Thread by @andrewbmaclean

Let me tell you a story about “orphan patients”. I’ve been tracking the #NB wait list for a family doctor or NP since 2016 via published news reports. In recent months, things have fallen off a cliff. Here’s the deal 🧵:

The Patient Connect list launched in 2013. The list grew steadily for a few years. I think the growth had less to do with ⬆️orphaned patients, and more to do with creating a list. A stable and growing list probably was a good thing, as people signed up.

According to the province, the list has a lot of churn. People get added to the list and leave it fairly quickly; most people are orphaned for a couple of years, not five or ten. Net numbers are important to track; are we improving or getting worse?

In Dec 2016 the list was at 18,000. We added about 1 net new person to the list a day.

In Dec 2017 it was 21,000. We added about 7 net new people to the list per day.

By the end of 2018 we’re at, ~25,000; 29 people added per day.

Government switched; but the pace continued through 2019 and we got to 39,000 = 31 net new people added per day.

Pandemic hits. In 2020 there was standstill; either the province was making serious progress on recruitment or no one added their name to the list at all because of world being on fire. We started the year with 39,000; we ended the year at exactly the same point.

During this, promises are made that everyone in NB will soon have a family doctor or NP - but the best we can do is keep it stable. Province argues other places are worse, so comparatively things are good. @doctorcountdown

Then 2021 arrives and the whole thing is still pretty stable until November, around 40,000 people...

Fast forward to today; we learned this week that the list has exploded. The list ballooned by 5000 people in December; 4000 people in January; and 5000 people in February.

This means we’re adding 100 people to the list DAILY.

Maybe it’s a new system of tracking; maybe there was pent-up demand; maybe the there’s a deal I am unaware of where for a *limited time only* you get $20 for signing up. I don’t know.

At this point, every week we need a new nurse practitioner to handle this growth, or a net new family doctor every ~2 weeks. That’s assuming not a single provider retires or moves.

Nothing in health is linear, but: the more people have no provider and go to ED, the longer the wait times there, + the more paramedics are stuck on "offload". The more patients each doctor takes on out of obligation/ desperation, the longer it takes to see your doctor or NP.

The cities are hardest hit: Fredericton has the longest wait list, followed by SJ and Moncton.

I worry that a stretched system is teetering because of a fundamental, evidence-based certainty: the system begins and ends with good primary care. The wait list needs taming. Now.