Good colleagues and happy clients: The satisfaction of working in Nova Scotia’s mobile primary care clinics

Over the past several months, Nova Scotians have benefited from mobile primary care clinics.Despite a lack of primary care physicians in the province, staffing the clinics hasn’t been a problem—because physicians, it turns out, enjoy working at them. The province has been through a lot lately: the COVID-19 pandemic, the subsequent vaccination campaign, Hurricane Fiona in 2022 that left communities without power and damaged properties, and then wildfires that ripped through the province in 2023. And like others across the country, the people of Nova Scotia are suffering a shortage of primary care providers.A phoenix from all this duress is the mobile primary care clinic. Public health offered mobile clinics throughout the COVID-19 vaccination campaign, so when Hurricane Fiona damaged many points of care in Cape Breton, Nova Scotia Health sent a public health van and an emergency medical services (EMS) trailer to provide primary care. Within a day, the team behind it had to plan out a bevvy of details, from how the queue would work to what continuity of care would look like, explained Tara Sampalli, senior director of implementation science and evaluation and global healthcare planning at Nova Scotia Health. The community was extremely thankful, Sampalli said.In October 2023, Nova Scotia Health opened two mobile primary care clinics, one in Middleton and one in Cobequid. It’s now scaled across the province, with clinics currently in 15 communities.Read: Nova Scotia has adopted the CLHIA’s disability form—will other provinces follow?No two mobile primary care clinics are quite alike. It all depends on what the community needs. Some use appointments, others are a drop-in service, some are open only on weekends or evenings and others provide services during the day. In some communities, like Cobequid, the clinic takes some of the pressure off the emergency room. In other areas, the clinic is meant to provide primary care where there are gaps. During the 2023 wildfires, a mobile primary care clinic provided mental health services, because many patients were distressed. Since the staff can only see one or two people at a time in the van, they often set up in another location, such as a community centre. In Antigonish, a clinic was set up at St. Francis Xavier University, to divert students and other residents with primary care needs from the emergency room.The clinics stay in the community for two to three months, depending on the types primary care needs that exist in each location, Sampalli said. Even with a shortage of primary care physicians in the province, staffing the mobile clinics hasn't been an issue, Sampalli said. Doctors working in the clinics are often semi-retired or put in shifts when not at their regular practice. “It seems to allow them to contribute differently to some of the planning that’s happening in the province.” Physicians have told Sampalli that the gratitude of the patients and the collegial atmosphere are welcome bonuses of working at the mobile primary care clinic. They also appreciate the absence of paperwork. Dr. John Jollymore told the Medical Post that he enjoys “the significant appreciation we receive from the patients we service, the efficiency of the program and staff and the camaraderie among the physicians in the program.”“I would recommend working with this program especially for physicians considering retirement as it maintains connection with the medical community, maintains mental stimulation and provides a much needed and appreciated service to the community,” Dr. Jollymore said.Dr. Amir Nejat said the mobile clinic is “a great place to work,” but noted that sometimes patients’ expectations are higher than the physicians can provide, which can cause conflict.Physicians can’t order tests that require follow-up and sometimes have to send patients to the emergency department. While not being able to order tests or screening can be frustrating, it does mean the team is able to deal with issues quickly and efficiently so they can help a large number of patients, Dr. Jollymore noted. Another doctor told Sampalli that not having to provide follow-up on tests or fill out forms was one of the highlights of working at the mobile primary care clinic. Read: Nova Scotia announces more modular housing for health workersThe patients who visit the mobile primary care clinics are mostly dealing with acute issues, infections or need medication refills, Dr. Jollymore said. Another physician told Sampalli that they see more new Canadians and new Nova Scotians than in their regular practice.The whole process has made Sampalli and her team re-think what access to primary care really means, because having a primary care provider might not be enough. Initially, her team thought only those without access to a primary care provider would use these clinics, but found that some jusrt can't see their care provider in a timely manner.“We actually see a good mix of people who have access to a primary care provider and those who don’t.” Sampalli and her team are examining how the mobile care clinics will move on from the test-and-try stage to a potentially more permanent fixture. It’s one part of multiple ways the province is trying to improve access to primary care, from expanding pharmacists’ scope of practice, to mental health and virtual care phone lines or online platforms. While the clinics are meant to be temporary, one physician recommended to Sampalli that the clinics should be attached to every large emergency department as a cost-savings service, since primary care costs the province less than emergency care. The same physician said that newly graduated physicians or retired physicians could staff them to provide medical care without paperwork or complex cases. Dr. Nejat would also like to see permanent primary care clinics similar to the mobile one. “I wish in every neighbourhood we could have a clinic like this with its own radiology and lab and certain physicians who can rotate and take care of the patients in that area.” Whatever the future of the mobile primary care clinics, Nova Scotian physicians and patients are appreciating their services now. And with some clinics seeing as many as 200 patients a day, they are filling important gaps in the province's healthcare system.Read: Nova Scotia health official says virtual care ‘here to stay’

Good colleagues and happy clients: The satisfaction of working in Nova Scotia’s mobile primary care clinics

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