Clinic built on teamwork and trust

Team-based primary care is considered the gold standard in Canada. But when team members don’t work cohesively, the result can be chaos.So what makes collaborative care work?The Medical Post has been asking that question at team-based primary care clinics across the country. This time, we turn to a rural medicine-style facility in Yarmouth, N.S., the Courthouse Medical Clinic where Dr. Joe Gillis practises.The clinic is located in a 1930s courthouse repurposed in 2017 by Yarmouth internist Dr. Brian Moses. Dr. Gillis and his partner, Dr. Tyler Green, moved in once renovations were completed.Yarmouth suited Dr. Gillis to a T—though he was raised a loyal Cape Bretoner. He worked in public relations before entering medical school at age 35. A three-year family medicine residency in North Carolina prepared him for broad-scope practice, including hospitalist and emergency medicine work.That turned out to be ideal preparation for practising in a fishing town of 7,000 at the southern tip of Nova Scotia.“We’re three hours away from Halifax and have a regional hospital, so family doctors need to be ready to do a little bit of everything,” Dr. Gillis said in an interview with the Medical Post.Dr. Gillis now refers obstetrics patients to a clinic partner who still provides that care. He has compressed his family practice into two clinic days a week and spends another two full days dealing with issues arising at the hospital and in emergency medicine.PAYING THE TEAMCourthouse is not huge—and yet it serves nearly half the town’s population with about 2,900 attached patients. It occupies one side of the ground floor. A range of internists, including Dr. Moses, practise on the other side.The clinic’s team—gradually assembled since 2023—includes five physicians, a full-time family practice nurse whom Dr. Gillis describes as the clinic’s anchor, plus a part-time dietitian, social worker, pharmacist and two administrators.Paying these salaries would be unaffordable, Dr. Gillis acknowledged, without support from the provincial health authority, Nova Scotia Health (NSH).NSH employs and pays the allied health professionals and covers the associated staffing and clinic space costs. Dr. Gillis describes the arrangement as “hybrid” because physicians still cover much of the clinic overhead, including the major portion of office space and administrators’ salaries.The doctors function as independent contractors who can choose either traditional fee-for-service billing or Nova Scotia’s blended longitudinal family medicine (LFM) payment model introduced in 2023. Dr. Gillis has opted for the LFM model, although some partners continue using fee-for-service because they find it more flexible and less administratively burdensome.For many physicians, the idea of having health-authority-employed, unionized staff immediately raises concerns about loss of autonomy—something that has been contentious in some health authority-run arrangements across Canada.But Dr. Gillis said this is not currently an issue at Courthouse.“The health authority would probably be very quick to call us a co-lead clinic,” he said. “I’m fine with that, but really we’re a private clinic.”ALLIED PROVIDER PROGRAMNova Scotia has been well-focused on expanding collaborative primary care clinics. Its allied healthcare provider (AHCP) program helps eligible independent clinics bring allied professionals into practices aligned with the patient medical home model favoured by the College of Family Physicians of Canada.Courthouse’s agreement with NSH came about before AHCP. Its staffing support comes with expectations that approximately 400 additional patients be attached per physician.Dr. Gillis’s panel is currently 900 patients. He believes the patient increase is achievable even though all but one of the clinic’s physicians work part-time.“We have a rock star of a family practice nurse,” he said. “All of us worked with her in hospital, and she has extensive pediatrics and OB training. She went through the program to get up to speed on some of the women’s health work, and she’ll do Pap tests, cryotherapy, blood pressure monitoring and other things that really take a lot of the load off us.”The clinic’s social worker has also become a critical support in a community that includes English and Acadian French populations, African Nova Scotians, Mi’kmaq communities and growing immigrant populations.Derick Hamilton has worked in the role for two years. “I provide support to the Courthouse Medical Clinic one day a week and will typically see about four patients in a given day,” he wrote in an email to the Medical Post.Referrals can come from any member of the clinic team, including physicians, the family practice nurse, pharmacist and dietitian. Patients attached to the clinic can also self-refer.“As a social worker, I often help connect the medical picture to the person’s lived reality—their housing, income, stress, caregiving, grief, isolation and access to community resources,” Hamilton said.He noted that patient anxiety may actually reflect grief, housing instability, food insecurity, financial strain or caregiver burnout.“By working together we can respond more effectively and prevent problems from escalating,” he said.Dr. Gillis believes careful selection of team members like Hamilton has been the key to improving patient care while relieving physician pressure.“It’s about being very strategic about who you bring on,” he said.Although the allied professionals are employees of NSH, Courthouse physicians sit on the hiring committees as well. “Everybody in Yarmouth knows everybody, so you know what you’re getting.”Successful urban collaborative clinics might emphasize EMRs, asynchronous communication and formal team meetings. Dr. Gillis and Hamilton rely on trust, informal communication, shared goals and respect for each team member’s expertise.“At its best, it works like a shared safety net—each professional contributing something different, but the patient experiencing it as one coordinated plan,” Hamilton said.Dr. Gillis expressed a similar sentiment. “We practise differently, but we all trust each other’s intentions, our commitment to patients and our belief in service to the community,” he said. “I work with great, good people.”

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