Nova Scotia health officials are trying to figure out how to accommodate thousands of patients who will be without a family physician when their doctor closes a clinic in Halifax at a time when the province is struggling to recruit and retain doctors.
Michael Power issued a letter to patients at the Lacewood Medical Centre late last year announcing his intention to shutter the practice at the end of March and relocate to Toronto after failing to attract new doctors as he sank further into debt.
The centre said it has been carrying up to 20,000 patients since opening in 2003 with seven doctors, but was left with three physicians after some left the province.
This latest closing puts added pressure on a system already stressed as physicians leave areas of the province to seek out higher pay and better workloads in other parts of the country, say experts.
"When we get these situations like Dr. Power's clinic, which is obviously very critical and something we need to address, it's challenging because the system is so complex," said Kevin Chapman of Doctors Nova Scotia.
"I don't know if there's capacity in the system for an additional 20,000 patients with the physicians we have."
Health Minister Leo Glavine, who met with Power, says over the short-term Lacewood patients can use walk-in clinics, the emergency room or be picked up temporarily by doctors if they can't find a family physician.
He says that even though it's rare to see that many patients suddenly without a family doctor, he's confident they will get care with help from the district health authority.
"I am concerned about this, but I do have very strong assurances from Capital Health that they will be able to look after placing those patients," he said.
Rick Gibson, chief of the district's department of family practice, says there are plenty of family doctors in Halifax who are taking new patients and the area has more family physicians than the national average per capita.
He also downplayed the idea that doctors are pulling up stakes and relocating to Ontario, British Columbia and Alberta.
"There's no great migration of people to Alberta or elsewhere and we get a steady flow of new ones every year," he said. "Each province has its own fee schedule. … But I don't see there's a huge difference when you take into account different variables."
The Canadian Institute for Health Information says doctors were paid an average of about $328,000 before taxes and expenses in 2011-2012. The average gross clinical payment per physician ranged from $258,000 in Nova Scotia to $376,000 in Ontario.
Figures for Prince Edward Island aren't included at that province's request due to what the institute says is a skewing effect on physician counts and their payments caused by visiting doctors.
Power said pay was central to his decision to leave, adding that he will make far more in his new Ontario practice. He says two other doctors in his centre are considering moving west.
"The clinic has operated at a loss and I can't do that anymore," he said.
Glavine says the problems will be addressed by a new team that will make recommendations on recruitment and retention, which will likely take pay, collaborative care and debt relief into account.
Nova Scotia has about 1,200 family physicians but will need up to 600 more over next 10 years, Chapman says, adding that 55 doctors have moved out of the province over the past five years.