2023-01-25

Doc. Jim hands over the reins

After nearly 50 years as a family physician, Dr. James Rafferty hung up his stethoscope earlier this month, a decision he says was made much easier knowing he'd lined up his replacement.

Rafferty, known as Doc Jim in the North Queens community where he's spent the last 24 years, decided to get the retirement ball rolling three years ago, when he was 75.

"I thought we should pick a date to shoot for to attempt to recruit somebody for our community," he told LighthouseNOW. "When I would say to patients, 'I'm retiring,' they'd be very disappointed because they need a primary care doctor. Once I said, 'But you have a new doctor,' the response was overwhelming. With their enthusiasm, that really helped me personally."

Rafferty found two doctors keen to take over his practice of 1,172 patients. One, a doctor from England, ended up unable to make the move for personal reasons.

The other was rural British Columbian Dr. Leanne DeLong, who was already on the South Shore, working in Shelburne. She took over the practice on Jan. 9.

Rafferty says he first met DeLong eight or nine years ago when she was a medical student and did a month-long stint with him. "I kept in touch with her from that point on," Rafferty says. "To recruit a physician to a rural area not necessarily an easy thing. Many communities don't have anybody. But it's worked well in our community."

Besides his personal connection with DeLong, he credits a list of other factors, such as the support of Nova Scotia Health that have programs to encourage local doctors to accept medical students into their practices at all different stages and medical teaching programs outside of Halifax in places like Sydney and Yarmouth.

Rafferty says it also helps that North Queens and surrounding areas are part of a unique larger community, where volunteers have banded together to build community medical centres and associations to support health-care needs.

More than 20 years ago, community leaders and Rafferty were advocates in pushing for collaborative care, making North Queens among the first in the province to integrate a nurse practitioner as part of the family practice team. Rafferty says the setup was a gamechanger and another draw for doctors.

His ability to secure a replacement comes amid a major doctor shortage in the province, a problem Premier Tim Houston says is his top priority but also admits will take years to remedy.

As of Jan. 1, 129,321 Nova Scotians (13 per cent of the population) were on a waitlist for a primary care family doctor or nurse practitioner. Of the 5,665 people who added their names to the list in December, 32 per cent did so because their doctor retired or plans to retire. A little over 40 per cent signed up because they are new to the area.

Nova Scotia Health knows of about 40 looming future retirements or departures in family medicine. But the number is likely higher. "Physicians self-elect when to notify us of retirements," says Brendan Elliott, a spokesperson for the health authority. "We sometimes get the notices for retirements coming in three years' time. Other times it is much shorter."

Between April 1 (the start of Nova Scotia Health's operating year) and Nov. 30, 52 doctors stopped practising in the province. Most retired, while others left for personal reasons such as illness or relocation. In the year ended March 31, 2022, 75 departed, up from 46 in the previous year.

In just under five years, the province has recruited 655 doctors, including 163 last year.

New doctors aren't burdened with the heavy patient load of many older doctors who are now retiring with a roster of as many as 4,500 patients.

Doctors on a full-time salaried contract are expected to have 1,350 patients. A fee-for-service physician takes on a similar number.

"In many cases, outgoing physicians in our province had enough patients that they are replaced with 1.5 to 2.5 full-time-equivalent positions," says Elliott.

Among the reasons for the smaller patient count for new doctors "is a general shift in work habits and work-life balance for younger physicians entering the profession" and the health status of Nova Scotians, which includes a growing number of elderly patients and many with complex needs, he says.

Kim Masland, MLA for Queens and government house leader in Houston's Progressive Conservative government, says it's a hard time for doctors with people living longer, but not necessarily healthier.

She says Rafferty was "one of those old-fashioned docs who just lived the profession."

He was her grandmother's doctor. "The extra time he would take to work with us as a family as my grandmother battled dementia was just incredible," she says.

He also could be relied on anytime of day when Masland was the safety co-ordinator helping Queens County seniors stay in their homes. "It didn't matter when I called this guy, whether it was two in the morning or 8 a.m. on a Saturday morning," she says. "He always was there."

Rafferty says when he graduated from Dalhousie in 1974 the first ultrasounds were available, and he knew the doctor who first named the segments of the human lung anatomically. "People don't realize how young health care is," he says.

He has possible retirement hobbies, such as fishing and genealogy, but his main interest remains health care. He's considering where he might be able to help. "There are so many areas where one can turn to assist," he says.

He's continuing to work in the field of addictions at Crosbie House, a not-for-profit recovery and addiction centre in New Minas run by a dedicated group of doctors, addiction specialists and volunteers.

His own opioid, barbiturate and alcohol addiction led Rafferty to his post at North Queens.

"I've had a colourful career, I guess I could say," he says. "I went to the Annapolis Valley and practised there for 20 years and ended up on the wrong end of a needle."

After the addiction nearly killed him, he sought treatment in 1993, generating a scandal at the time. In 1998, he moved to North Queens and resumed practising.

"They were so kind," he says. "I could never repay them for what they did for me. To give me trust was a huge thing for their community to do."