The McNeil government had no choice but to reverse course and give Doctors Nova Scotia a new four-year deal with plenty more perks and money, says a Dalhousie University political science professor.
“They decided in the end that going head-to-head with doctors in this province was just not going to be worth it,” said Katherine Fierlbeck, an expert in health care policy and governance. “If you want to change the system, the bottom line is, you have to have a willing party to negotiate with you and there has to be an element of trust.”
On Wednesday Doctors Nova Scotia confirmed that the agreement, topping the previous contract by $135 million, had been ratified. Details of the agreements were also disclosed, including a pay bump for all Nova Scotia doctors over four years, at two per cent annually. The contract also includes $55.5 million in new funding for five critical specialties: family physicians, anesthetists, emergency physicians, psychiatry and obstetrics/gynecology.
Family physicians, anesthetists, and emergency physicians who make less than their counterparts in other provinces will be the top paid in Atlantic Canada by the end of the contract. Psychiatry and obstetrics/gynecology will come very close.
Premier Stephen McNeil told reporters on Wednesday that the new agreement symbolized the beginning of a new harmonious partnership with doctors in Nova Scotia and that the province could afford the $135-million dollar top up. But Fierlbeck isn’t so sure.
"If you look at the last round of negotiations in 2015, the province was objecting continually that the province couldn’t afford it so how is it that we can suddenly afford an extra $135 million with not much more than a shrug? Are we really doing that much better now?"
Fierlbeck is convinced that the premier’s real motivation is winning an election that's just around the corner.
The deal also includes several other incentives, including a Rural Specialist Retention Incentive Program that will double to $16,000 by the end of the contract, and a $9 million fund to recruit new specialists to Nova Scotia.
More than money, the contract is about mending some of the damage done by the decision five years ago to consolidate health care management under the Nova Scotia Health Authority, said the professor. The move ultimately served to alienate doctors and restrict local decision making. The new contract and the health authority’s governance shakeup last week, eliminating three executive vice-president positions while pledging to decentralize decision making powers to local zones, proves that the province now knows it’s mismanaged the health care file, said Fierlbeck.
“They thought this centralization model was going to solve a lot of problems as a matter of course, but didn’t really realize that it wasn’t going to solve these problems. It actually introduced a whole lot of other problems .
"If you listen to the doctors it’s not just a matter of salaries. They’ll put up with a lower salary everything else being equal. The problem is the restructuring of the health authority led to immense degree of marginalization and frustration with the physicians."
Dr. Gary Ernest, president of Doctors Nova Scotia, agreed, but called the new contract a game changer that would go far in recruiting doctors to the province and keeping them here.
"The government recognized that the key to improving the major issues of health care in Nova Scotia, especially around access for patients, is to address the factors that are keeping doctors from coming here or staying here. One is compensation and the other is work environment.”
He said the turning point in the negotiations happened about six months ago when the premier appointed Dr. Tom Marrie to help with the negotiations. Marrie had the trust of doctors and was able to change the tone of the negotiations, making a fair deal possible, said Ernest.
But Ernest couldn’t guarantee that the new contract would translate into increased access for Nova Scotians still on a waiting list for family doctors and specialists. He said another 130 to 150 doctors are still needed to keep up with the demand. The new deal would go far in enticing physicians to come, he said.
"No question will still have challenges," said Ernest. “We all have to work together to take a look at how we can figure out the best possible ways to improve and deliver health care.”
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