly through alternate payment methods, 2008/09 (Source: CIHI) .......................... 19Figure 11 Ten-Year Provincial Population Forecast (Source: NS Department of Finance ............................................................................. 21Figure 12 Number of FTE by Physician Category by DHA/IWK, 2009/10 (Source: NS MSI) .......................................................................... 22Figure 13 Population per Physician FTE, 2009/10 (Source: NS MSI) ............................................................................................................. 23Figure 14 CPSNS - Register Change 2006 to 2010 ........................................................................................................................................ 23Figure 15 Percent Above/(Below) the provincial average population per 1.0 Generalist FTE, 2009/10 ...................................................... 23Figure 16 Provincial ratio of population per FTE by Functional Specialty, March 31, 2010 (Source: PHReD) .............................................. 24Figure 17 Provincial Physician Utilization - Total Services provided by Age Cohort (Source: NS MSI) .......................................................... 26Figure 18 Provincial Physician Utilization – Relative Utilization of Services by Age Cohort (Source: NS MSI) .............................................. 26Figure 19 Supply Assessment Model ............................................................................................................................................................ 38Figure 21 Methodology – Data Model .......................................................................................................................................................... 39Figure 20 Population Need Assessment Model ............................................................................................................................................ 39Figure 22 Nova Scotia – Relative #Services utilized by age cohort (2009/10) (Source: Department of Health and Wellness MSI).............. 43Figure 23 Population per Physician FTE 2008/09 (Source: CIHI) ................................................................................................................... 47Figure 24 Percent of Canadian-trained physicians practicing in the jurisdiction where they graduated from Medical School, 2009 (Source:CIHI) .............................................................................................................................................................................................................. 49Figure 25 Net International Migration by Province, 2000 to 2009 (Source: CIHI) ........................................................................................ 49Figure 26 Health Quality Matrix - Health Quality Council of Alberta ......................................................................................................... 51Figure 27 Quality Domains - Physician Workforce ...................................................................................................................................... 52Figure 28 Nova Scotia - Future of Primary Health Care ................................................................................................................................ 57Figure 29 U.K. NHS - Change in proportion of consultations by provider ..................................................................................................... 59Figure 30 Veterans Affairs- Comparison of primary visit procedure codes, 2010* ...................................................................................... 60Figure 31 Collaborative Care - Cost comparison between Nova Scotia Current State and U.K. Model ........................................................ 62Figure 32 Nova Scotia - Hospital Admissions by Most Responsible Doctor Service, 2009/10 (Source: DAD) ............................................... 64Figure 33 Physicians by Province paid partially and mainly through alternate payment methods, 2008/09 (Source: CIHI) ........................ 67Figure 34 Alternative Clinical Payments by Payment Mode and Province/Territory, 2008/09 (Source: CIHI) ............................................. 68Figure 35 Provinces – FTEs per 1,000 Population (Source: CIHI) .................................................................................................................. 68Figure 36 Provinces - Population per Physician FTE, 2008/09 (Source: CIHI) ............................................................................................... 69Figure 37 Provinces – FTE by Specialty 2008/09 (Source: CIHI) .................................................................................................................... 70Figure 38 National PGME – Residents by Gender 2009/10 (Source: CAPERS) .............................................................................................. 70Figure 39 Field of Post-M.D. Training by Gender (2009-2010) ..................................................................................................................... 71Figure 40 FFS counts and FTE by Province, Gender, and Broad Physician Specialty, 2008/09 (Source: CIHI) .............................................. 72Figure 41 Nova Scotia – FTE by Gender - Actual province-wide 2009/10 FFS and Shadow-bill data (source: MSI and PHReD) ................... 73Figure 42 Physician Ratio of Counts and FTEs, 2008/09 .............................................................................................................................. 73Figure 43 Average Age for General Practitioners and Specialists by Province, 2009 (Source: CIHI) ............................................................. 74Figure 44 Post-Graduate Resident Positions - Change 2000/01-2009/10 .................................................................................................... 75Figure 45 National growth (Volume & %) in Post-Graduate positions (2000/01-2009/10) by Major Category ........................................... 76Figure 46 National growth (Volume & %) in Post-Graduate positions (2000/01-2009/10)- Generalist and Non-Generalist Disciplines ..... 76Figure 47 DFM growth (Volume & %) in Post-Graduate positions (2000/01-2009/10)- Generalist and Non-Generalist Disciplines ........... 77Figure 48 National and DFM: Annual % change in Generalist/Non-Generalist Resident positions .............................................................. 77Figure 49 National Ratio: Growth of #M.D. Graduates over Growth in Population - 1990 to 2009 ............................................................ 78Figure 50 National Ratio: cumulative growth of #M.D. Graduates compared to cumulative growth in Population - Actual 1990 to 2009,Estimate 2010-2021...................................................................................................................................................................................... 78280 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental ScanFigure 51 Provincial physician workforce by DHA 2009/10 - M.D. degree according to location of medical school ................................. 79Figure 52 Provincial generalist physician workforce 2009/10 - M.D. degree according to location of medical school ............................... 80Figure 53 Net in/(out) migration by province, 2000-2009 ............................................................................................................................ 81Figure 54 National Enrollment 1989-2009, 1st Yr M.D. Entrants, and Year Practice Entry .......................................................................... 81Figure 55 Physicians Migrating within Canada Who Were in Canada on Both December 31, 2008, and December 31, 2009 ................... 82Figure 56 National Physician Survey, 2010, Average weekly hours of work ................................................................................................. 83Figure 57 National Physician Survey, 2003, Average weekly hours of work ................................................................................................. 83Figure 58 Nova Scotia Physicians ratio of Count to FTE by Gender (Source: MSI and PHReD 2009/10) ..................................................... 84Figure 59 CPSNS - Register Change 2006 to 2010 ........................................................................................................................................ 84Figure 60 Number and Percentage Change for Total Physicians, Jurisdiction, Canada, 1978 to 2009 ......................................................... 85Figure 61 Physicians, by Physician Type, Years Since MD Graduation and by Jurisdiction, 2009 ................................................................ 85Figure 62 10-Year Provincial Population Forecast (Source: NS DOF) ............................................................................................................ 89Figure 64 Visible Minority Population (Source: Statistics Canada, 2006) ..................................................................................................... 90Figure 63 Ten-Year DHA Population Forecast (Source: NS DOF) .................................................................................................................. 90Figure 65 Dependency Ratio – Interprovincial Comparison ......................................................................................................................... 92Figure 66 Interprovincial - prevalence of Chronic Disease – Comparison (Source: Statistics Canada and CIHI 2009 CHS) ...................... 92Figure 67 Interprovincial - prevalence of Chronic Disease – Comparison (Source: Statistics Canada and CIHI 2009 CHS)........................... 93Figure 68 Interprovincial - Self-Reported Conditions and Well-being – Comparison (Source: (Source: Statistics Canada/CIHI 2009 CHS) . 93Figure 69 Age Standardized rates (ASR) of Hospitalization for select conditions, 2009/10 (Source: CIHI) ................................................... 94Figure 70 Cancer incidence – National comparison of Female cancers (Source: Cancer Registry Canada, 2011) ........................................ 94Figure 71 Cancer – Canada incidence Trend in Females (Source: Cancer Registry Canada, 2011) ............................................................... 95Figure 72 Cancer incidence – National comparison of Male cancers (Source: Cancer Registry Canada, 2011) ........................................... 95Figure 73 Cancer incidence – National comparison of Male cancers (Source: Cancer Registry Canada, 2011) ........................................... 95Figure 74 Trends in New Cases and Deaths – Females, Canada, 1981-2010 ................................................................................................ 96Figure 75 Provincial & DHA diabetes prevalence population Aged 20+, 2008/09 (Source: NS Diabetes Care Program) ............................. 96Figure 76 Provincial prevalence of diabetes – 2004/05-2008/09 (Source: NS Diabetes Care Program) ...................................................... 96Figure 77 Provincial & DHA diabetes IR (per 1000) for the Population Aged 20+, 2008/09 (Source: NS Diabetes Care Program) .............. 97Figure 78 Provincial trend in Crude & Standardized Diabetes IR (per 1000) for the Population Aged 20+, 2004/05 to 2008/09 (Source: NSDiabetes Care Program) ............................................................................................................................................................................... 97Figure 79 Provincial trend in Ratio of Standardized number of GP Office Visits for the Diabetes Pop. Aged 20+ (Source: NS Diabetes CareProgram) ....................................................................................................................................................................................................... 99Figure 80 Provincial trend in the Ratio of the Standardized Number of Specialist Office Visits for the Diabetes Population Aged 20+(Source: NS Diabetes Care Program) ............................................................................................................................................................ 99Figure 82 New cases & incidence rate of CHF and ACS in DHAs (Source: NS Cardiovascular Health Program) .......................................... 100Figure 81 Location of Diabetes Centres in the Province (Source: NS Diabetes Care Program) .................................................................. 100Figure 83 Prevalence of End Stage Kidney Disease, 2009 ........................................................................................................................... 101Figure 84 Renal Program Treatment Statistics - 2008/09 & 2009/10 ......................................................................................................... 101Figure 85 Prevalence of a mental health condition (Source: 2002 CHS) .................................................................................................... 102Figure 86 Nova Scotia – Estimated prevalence of a mental health condition ............................................................................................ 103Figure 87 Provincial Physician Utilization - Total Services provided by Age Cohort (Source: NS MSI) ....................................................... 104Figure 88 Provincial Physician Utilization – General Practice Only - Total Services provided by Age Cohort (Source: NS MSI & S.Bill) ..... 104Figure 89 Provincial Physician Utilization – Relative utilization of services by Age Cohort (Source: NS MSI) ............................................. 105Figure 90 Alberta Physician Utilization – Relative utilization of services by Age Cohort, 2000 (Source: Alberta Health Care Insurance Plan).................................................................................................................................................................................................................... 105Figure 91 Impact of standardizing DHA populations for age/gender based differences in physician service utilization, 2005 & 2010(Derived from NS MSI & S.Bill) .................................................................................................................................................................... 106Figure 92 #Physician Services provided per FTE by Specialty by DHA (2009/10) (Source: NS MSI) ............................................................ 107Figure 93 # Services per Unique Patient seen on a FFS and Shadow-Bill basis per 1.0 FTE by DHA, 2009/10 (Source: MSI & S-Bill) ......... 108Figure 94 # Unique Patients seen on a FFS and Shadow-Bill basis per 1.0 FTE by DHA, 2009/10 (Source: MSI & S-Bill) ............................ 108Figure 95 Out-of-Province Hospital Admissions – Summary 2009/10 (Source: NS Hospital Discharge Data) ............................................ 108Figure 96 Out-of-Province Admissions to DHA9 and IWK Paediatrics, 2009/10, by Doctor Service (Source: NS Hospital Discharge Data)109Figure 97 Number of services provided in NS to out-of-province patients, 2009/10 (Source: MSI & S-Bill) .............................................. 110Figure 98 Home Residence of all patients seen by IWK Department of Paediatrics, 2010/11 ................................................................... 110Figure 100 Number of patients seen in travelling clinics outside Halifax, 2010/11 (Source: IWK) ............................................................. 111Figure 99 Travel Clinics by Division 2005/06 to 2007/08 (Source: Postl Report, Jan/11) ........................................................................... 111Figure 101 Services to Out-of-Province Patients provided at the QEII/Halifax Infirmary Health Campus, 2009/10 (Source: MSI & S-Bill) 112Figure 102 Physician Utilization - Inter-DHA- Resident Net (Export)/Import of Services 2009/10 – Payment Summary (Source: NS MSI)113Figure 103 Physician Utilization - Inter-DHA- Resident Net (Export)/Import of Services – General Practitioner Payments (Source: NS MSI).................................................................................................................................................................................................................... 113281 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
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3 KEY OBSERVATIONS3.1 IntroductionP
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KEY OBSERVATIONSPhysician Resource
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4.8 Methodology Guiding PrinciplesP
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ContextooPhysician Resource Plannin
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7 CONCEPTUAL MODELS7.1 Methodologie
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7.4 BenchmarkingPhysician Resource
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Figure 23 Population per Physician
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8 NATIONAL ENVIRONMENT8.1 Quality o
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All communities in all LHAs:oo−
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9.5 Canadians Studying AbroadPhysic
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Figure 53 Net in/(out) migration by
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9.7 Worked HoursPhysician Resource
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11 POPULATIONPhysician Resource Pla
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INCIDENCEPhysician Resource Plannin
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PHYSICIAN SERVICESPhysician Resourc
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12.5 Renal DiseasePhysician Resourc
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−−−−−−−Physician Reso
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POPULATION NEEDPhysician Resource P
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• Specific Disciplines−−−
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Background DataPhysician Resource P
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19.1.4 Language - FrenchPhysician R
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22 FAMILY MEDICINE22.1.1 NationalPh
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PRIMARY CARE NETWORK - COORDINATED
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23 MEDICAL DISCIPLINES23.1 National
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• Benchmark(s):Physician Resource
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• Benchmark(s)Physician Resource
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Environmental Scan - Government of Nova Scotia

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