New Brunswick needs about 300 additional physicians to bring its physician:patient ratio in line with the national average. The province now has a ratio of about 1:748, compared with the national ratio of 1:541 (CMAJ 1999;161[6]:679). For now, however, the New Brunswick Medical Society (NBMS) is concentrating on filling 28 positions, including 13 funded vacancies and 15 new positions proposed in the last provincial budget.
Remuneration is the underlying problem. Salaried NB physicians now earn less than their counterparts in other Atlantic provinces, while their fee-for-service colleagues, who face global and individual caps, are the second lowest-paid in the country. Only Newfoundland doctors rank behind them. The NBMS says this longstanding inequity has led to higher patient volumes and problems with recruitment and retention that affect the province's 1146 physicians. To make matters worse, a provincial physician resource plan that dictates where physicians can practise has medical residents convinced that the province is essentially closed to new doctors.
"That's not true," said NBMS Past President Jeanne McNeill of Moncton. "We have to get beyond that perception. If we don't get this problem solved soon, it's going to be really bad. Every month more physicians are leaving." (Six doctors left Fredericton in the spring, and 2 pathologists have since departed.)
Among other things, the medical society is lobbying the new Progressive Conservative government to remove the caps and address fee-schedule issues. The new health minister is Dr. Dennis Furlong, a former rural community physician and past president of the NBMS.
The medical society is heavily involved in the NB rural summer medical student program, through which about 10 first- or second-year medical students from Dalhousie or Sherbrooke universities work alongside a rural physician-preceptor for up to 10 weeks. The program, now in its second year, aims to encourage the students to practise in New Brunswick. In addition, the society hosts a spring job fair in Moncton to recruit new physicians.
To help ease the workload, a new collaborative practice model - government funded nurses working in physicians' offices - is now being piloted at 2 sites. "A lot of things could be done with a trained nurse," said McNeill. "We could see more patients more efficiently, with less burnout."