How a community approach to health care and a personal touch deliver the docs

Photos: Aberdeen Health Foundation and Steve Smith, VisionFire Studios

Pictou County, we have a problem. This was the message that the executive committee of the Pictou County Medical Staff shared with a board room full of community members at the Aberdeen Hospital in May of 2018. The dilemma wasn’t a surprise to the occupants of the room who all have had their hand in some aspect of wellness and community development for years.

There had been little change to the complement of family physicians and specialists who had been the backbone of health care delivery in the region. Many had worn the white coat for three decades or more and were ready retire. Several more would soon be nearing that point in their career. It would not take much to destabilize a system that was still in need of balancing for the needs of the community.

“We were on the verge of a real human resource crisis and had to do something about it,” says Dr. Brad MacDougall a family practitioner at the Westville Medical Clinic and President of the Pictou County Medical Staff. “At the time, the Nova Scotia Health Authority had physician recruiters but there was only one for our zone from Amherst to Antigonish. We knew that we had to take it upon ourselves to improve the situation. Our physician group was aware of the amount of knowledge and wisdom in our community and we were going to need their help.”

Murray Hill was one of a dozen or more community members in the room when Dr. MacDougall painted the picture of the future of heath care in Pictou County without quick intervention.

“I never thought about what the medical community was telling us as a crisis,” says Murray Hill, remembering that meeting from just two years ago. “I looked at this situation as a real opportunity to change the conversation about health care delivery in our community. The medical community knew that they needed help. The real question was, did the broader community have a role to play? It was very clear to the people in the room that an organization already existed that had a proven record to tackle issues like this,” says Hill.

Dr. Deborah Straub

The organization was Citizens for a Healthy Pictou County and got its start much the same way as the initiatives being sought by the physicians when a group of local thought leaders gathered in a board room and agreed that a collaborative effort was needed to institute transformational change to the local health care system. The building of partnerships with various groups that intersected the health care system was at the foundation of their plan. Their analysis led to the creation of a master plan titled Healthy 2020. The first of the four phases of the plan included the building of the Pictou County Wellness Centre, a new state of the art ER and hospital pharmacy and the relocation of services, like blood collection, off of the hospital campus to the nearby East River Road professional mall.

The first phase demonstrated the success of community collaboration, cooperation between municipalities, and a new, more holistic approach to health care with the understanding of how important a wellness hub would be in contributing to the over-all wellbeing of citizens. The Wellness Centre is now one of the most important assets used for attraction and retention across all professional sectors.

“Most of the members of that citizens group formalized in 2008 were at that initial meeting with the physicians in 2018,” says Hill. “We didn’t say yes that night but when we all left that meeting we knew that there was a good plan.”

Hill, who has been engaged in many facets of community development for almost two decades was aware that the physician recruitment plan would be no different than any other community building effort. From the beginning, Citizens for Healthy Pictou County always believed that the people affected should be the people involved.

Dr. Tamir El-Tahan

“The community is part of the team,” says Dr. James MacLachlan who was site lead for the Aberdeen Hospital when the new plan started to take shape. “If you don’t have that team then it doesn’t work. We have the hospital foundations and all of the pieces to make this work including a community environment that is very supportive of its physicians,” adds Dr. MacLachlan.

The team that emerged ticked off a number of boxes that were deemed critical for success laid out by the Citizens group. First, they wanted at least a five-year commitment creating stable leadership from the physicians group followed by a financial plan that had funds in place. In very short order, 75 funders including all six municipalities, both local hospital foundations, several businesses, and every physician in the county had a financial stake.

The plan would not only focus on recruitment activities but also on the retention of their current GPs and specialists, and they would work on the relationships with Pictou County students, so they recognized their importance in the future of health care in their own communities.

Dr. Pat Craig says that she has been a direct beneficiary of the recruitment program. She has been a general practitioner in the region for 29 years but had an interest in expanding her role in the Oncology Department at the Aberdeen.

“I was able to find someone to come in and take over my practice. I was prepared to handle both jobs for six months but fortunately there was one of the new doctors recruited to the area that took over my practice and I can focus on Oncology full time,” explains Dr. Craig.

The final piece was securing a lead for the entire project. “We needed someone to lead all of this. Someone who saw this same opportunity, leaving us to just push go,” says Hill.

Dr. Brad MacDougall

In the summer of 2018, Nicole LeBlanc was hired as the first community navigator for physician recruitment and retention in Nova Scotia, the group now known as Healthy Pictou County is seen as the gold standard in the province.

“If there was anyone that was suited for this job it was Nicole,” says Hill.

In the last two years six new family physicians and five specialists have moved their practice to Pictou County.

“When I finished my residency at Dal, I knew that I would be working in Nova Scotia,” says Dr. Whitney Lum who is originally from British Columbia but attended medical school in England.

“I set up visits all over Nova Scotia to see what was available. I came across New Glasgow and what was unique was Nicole LeBlanc. I saw six or seven other locations and they all showed me the hospital and clinics and talked about my schedule but what Nicole did that was different was to arrange things outside of my work environment. One day not long after my first visit I called Nicole and told her I would be driving by New Glasgow and could I pop in. I don’t know how she did it but she dropped everything and took me around to show me the Y and the local hiking trails. She knew the things I was interested in.”

Dr. Lum now has a practice at the Pictou West Medical Clinic. She started to see patients referred from the 811 list in September of 2019. These are patients who did not have their own family physician.

Pictou County Wellness Centre

“I think it is very important that younger physicians make connections outside of work. I was able to connect Dr. Lum with members of Pulse Pictou County. This group is very unique across the province and even the country,” says Nicole LeBlanc.

The PULSE group that was formed in 2014 to build a network for the young professionals in the community, has been an important piece in the recruitment process.

“The peer-to-peer connections are so critical,” says Healthy Pictou County Chairman Murray Hill. “I have yet to meet one of the new physicians on their first visits to the county. If they want to hear what Pictou County is about from the perspective of their grandfather then I am their guy but otherwise it’s the young professional people who share their stories about Pictou County that really matter,” he adds.

A grassroots movement is part of the ethos of Pictou County and has been the key to the success of many community assets in the region.

“The Nova Scotia Health Authority and other communities often contact us to see how we do things. We want to help other communities get caught up. We are ahead of the game when it comes to the community approach. The thing to remember is that we are not in competition with each other. Each community has specific needs and we all have different assets,” adds Dr. MacDougall.

Dr. Patricia Craig

The physicians as financial stake holders is another differential of the Pictou County project.

“The financial contribution has not been onerous, “says Dr. Aulayne Jeans who has been practicing in Pictou County for 33 years. “The potential return of investment is really lovely on many levels but certainly from the perspective of creating a better community,” she adds.

Jack Kyte, Executive Director of the Pictou County Chamber of Commerce and member of the community recruitment and retention committee believes that business has a real stake in the physician recruitment program and the role it plays in providing exceptional health care in the region.

“It is crucial to the recruitment and retention of today’s employees and their families looking to build their lives here,” says Kyte.

“It has been fascinating for me to see how willing all sectors of the community are supporting this work. As we put our best foot forward to sell our community to prospective physicians, we all get a feeling of pride and realize how great it really is to live and work here.”

Nicole LeBlanc

While the community is seeing success in their recruitment, retention of medical staff has also been significant.

Both Dr. MacDougall and Dr. MacLachlan have a sense that the collegiality and morale of existing and new physicians is improving. MacDougall who was brought up in Antigonish, attended Dalhousie Medical school and returned to the area for clinical work when he was still a medical student and has been building his practice in Pictou County for nine years. “I think that improving events for medical staff and their families, and to be a more welcoming to family and spouse makes a significant difference. We are all busy and sometimes it’s hard to make time for these things, but some of the events, like when medical staff take turns every couple of months inviting their colleagues into their homes and getting to know each other on a more social level, really does make a difference,” says Dr. MacDougall.

Dr. Whitney Lum adds that from a work perspective she could not ask for a better place to be. “As a new grad you are always a little concerned about the support you will receive from other GPs. This is such a collegial group and they are so helpful and supportive,” she adds.

Residents Day last summer: inviting new docs to take the plunge in Pictou County

With Healthy Pictou County’s attention to recruitment and retention in the last two years the Nova Scotia Health Authority and its partners have been able to stop the bleed that could have put them in a critical care situation. Even with some recent retirements and loss of physicians to other areas there are still approximately 60 physicians practicing in Pictou County. That number puts them in good shape but still a reach to be considered in optimal health. Right sizing to the needs of the population and improved mental health services are on-going priorities for the recruitment group.

Dr. MacDougall believes that the community needs another four or five GPs to address the number of citizens who do not have direct access to primary health care and there is a significant need to address the lack of mental health services. With the recruitment program in place it will take time, but there is good reason to believe that Pictou County will be able to fulfill the need for GPs, however, the psychiatry specialty has been more difficult to address. MacDougall acknowledges that Psychiatry is in high demand all over North America, but it is very important for healthy outcomes in the Pictou County community. There are other aspects of the delivery of specialized care that have been able to be enhanced in the last few years, including cancer care.

Dr. Whitney Lum and Dr. Simran Ohson

Nicole LeBlanc is only 18 months into her new role. She reflects on her work and acknowledges that she has a big responsibility to ensure that Pictou County has a health care system that supports the changing needs of the community.

“I have the best job in the world. I get to show other people from all over the world how incredible this community is and share it with them – introducing them to the tastes, sights, sounds, and people that make this one of the best places to live, work, and play,” said LeBlanc. “To be able to be in a role where you get to share with others the community that helped raise you is really special.”