"Oh, you're my health care provider?" Recounting the experiences of people of African descent in Nova Scotia pursuing or working in health professions.

BACKGROUND: Increasing, supporting and cultivating diversity in health programs is key to addressing health inequities. We sought to investigate barriers and facilitators that could affect enrolment and success in health professions among people of African descent in Nova Scotia, Canada. METHODS: We conducted semistructured interviews with people who self-identified as being of African descent who resided or grew up in Nova Scotia, who were working in or pursuing a career in a health profession, and who had participated in culturally specific mentorship programs. Semistructured interviews explored participant experiences that shaped their pursuit of a health profession, as a person of African descent. We thematically analyzed transcribed interviews using constructivist grounded theory. RESULTS: We interviewed 23 participants. Thematic coding showed 4 major themes. The theme of "stand on my shoulders" spoke to the importance of mentorship within the Black community. "Growing through pain" spoke to resilience amidst race-related challenges. "Never the student; ever the teacher" showed the repeated need to educate on issues of race or diversity. The final theme, "change," highlighted next steps, including the need for improvement in curricula, for development of Black faculty and for initiatives that offer support. INTERPRETATION: We found that mentorship, particularly within the community, was instrumental to promoting feelings of belonging. However, participants described the need for resilience in the face of discrimination during training and in practice in health care professions. Rather than focusing on their education, many had to educate those around them. Increased representation, support programs and updated curricula are needed to promote change.

Family doctors providing home visits in Nova Scotia: Who are they and how often does it happen?

OBJECTIVE: To examine how FP and practice characteristics relate to the provision of home visits. DESIGN: Census survey linked to administrative billing data. SETTING: Nova Scotia, 2014 to 2015. PARTICIPANTS: Respondents to the family physician practice survey (N = 740; 84.5% response rate), the FP provider survey (N = 677; 56.7% response rate), and the nurse practitioner provider survey (N = 45; 68.9% response rate). MAIN OUTCOME MEASURES: Provision of home visits. Family physician characteristics included age, sex, and proximity to retirement; practice characteristics included patient age and practice rurality. RESULTS: Overall, 84.4% of surveyed FPs reported that they did home visits. In both survey data and billing data, older FPs were more likely to do home visits (P < .01). In multivariate analyses, older FP age, older patient age, rural practice location, and male FP sex were all independently associated with provision of any home visits and with the number of home visits (all P < .0001). Among FPs who had billed for home visits in the study year, the median (interquartile range [IQR]) number of visits was 16 (2 to 42); the range was 1 to 1265. Male FPs billed for more home visits (median [IQR] = 21 [7 to 54] visits) than female FPs (median [IQR] = 12 [4 to 30]) did (P < .001). Rural FPs had performed more home visits (median [IQR] = 29 [8 to 83]) than their urban counterparts (median [IQR] = 14 [5 to 36]) had (P < .001). CONCLUSION: Most FPs in Nova Scotia who responded to our survey reported doing home visits. This is an encouraging finding for the care of vulnerable older adults and runs counter to the widely held view that home visits are a dying art. Nevertheless, given that older male FPs are more likely to do home visits, there could be work force implications as these FPs retire. As the population ages, strategies to support home visits will be an important area for further research and policy development.

Nova Scotia Needs Doctors: How Do We Attract and Keep Them?

Recruitment and retention of physicians, especially in rural communities, are severe public health policy problems in Canadian hospitals. This characterizes the situation in Nova Scotia. This study explored the Eastern Zone of the Nova Scotia Health Authority to determine ways to overcome the physician shortage. Six participants, all working in physician recruitment in Nova Scotia, were asked semi-structured, in-depth questions about the current recruitment process in their respective zones. The research participants presented many parallel perspectives on problems and solutions. It was determined that the biggest obstacles faced by recruiters are bureaucracy, a lack of clear communication channels, failure to track return on investment, a lack of community integration (including spousal employment supports) and a lack of clearly defined roles and responsibilities within the Eastern Zone. This study is timely given the salience of the subject, especially on the Canadian public agenda.

Funding models and medical dominance in interdisciplinary primary care teams: qualitative evidence from three Canadian provinces.

BACKGROUND: Primary care in Canada is the first point of entry for patients needing specialized services, the fundamental source of care for those living with chronic illness, and the main supplier of preventive services. Increased pressures on the system lead to changes such as an increased reliance on interdisciplinary teams, which are advocated to have numerous advantages. The functioning of teams largely depends on inter-professional relationships that can be supported or strained by the financial arrangements within teams. We assess which types of financial environments perpetuate and which reduce the challenge of medical dominance. METHODS: Using qualitative interview data from 19 interdisciplinary teams/networks in three Canadian provinces, as well as related policy documents, we develop a typology of financial environments along two dimensions, financial hierarchy and multiplicity of funding sources. A financial hierarchy is created when the incomes of some providers are a function of the incomes of other providers. A multiplicity of funding sources is created when team funding is provided by several funders and a team faces multiple lines of accountability. RESULTS: We argue that medical dominance is perpetuated with higher degrees of financial hierarchy and higher degrees of multiplicity. We show that the financial environments created in the three provinces have not supported a reduction in medical dominance. The longstanding Community Health Centre model, however, displays the least financial hierarchy and the least multiplicity-an environment least fertile for medical dominance. CONCLUSIONS: The functioning of interdisciplinary primary care teams can be negatively affected by the unique positioning of the medical profession. The financial environment created for teams is an important consideration in policy development, as it plays an important role in establishing inter-professional relationships. Policies that reduce financial hierarchies and funding multiplicities are optimal in this regard.

'Not everyone can be a Gandhi': South Asian-trained doctors immigrating to Canada, c. 1961-1971.

OBJECTIVES: This paper will explore the social history of the transnational migration of foreign-trained doctors to western countries in the post-WWII era, by examining, as a case study, South Asian-trained doctors who were first licensed in the Canadian province of Nova Scotia between 1961 and 1971. DESIGN: This article draws on both quantitative and qualitative primary sources. First, we analyzed the 1966 and 1971 copies of the Canadian Medical Directories (CMD), the annual compendium of all licensed practitioners in the country (over 20,000 practitioners). These CMD entries were supplemented by the annual returns of 'intended occupation' (those designated as 'physician' or 'surgeon') of landed immigrants to Canada, as compiled by the federal Department of Manpower and Immigration. Secondly, we analyzed testimony of 26 oral histories and narrative accounts of foreign-trained doctors being compiled as part of an ongoing multiyear program of research on the immigration of foreign-trained doctors to Canada. We have interviewed 14 doctors who, at one point in their career, practiced in Nova Scotia, 8 of whom were South Asian-trained medical practitioners. These oral interviews provide personal reflections on the process of professional and social acculturation that occurred as these foreign doctors settled in Canada. RESULTS: The results of this paper indicate that the social history of the immigration of South Asian-trained doctors to Canada in the 1960s must be seen within a larger and more complicated pattern of the international migration of health care professionals. Indeed, the demand for foreign-trained doctors in Britain was in part a reflection of the out-migration of British-born doctors who were leaving the National Health Service for Canada, the USA, and Australia. And the demand in Canada for doctors was itself a reaction to the drift of a certain number of Canadian-trained doctors for advanced training in the USA. CONCLUSIONS: In this way, this article sheds important historical perspectives on the globalization of health human resources and the complicated, multiple migrations that continue to animate international health human resources today.

Understanding and addressing changing administrative workload in primary care in Canada: protocol for a mixed-method study.

INTRODUCTION: Many Canadians struggle to access the primary care they need while at the same time primary care providers report record levels of stress and overwork. There is an urgent need to understand factors contributing to the gap between a growing per-capita supply of primary care providers and declines in the availability of primary care services. The assumption of responsibility by primary care teams for services previously delivered on an in-patient basis, along with a rise in administrative responsibilities may be factors influencing reduced access to care. METHODS AND ANALYSIS: In this mixed-methods study, our first objective is to determine how the volume of services requiring primary care coordination has changed over time in the Canadian provinces of Nova Scotia and New Brunswick. We will collect quantitative administrative data to investigate how services have shifted in ways that may impact administrative workload in primary care. Our second objective is to use qualitative interviews with family physicians, nurse practitioners and administrative team members providing primary care to understand how administrative workload has changed over time. We will then identify priority issues and practical response strategies using two deliberative dialogue events convened with primary care providers, clinical and system leaders, and policy-makers.We will analyse changes in service use data between 2001/2002 and 2021/2022 using annual total counts, rates per capita, rates per primary care provider and per primary care service. We will conduct reflexive thematic analysis to develop themes and to compare and contrast participant responses reflecting differences across disciplines, payment and practice models, and practice settings. Areas of concern and potential solutions raised during interviews will inform deliberative dialogue events. ETHICS AND DISSEMINATION: We received research ethics approval from Nova Scotia Health (#1028815). Knowledge translation will occur through dialogue events, academic papers and presentations at national and international conferences.

Government policies targeting primary care physician practice from 1998-2018 in three Canadian provinces: A jurisdictional scan.

Primary care is the foundation of health care systems around the world. Physician autonomy means that governments rely on a limited selection of levers to implement reforms in primary care delivery, and these policies may impact the practice choices, intentions, and patterns of primary care physicians. Using a systematic search strategy to capture publicly available policy documents, we conducted a scan of such policies from 1998 to 2018 in three Canadian provinces: British Columbia, Nova Scotia, and Ontario. We reviewed 388 documents and extracted 170 policies from their texts, followed by analysis of the policies' instruments, actors, and topic areas. Policy reforms across the three provinces were primarily focused on physician payment, with governments relying on both targeted incentives and reformed payment models. Policies also employed various instruments to target priority areas of practice: 24/7 access to care, team-based primary care, unattached patients, eHealth, and rural/Northern recruitment of physicians. Across the three provinces and the 20-year timespan, reform priorities and instruments were largely uniform, with Ontario's policies tending to be the most diverse. Physicians helped shape reforms through the agreements negotiated between provincial governments and medical associations, influencing the topics and timing of reforms. Future research should evaluate impacts on the delivery of primary care and explore opportunities for policy innovation.

Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers: The Case of Nova Scotia, Canada.

Mobility and movement is an increasingly important part of work for many, however, Employment-Related Geographical Mobility (ERGM), defined as the extended movement of workers between places of permanent residence and employment, is relatively understudied among healthcare workers. It is critical to understand the policies that affect ERGM, and how they impact mobile healthcare workers. We outline four key intersecting policy contexts related to the ERGM of healthcare workers, focusing on the mobility of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Continuing Care Assistants (CCAs) in Nova Scotia: international labour mobility and migration; interprovincial labour mobility; provincial credential recognition; and, workplace and occupational health and safety.

Physician recruitment in rural Canada: programs in New Brunswick, Newfoundland, and Nova Scotia.

This paper examines programs used in the Atlantic provinces of New Brunswick, Newfoundland, and Nova Scotia to recruit and retain physicians in rural areas. The provinces have many similarities but have unique characteristics that have shaped recruitment methods. The total number of physicians in each province has grown at a faster rate than the population. Each has problems attracting physicians to underserved areas, although the magnitude of the problems vary. The data for this paper were gathered from documents available from various agencies in each province and a series of personal interviews conducted in the spring of 1993. The provinces have chosen different avenues in attempting to solve the maldistribution of physician resources, ranging from regulatory methods in New Brunswick to moves in Newfoundland to encourage graduates of the province's medical school to locate in the rural areas and lessen the dependence on foreign medical graduates. Nova Scotia, with fewer areas needing physicians, has been able to focus its efforts on selected locations. Reviewing the methods used in the three provinces provides an insight into the attempts to solve the shortage of physicians in rural areas.

Pretrial preparations can improve a physician's value as an expert witness.

Many physicians appear in court as expert witnesses, but the quality of their testimony varies considerably, says a Nova Scotia judge. Pretrial preparation will improve the quality of a physician's testimony, reduce stress and save time, says Judge Timothy Daley, who provides some suggestions about how to prepare to be an expert witness and what to expect in the courtroom.

Nova Scotia hopes to solve recruitment problem with joint effort from MDS, government.

The Medical Society of Nova Scotia and the provincial government hope to solve the physician shortage in rural parts of the province with a recruiting effort that includes monetary incentives to fill some positions. A new locum service is designed to improve physician retention by making it easier to take vacations and pursue education programs.

Home care: the cornerstone of health renewal in Nova Scotia.

Until recently, home care services in Nova Scotia lacked uniformity and were difficult to access. This changed dramatically last June when the province launched Home Care Nova Scotia, the linchpin in the province's plan for health renewal. The program provides chronic and home hospital care to Nova Scotians of all ages, with five additional categories of care planned for the future. Like the 400 other coordinated home care programs in Canada, Home Care Nova Scotia is one alternative to the inappropriate use of acute and long term care facilities. It is also a valued service in its own right within the continuum of health services.