HALIFAX — Nova Scotia's premier likens doctor recruitment in his province to "squeezing a balloon."
"Something pops out in another direction — and after you get that fixed, it pops out elsewhere," Stephen McNeil said in a year-end interview with The Canadian Press.
Seven months into a renewed mandate, and more than four years after he first won power campaigning on a "doctor for every Nova Scotian," McNeil said he believes some progress is being made on the province's persistent shortage of family physicians.
He admits, though, that's "cold comfort" to those who are still without a family doctor.
McNeil pointed to areas where doctor shortages had been a chronic problem as an example of his balloon analogy.
"Digby had a chronic issue, we dealt with it. Shelburne, we had a number of physicians (to fill) there — now it's starting to show up even in our urban centres."
Earlier this month, provincial health officials said 42,000 Nova Scotians are actively seeking a family physician, although federal statistics, which include people who aren't looking, place that number at closer to 100,000.
That's mainly due to 60 or more doctor vacancies caused by retirements and other issues.
McNeil believes it's also because governments, including his own, have been slow to implement primary care that is based on collaborative practices, where health care teams that include physicians and nurse practitioners serve as the patient's entry point to the health system.
"We haven't done a great job of providing the infrastructure ... of ensuring we have the right structure," McNeil said. "We know where some of the hot spots are and where we need to continue to address it."
About 50 of more than 70 planned collaborative practice teams are currently in various stages of development.
McNeil said work is being done to better manage the system in anticipation of shortages, including efforts to recruit doctors internationally in countries such as the United Kingdom.
He said the province is also working with Ottawa in hopes of increasing the province's pool of doctors.
"We are hoping we will have an arrangement with Ottawa from an immigration point of view that will work specifically around health care, which would be unique for us," said McNeil, who called doctor recruitment one of his government's top priorities.
But criticisms of the government's efforts in health care have rankled the premier — including those made in an auditor general's report last month. Michael Pickup said public agencies had done a poor job of communicating their plan to address problems in primary care, including doctor shortages.
McNeil explained his frustration in lashing out at Pickup a day after the auditor tabled his report — a move the premier said was his personal low point in 2017.
"The solution to it (shortages) isn't as straightforward as just communicating it," McNeil said. "There is a complexity to the layers associated with it."
In the year-end interview, McNeil also addressed other issues facing his Liberal government.
The premier has weathered heavy criticism on the labour front, where his government has waged high-profile battles to impose public sector salary restraint.
Several key contracts remain unresolved heading into 2018, including with the province's health care workers.
McNeil wouldn't predict how talks would go in light of an arbitration ruling last month which resulted in a seven-per-cent wage hike over six years for about 7,200 civil servants. He noted there are other issues to negotiate besides the wage package — including essential service agreements and sick time, according to union leaders.
McNeil expressed satisfaction, though, with the arbitrators' ruling, calling it a "reasonable approach" that his government can afford.
"I believe the pattern has been set," he said.