What a N.S. palliative care unit tells us about Canada’s rural health care challenges

Nova Scotia Health needs doctors, nurses and other staff to open its five-bed palliative care unit at Fishermen’s Memorial Hospital in Lunenburg, N.S., according to a spokesperson. 

The challenge of finding qualified staff continues to delay the unit’s opening more than four years after it was announced. 

“Efforts are focused on continuing to work on securing the rest of the team needed to open the beds,” said the health authority, which hired a medical director for the unit in June. 

“Staffing the unit is more complex than simply looking at the numbers,” a spokesperson said when CBC News asked how many more staff are needed to open the unit.

“For example, when we hire different types of nursing staff, their competencies vary, so it’s not as straightforward as having a set number of positions.”

Daniel Nowoselski, senior advocacy manager for the Canadian Cancer Society, says this is a reality that many palliative care units, home care services and hospices around the country face, especially in rural communities. 

“Unfortunately, this is not a unique situation,” he said. “These challenges are very significant and they are going to continue to impact us, particularly as demand rises.”

According to Statistics Canada, seniors could represent more than 20 per cent of the country’s population by 2030. 

While palliative care isn’t exclusive to older people, Nowoselski said, aging is one of the contributing factors to higher demand. 

Nova Scotia’s rural populations are aging more than urban communities. According to a 2023 report by the Nova Scotia government, the median age continues to climb in most of the province, with the exception being the Halifax and Cape Breton regional municipalities.

Nowoselski said the exact number of specialized palliative care staff nationally is unknown, so the number needed to meet current demand is also a mystery. 

What we do know, he said, is that “we don’t have enough people who are trained and able to deliver those services across the country.” 

Dr. Caitlin Lees, an assistant professor at Dalhousie University’s division of palliative medicine, says while urban areas have greater demand due to larger populations, attracting palliative care specialists to rural areas is difficult.

“Part of the issue there is that there’s a smaller community of practice, we would call it. So there’s not as many other physicians around for support,” she said. “And a lot of people want to live in cities.”

She said she typically has one or two graduates specialized in palliative care from the family medicine training stream each year.

Lees, who also works as a physician in the field, said there are other factors keeping people from the profession. 

“It’s one of the lowest-paid medical subspecialties. So I could do other work in internal medicine and make a lot more money, but I don’t because I really love my job. But I think for trainees that are coming up now in particular, their debt loads are much higher,” she said.

“It’s difficult for them to wrap their minds around doing an extra one to two years of training to actually be a palliative medicine subspecialist and then make much less money than they would have been in another field.”

According to the Association of Faculties of Medicine of Canada, graduates have an average debt of $84,172 for medical school expenses, on top of non-education related debt.

And it’s a job that comes with a great emotional burden, Lees said.

“It’s difficult to build relationships with patients and their families and then have them go on to die,” she said. 

Keith Savory, whose mother and father lived close to Fishermen’s Memorial Hospital, says he would like to see a palliative care unit closer to home.

When his mother needed palliative care, he and his family had to travel over an hour away to Kentville and spent a considerable amount of money renting an Airbnb to be close to her during her last three weeks. 

But he said he realizes some families aren’t able to do what his family did.

“I think maybe some of these people don’t have the capacity to travel, to cancel [work] every day. There is the cost factor.”

As for Lees, she said it is important to plan ahead considering the aging population in rural areas.

“We know from our family medicine training program, but when we train residents in those areas, they’re more likely to stay,” she said. “So improving capacity for training subspecialists like palliative medicine specialists in more rural areas would probably improve access as well.”

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