I arrive early at the North End Community Health Centre in Halifax, watching as people trickle in before the doors officially open. Some have been waiting since dawn, hoping to secure one of the few walk-in appointments available. Among them is Marie Landry, a 67-year-old retiree who’s been without a family doctor for nearly three years.
“I keep all my medical records in this binder now,” she tells me, patting a worn folder bursting with papers. “Every time I come to a walk-in, I have to retell my whole story. It’s exhausting, but what choice do I have?”
Marie is one of approximately 27,000 Nova Scotians currently without access to primary care. The province’s doctor shortage has reached critical levels, with rural communities hit hardest by what many health professionals describe as a perfect storm of retirements, recruitment challenges, and increasing patient needs.
Dr. Leisha Hawker, president of Doctors Nova Scotia, has watched the situation deteriorate over the past decade. “We’re seeing the results of long-term underinvestment in primary care,” she explains as we meet in her Halifax office. “When doctors retire now, their practices often close completely because there’s no one to take over. Each retirement can leave hundreds or even thousands of patients scrambling.”
The ripple effects extend throughout the healthcare system. Emergency departments across the province report increasing visits for non-emergency issues that would typically be handled in a family practice. At the Valley Regional Hospital in Kentville, ER physician Dr. Rebecca Brewer estimates that 30% of the patients she sees are there primarily because they lack primary care access.
“People come in for prescription renewals, minor infections, or management of chronic conditions,” Dr. Brewer says. “They apologize for being there, but they’ve tried everything else. Meanwhile, it backs up the emergency system for critical cases.”
What makes Nova Scotia’s situation particularly concerning is that those without a doctor are often the most vulnerable. According to a 2023 report from the Nova Scotia Health Authority, seniors, rural residents, and those with multiple health conditions are disproportionately represented on the provincial Need a Family Practice Registry.
In Antigonish County, community health worker Jessie MacDonald has witnessed this firsthand. “In some of our rural communities, particularly along the Eastern Shore, we have entire areas where no one has a family doctor,” she explains. “For people managing diabetes or heart conditions, this isn’t just inconvenient—it’s dangerous.”
The provincial government has implemented several initiatives to address the crisis. Last year, Nova Scotia Health launched its “More Doctors, More Care” campaign, which includes increased residency seats at Dalhousie Medical School, financial incentives for new graduates to practice in underserved areas, and expanded roles for nurse practitioners.
Health Minister Michelle Thompson points to early signs of progress. “We’ve recruited 160 new family physicians to the province in the past 18 months,” she noted in a recent press statement. “That’s more than the previous three years combined.”
However, critics argue these efforts aren’t keeping pace with the scale of the problem. The Nova Scotia College of Nursing reports that collaborative care clinics—designed to pair doctors with nurse practitioners and other healthcare professionals—remain understaffed. Meanwhile, the provincial registry of Nova Scotians seeking a family doctor has grown by 12% since January.
For Dr. David Gardner, who operates a small family practice in Yarmouth, the challenges are both systemic and immediate. “The current fee-for-service model doesn’t work for modern family medicine,” he explains during a rare break between patients. “We’re asked to manage increasingly complex cases in 10-minute appointments while handling more administrative work than ever. Young doctors see this and choose other specialties or locations.”
Indeed, a 2023 survey by the Canadian Medical Association found that medical residents ranked work-life balance and practice model as top factors in their career decisions—areas where traditional family medicine often falls short.
Community-based solutions are emerging to fill gaps. In Cape Breton, the Ally Centre has established a street medicine program that brings care directly to homeless and marginally housed individuals. In Bridgewater, a retired nurse has organized a volunteer network to help seniors navigate virtual care options and transportation to appointments.
Back at the North End Community Health Centre, innovative approaches are showing promise. The centre has expanded its team-based care model and extended hours, allowing them to accept more patients without overburdening individual providers.
Nurse practitioner Caroline Smith shows me around their renovated space. “We’ve redesigned our workflow so practitioners can focus on what they do best,” she explains. “Our social worker handles housing and income supports, pharmacists manage medication reviews, and mental health counselors provide therapy. It means our physicians and NPs can see more patients effectively.”
This integrated approach aligns with recommendations from Healthcare Excellence Canada, which identifies team-based care as essential for sustainable primary care delivery. However, scaling such models across the province requires significant investment and organizational change.
For Marie Landry and thousands like her, these systemic solutions can’t come soon enough. As she waits to be called for her appointment, she mentions that her neighbor recently moved to Ontario specifically to access a family doctor.
“I’ve lived in Nova Scotia my whole life,” she says. “I don’t want to leave, but sometimes I wonder if I’ll have to choose between my home and my health.”
As evening approaches and the centre prepares to close, several people who arrived too late for appointments reluctantly depart. They’ll try again tomorrow, joining thousands across the province in what has become a daily struggle for basic healthcare access—a struggle that reflects both the urgency and complexity of solving Nova Scotia’s family doctor shortage.
