As a family doctor, working in Greater Victoria for 20 years, I want to thank Health Minister Adrian Dix for his continued commitment to primary care through his ministry’s efforts in the development of Primary Care Networks (PCNs), Urgent and Primary Care Centres (UPCCs) and the increased role for nurse practitioners in our health-care system.
These initiatives offer important steps towards addressing an increasingly dramatic crisis in primary care. I know that the answers aren’t always easy, nor welcomed by all, and so thanks to Dix for moving in a direction of positive change.
Unfortunately, despite these efforts, the crisis in primary care continues to intensify and I am deeply concerned that current efforts are not adequately addressing the root causes of the challenges we are facing.
Communication breakdown
I remember reading a study, published in the 1990s, about the effectiveness of international development aid in less-developed countries. The results were predictable and tragic.
Those projects — new schools, water wells, clinics, road building — that did not involve the community leaders (and the users of the services) in their development, implementation and ongoing maintenance and evaluation, ultimately proved unsustainable and ineffective. This happened consistently, no matter how well intended, or funded, a given project might have been.
We have a serious communication breakdown in health care. While there are good intentions and committed funding, there is an insufficient mechanism for community members, physicians, and other health-care providers to give their input as to what might be effective change in our primary care reform, and whether a given initiative is working or not.
UPCCs have had significant difficulty maintaining physician staff and creating the attachment (patients having a primary care practitioner) that they promised. PCNs currently provide only 0.1 full-time equivalent of allied health provider service per family doctor.
And while nurse practitioners are offered paid office-overhead coverage, most family doctors struggle to support the business of their practice with an antiquated fee-for-service model. In the past four months alone Eagle Creek, James Bay and Cook Street Village walk-in clinics have closed, unable to find physicians, and funding, to continue.
Many physician leaders I have spoken to sounded this alarm many years ago, when this agenda was initially proposed. The intention is good, and even evidence-based, however the communication, inclusion and transparency of the implementation did not adequately involve, nor listen to family doctors, who know primary care better than anyone. These initiatives will simply never be a solution without more inclusive communication.
Valuing family doctors
More than 50 per cent of all physicians in Canada meet the criteria for burnout, and 45 per cent of us are planning on decreasing our clinical practice in the next two years, according to the latest Canada Physician Health Study conducted by the Canadian Medical Association.
In B.C. we have 900,000 people (and counting) without a family doctor. The average family doctor is unable to compete with the UPCC contracts, or nurse practitioner overhead payments.
We are working within a system of ever-mounting complexity, stress and administrative burden, often working hours after our clinic doors close, and our children have gone to bed.
For all of these reasons, we will continue to see family doctors pull back from longitudinal family medicine, and our new physician graduates choosing alternative paths that are available to them. We will continue to witness more clinics closing.
We will continue to have an ever-greater number of British Columbians without a primary care provider. We have but seen the tip of this iceberg.
Family physicians are, understandably, feeling undervalued. We do the work we do because we care. We will fit patients into an already overcrowded schedule; advocate for those without a voice; and spend 45 minutes with a patient in crisis (even though we only get paid for 15).
On any given day we are called to be clinicians, counsellors, coaches, teachers, social workers, administrators, and business owners. And yet we B.C. family doctors lack overhead support, disability insurance, adequate pay (compared to other provinces and specialties), and even sick days.
As a veteran family doctor, it feels in health care as though we are rearranging the furniture — or even buying a new, fancy appliance — whilst the foundation of our home crumbles….
Communication and value are foundations of any relationship.
When we feel cared for, and worthy; when open, honest communication is present, we flourish. When they are not, we wither. Somewhere along the way we have lost the plot of why health care exists at all. It is about caring for each other and our society. In order to build a robust, efficient, and compassionate primary care system that cares for our population, we need to take care of our family doctors.
I will be joining the B.C. College of Family Physicians, B.C. Health Care Matters, and thousands of British Columbians on the legislature lawn on May 19 to honour World Family Doctor Day.
Along with hundreds of family doctors from across the province, I will be closing my clinic practice for this day in order to raise awareness of the gravity of this situation, and the need for immediate emergency measures to prevent further deterioration of this primary care crisis we are facing.
I can no longer witness my colleagues suffering, patients going without appropriate longitudinal care, and emergency rooms filling with people who simply needed a family physician, without doing something about it.
We are ready, willing and eager to help PCNs, UPCCs and NPs succeed, we just need to adjust the recipe. We want to continue our practice of caring for families and seek fair remuneration and practice support to sustain the health of primary care. We’re committed to dialogue where we seek to understand one another’s barriers so we can get on the same side of the problems and collectively resolve them.
We want to innovate and become centres of excellence for B.C. through primary care transformation. Given the will, I believe we can do it together.
Will Dix stand with us so that we can better take care of others?
