Will new NS law lead to bidding wars for MDs?

A much-debated bill in Nova Scotia may change the way physicians are recruited and paid within the province. Bill 54, introduced as a private member's bill by a Progressive Conservative backbencher, allows the town of Barrington to pay a physician more than the provincial insurance program provides. Critics worry that the bill may allow more prosperous communities to attract physicians at the expense of those that can't afford to pay more.

“When we get in a bidding war between municipal units, the rich units are [in a better position] to recruit physicians than the less-rich ones,” warns Dr. Jim Smith, the former health minister and Liberal health critic.

Health Minister Jamie Muir admits that bidding wars are a possibility, but says incentives of one kind or another are already being offered. Several classified advertisements in CMAJ do offer benefits such as moving expenses and free rent. However, these offers are usually made by individual clinics, not municipalities.

The Medical Society of Nova Scotia is concerned that the new bill — it was debated so fiercely that the spring sitting of the legislature had to be extended — changes the nature of incentives and enshrines the changes in legislation.

Concerns about a 2-tiered payment system for doctors came to the fore recently in neighbouring New Brunswick after an infant was unable to get emergency treatment in his hometown and died en route to a hospital 50 km away. The town of Tracadie-Sheila was unable to keep its emergency room open around the clock because it was could not afford the higher fees being paid to emergency doctors in centres such as Saint John and Moncton. Although doctors' fees are set by the province, larger communities in New Brunswick are now routinely topping them up in order to staff emergency rooms. For instance, Moncton is dipping into a special parking-ticket fund to pay physicians more than the established rate.