Bridging the Gap in Physician Retirements and Ensuring Patient Care

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The Transitioning in Practice, Transitioning Out of Practice (TIP-TOP) program, part of Nova Scotia Health’s Action for Health plan, is transforming how family physicians transition their patient care while retiring.

Dr. Michelle Dow, an experienced family physician at the Clare Health Center in Meteghan Centre, and the former MD Recruitment and Retention Lead for the Western Zone, shares how the TIP-TOP program helped her smoothly transition out of practice while ensuring a seamless transfer of care for her patients.

The TIP-TOP program helps physicians transition in and out of practice by allowing an overlap between retiring doctors and those starting their careers, ensuring continuity of care for patients, and a smooth transition process for both physicians.  

By connecting experienced physicians with new or incoming doctors, the program reduces the number of patients left without a doctor and provides mentorship for the next generation of healthcare providers.

Dr. Dow, one of the first to introduce the program to the Western Zone in 2022, saw firsthand how valuable it could be. " I knew about the program and wanted to get involved. Doctors Nova Scotia and the Department of Health and Wellness (DHW) were helpful in setting it up in the Western Zone and supporting my successor with the process," she said.

With over 35 years of experience in family medicine, Dr. Dow has been actively involved in physician recruitment efforts while maintaining her own practice. "When I was involved in TIPTOP, part of my job was focused on recruitment, which allowed me to meet many of the residents and students training in our area," she said. "Being able to recruit residents who have trained in our community for two years is invaluable. They’re familiar with the local needs and the patients, making it easier for them to step into practice."  

Through her role, she has helped numerous residents transition from trainees to full-fledged physicians, while also easing into her own gradual retirement.

Dr. Dow’s experience with TIP-TOP symbolizes the program’s focus on ensuring patients are not left without a family doctor during the physician transition process. Her last medical resident in the longitudinal program, Dr. Emma Leon spent two years working alongside Dr. Dow, eventually taking over two-thirds of her patient roster. "The TIPTOP program allows for continuity of care," Dr. Dow said. "Patients already knew Dr. Leon from her time as my resident, so it was an easy transition for them when she took over their care. This way, patients don’t have to go on the Need a Family Practice Registry, and they don’t experience a gap in care."

One of the primary goals of Nova Scotia Health’s Action for Health plan is to provide faster, better care for all Nova Scotians, and the TIP-TOP program aligns perfectly with this objective. By facilitating a smooth handover of patient rosters between retiring and new physicians, the program improves access to care and prevents patients from having disruptions with their care.

“By investing in succession planning, we bridge the gap between experienced physicians transitioning out of practice and the new generation stepping in, ensuring a seamless exchange of knowledge, mentorship, and uninterrupted patient care,” said Katrina Philopoulos, Director, Physician Recruitment at Nova Scotia Health. “TIP-TOP not only guarantees that patients experience no gaps in treatment but also supports a smoother, more structured transition for both outgoing and incoming physicians. Ultimately, it creates a stronger, more sustainable future for healthcare, where practitioners can confidently step into or out of practice, knowing their patients are taken care of.”

The TIP-TOP program involves thoughtful planning and coordination. While some doctors may know someone who could take over their practice, others work with Nova Scotia Health’s recruitment team to find the right fit. This teamwork helps ensure a smooth transition for both the retiring doctor and their patients.

"Having both of us working in the same practice means there are two sets of hands available, which definitely helps with access," Dr. Dow noted. "I have more experience, so I tend to see more patients per day, and most days offer same-day appointments. Patients benefit from having two doctors available during this transition."

Dr. Dow emphasizes the give-and-take learning that occurs between an experienced physician and their successor. "I’ve been in practice for 37 years, so I know my patients well, and I can pass that knowledge on. But, it’s also a two-way street, I learn from the medical residents too. It’s a nice back-and-forth exchange."

Dr. Dow’s involvement in TIP-TOP has not only helped her transition out of full-time practice at her own pace but has also strengthened the patient care landscape in Nova Scotia. "I think TIP-TOP is brilliant," she said. "It’s helping both patients and doctors, and ultimately, that’s what healthcare should be about." As she looks ahead to her retirement, Dr. Dow is confident that her patients will continue to receive the high-quality care they deserve—thanks to programs like TIP-TOP.

What’s next for Dr. Dow? Michelle looks forward to retiring next year, continuing her role as Family Medicine Department Head in the Western Zone, and spending more time with her grandchildren, traveling, and enjoying nature through activities like kayaking, canoeing, and making maple syrup—now with the peace of mind that, thanks to the TIP-TOP program, her patients are in good hands, with Dr. Leon.

Photo of Dr. Emma Leon (left) Dr. Michelle Dow (right). Photo Credit Doctors Nova Scotia