Time is money: B.C. doctors' group proposes 'overnight' fix for primary care crisis

A new advocacy group of B.C. family doctors is coming forward to say the primary care crisis in the province isn’t the result of too few physicians, but a matter of priorities and compensation that could be solved virtually overnight. 

Family Doctors for Better Patient Care in B.C. is proposing a five-point plan to improve primary care, with the first and quickest action with the biggest impact being to pay general practitioners for the time they actually spend with patients – a move that would not require a dramatic overhaul of the system. 

B.C currently pays them per visit, no matter how much time they spend with a patient, which often leads to either rushed appointments or doctors making significantly less than their hospitalist counterparts. In Alberta, family doctors are paid under the fee-for-service model, but with “time modifiers” that allow them to bill the province when they need to spend more time with a patient.

There, family practices are thriving, with hundreds of doctors currently accepting new patients. 

“It's a very common sense solution to a problem that can be addressed relatively quickly,” said Dr. Carllin Man, a family doctor in New Westminster who also works in Alberta as a locum. “I know many (B.C.) doctors who spent countless hours seeing their patients and caring for them and they’re not being valued for it by our government in our current fee-for-services system.”

The document his group presented to MLAs in Victoria last week points out that B.C. has a high doctor-to-patient ratio compared to other provinces and would only require 8.8 per cent of doctors trained in family medicine to return to primary care practices to resolve the access issue; many currently work in hospitals where they make significantly more income without the burden of running a business.

“(Health Minister) Adrian Dix could do this overnight, almost,” said family doctor Erin Carlson. “It would get more doctors working as family doctors here instead of doing other work and that would help solve the crisis."

She points out that when the pandemic shuttered doctors’ offices and patients could largely only access care virtually, the provincial government was swift to adapt the system so that general practitioners could bill for telehealth on par with in-person visits.

“Solutions we could put into place right now to turn this crisis around on a dime,” insisted Carlson.

PREMIER NOW DIRECTLY INVOLVED IN ‘RESET’ WITH DOCTORS

After an eyebrow-raising misstep by the health minister that further damaged the already-deteriorating relationship with physicians when he suggested nurse practitioners provide better care, the premier is now directly involved with the situation. 

“It is a crisis,” acknowledged John Horgan last week, as doctors and patients gathered on the legislature grounds to demand solutions. 

He also revealed to reporters that when he met with the Doctors of B.C. earlier in the week, he considered it a “reset” of their relationship and a chance to move forward, but cautioned that true progress could only happen if the federal government accepted the demands of Canada’s premiers for more health-care funding.

“Over the decades, the federal component of delivering health care has gone from about 50 per cent to less than 25 per cent – that's had a huge impact on the government’s ability to provide services, which is our jurisdictional responsibility,” Horgan said, insisting that several payment models and funding options are on the table.

“We can't do that without an infusion of cash. the federal government is starting to come around to that and I'm hopeful we can have a new vision for healthcare in the 21st century that includes a federal government that's fully participating in the delivery of these services by funding them adequately.”

PATIENTS INCREASINGLY IMPATIENT FOR SOLUTIONS

With an estimated one million British Columbians without a family doctor, the stakes are high for those seeking a long-term relationship with a health-care provider who can see to their problems before they become serious enough to need urgent or emergency care. 

But even those with family doctors are typically waiting several weeks to see them, and a few are going to considerable lengths to keep the one they have. 

"I go back to Vancouver," said Victoria resident Steffani Cameron, who relies on friends to find accommodation on the mainland. "I don't feel it's an option. What other choice do I have?" 

She spent more than four years travelling the world and working abroad and her experience with multiple health-care systems has her particularly frustrated at policymakers’ lack of innovation and agility to adapt to changing challenges and issues in B.C.’s system. 

“I think it’s a lack of intelligence, a lack of perspective, a lack of worldliness, a lack of experience, a lack of creativity,” said Cameron. “There’s a whole lot of lacks right now with the attitude the provincial government has about medical.”

As patients struggle, so do the physicians putting in long hours of paperwork and administrative effort to keep their doors open – and finding it increasingly not worth it.

“We really need to change the system now to stop the bleeding of family doctors leaving practice,” said Man.