BC. working on remedies to cure the crisis of doctors: Dix

Jun 30, 2019 | | Say something

This story is part of an ongoing look at the challenges facing the health care system in Greater Victoria and B.C. Future stories will analyze possible solutions, things that work well and B.C. the government's continued efforts to reform primary healthre.

The b. The government is working on multiple fronts to improve people's access to family doctors and to fix what patients and doctors in Greater Victoria call a "crisis", says Health Minister Adrian Dix.

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Dix said he inherited a significant challenge when the NDP took power two years ago.

At that time, there were about 750,000 people in the province without a family doctor, despite the promise of the former liberal government to find a doctor for all who wanted one through their GP for Me program.

"The previous plan of the previous government had been abandoned the year before I arrived," said Dix.

The program made significant progress, but with the continued removal of doctors, it did not keep its promise.

"The number of people who needed a primary care provider increased in that time and it's not because the people who did it did not care or did not know what they were doing," Dix said. "It's hard."

The problems are particularly severe in Greater Victoria, where 18% of the population or nearly 60,000 people did not have a regular health care provider in 2015-2016, the most recent period for which Statistics Canada information is available.

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During the 2017 election campaign, the NDP promised to address the problem. It has adopted a team-based primary care approach in which physicians share the workload with specialized nurses, licensed practical nurses, registered nurses, addiction specialists, mental health, pharmacists, dieticians, and other health professionals.

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The goal is to make more efficient use of doctors and nurse practitioners by allowing them to focus on more serious issues, and direct some cases to other professionals.

To do this, the government is using a three-pronged strategy: establish primary care networks, open urgent primary care centers, and expand the number of nonprofit community health centers. (See our explainer for more details.)

"Younger doctors will not practice now or in the future the way more traditional doctors do," said Stephen Brown, deputy assistant health minister. "That is the change, the changing reality that the province is trying to address."

As part of the plan, the government has pledged around $ 225 million over three years to hire 200 new GPs and 200 nurses. The hope is that they work on the contract instead of the fee-for-service model, which pays doctors a fee for each service rendered. There is additional money available for primary care networks to add other health professionals and create team-based practices.

"This is a significant reform," said Dix.

However, the recruitment of these new professionals by the communities has been slower than the government expected, without an official number of how many have been hired under the new financing to date, and doctors, patients and other observers They are taking a big wait. focus.

"I think the government is really going in the right direction with care and team-based networks," said Dr. Martin Dawes, a professor of family medicine at B.C. "There is no doubt that they are part of the solution."

But that does not mean there are no problems.

On the one hand, it is difficult to build a network of clinics when some are closing their doors as older doctors retire or reduce their schedules, and younger doctors show little interest in establishing a classical family practice.

"The idea of ​​having networks is great, but right now, I'm not sure what they're going for," said Dr. Rita McCracken, a family doctor and researcher at B.C.

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McCracken favors more investment in community health centers. She questions the government's drive to open urgent primary care centers when the main problem is gaining access to a family doctor.

She is not alone

"There has never been an emergency care crisis in BC," said Dr. Vanessa Young, who teaches in the Medical Program at the University of Victoria and serves as board chair of the Family Practice Division of the South Island. . "It's a primary care crisis."

The repeated presentation by the government of new urgent care centers worries some family doctors.

"If primary care were solid, many patients would never end up in emergency rooms or urgent care centers for things like bladder infections or rashes or prescription refills, which is the vast majority of the type of patients who come to emergencies and emergencies, "Young said, noting that this is his personal opinion.

For some, the real problem is the way doctors are compensated.

Most family doctors still receive their payments using the fee-for-service model. But many say that the system is archaic, time consuming and does not cover its high overhead costs or compensate for long hours of paperwork.

"Most family doctors really feel that they do not receive adequate financial reimbursement for what they do, for the amount of training they had to go through and for the responsibility they have," said Dr. Robert Brown, a family doctor. . and medical director of Ocean Pier Medical Center in Sydney.

"That's why many people have abandoned community practice."

Dr. Eric Cadesky, former president of Doctors of B.C., says some of those problems are addressed in the new doctors' master agreement, including efforts to help doctors cover the rising overall costs.

"It does not cover rising general expenses, but it's an acknowledgment and it's a step in the right direction," he said.

The new agreement, which was approved this spring, also commits the government and doctors to working with other health professionals to form teams.

Negotiations with doctors in some regions have stalled on how much to pay new doctors and health workers allies who choose to receive a salary from the health authorities.

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More discussions between the government and family doctors and doctors of B.C. they are expected to take place in the autumn of a contract for physicians who have developed practices and wish to change the fee-for-service model. If successful, the changes could be implemented during the winter.

Dr. Jason Wale said that family practice is "one of the most challenging and rewarding areas of medicine." However, "unable to emotionally separate from patients who needed help 24-7", he moved to emergency medicine.

Wale said that it has reached a point where it is not uncommon for a doctor to diagnose metastatic cancer in the emergency room and arrange for the results of the patient's biopsy to go to an outpatient clinic.

"No one should hear about a diagnosis of cancer in an emergency room or in an outpatient clinic of a stranger who does not have more than a few minutes of free time, after waiting hours to be seen."

Wale applauds the efforts of the province and health authorities to develop team-based care, but given the seriousness of the "crisis", he said other solutions must come from "society in general." Otherwise, he fears that "change will not come fast enough."

Dix has indicated that it remains open to several different approaches, noting that there is no single way to increase access to family doctors.

"I'm trying not to get stuck in the models," he said. "I want these to be as efficient as possible, we want to see how they work and we will make changes if we need to make changes."

Cadesky agrees.

"There are things we should try that may or may not be successful the first time," he said. "It takes courage to work together.

"I am optimistic that within this framework, we can unite and find solutions because we have no other option, our health care system can not continue as it is going."

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