The B.C. government promised to find everyone a family doctor by last year. It didn’t happen. And it won’t happen this year, either. Finding and keeping family doctors might be a difficult task, but it should not be an impossible one. Yet the government has moved the goalposts, saying that instead of a doctor, patients might have to see someone less qualified.
This is a disgrace. Family-practice medicine is called primary care for a reason. It is the principal point of access to any properly organized health-care system.
By defaulting on this commitment, the government is inviting patients to crowd hospital emergency departments instead. That is bad medicine and a huge waste of scarce resources.
The province committed $132 million to a program called A GP for Me during the 2013 election campaign. At that time, 200,000 British Columbians needed family doctors, an increase of about 25,000 over 2010. Negotiated with the Doctors of B.C., the program aimed to match all British Columbians with a family doctor by 2015.
However, Health Minister Terry Lake admitted last year the program wouldn’t meet its goal. Health Match B.C., a health-professional recruitment service funded by the province, has postings for 329 permanent family-doctor positions in B.C. Of those, Vancouver Island accounts for 57 postings, 11 in Victoria.
“Was it a very stretched target? Yes. There is not a jurisdiction that I know that’s been able to achieve it,” Lake said.
That makes it sound as if the whole exercise is beyond our capacity to plan. But doctors are not like truffles. We don’t send pigs to forage for them under trees. We train them at our universities. If we have too few, we must educate more.
It costs the government about $500,000 to educate a general practitioner. That means training 200 more doctors would cost about $100 million — not a huge amount for a ministry that spends $18 billion a year.
The province has already more than doubled the number of spaces for medical students, from 128 in 2003-04 to 288. Certainly, all those new doctors would have to be paid after they graduate, but paying general practitioners is a far cheaper way to treat people than looking after them in emergency wards.
Finding good candidates is easy. Applicants with grades in the 90s who scored in the 99th percentile on their medical aptitude tests have been rejected at the University of British Columbia.
In Canada, 98 per cent of medical students graduate. The challenge is getting in the door in the first place.
Besides numbers, of course, the dilemma is how to get those newly graduated MDs to choose careers in the locations where we need them.
Family practice can be a meat-grinder for doctors who have to churn through as many patients as they can. Current medical thinking emphasizes team care. Creating teams of caregivers, with doctors, nurse practitioners, pharmacists and others can provide a more satisfying and safe environment.
There’s an element of this in the province’s new approach. It talks about matching patients with clinics that offer such multiple services.
At the same time, the province and Doctors of B.C. are discussing different ways of paying doctors that better meet contemporary needs.
Some new doctors, whose pay might be relatively low, can find themselves with $2,000 in monthly student loan payments. The need to pay off those loans often makes rural practice financially unattractive, even taking into account the higher pay offered in rural areas.
Better pay arrangements aren’t the only incentive for doctors, but they’re one effective carrot that the province can offer as it tries to encourage career choices.
This is an essential service. The government must keep trying.
