A promise, you might think, is a promise. So what are we to make of this one? Five years ago, the provincial health minister of the day, Kevin Falcon, offered the following pledge: 鈥渟a国际传媒 commits to a family doctor for everyone by 2015.鈥�
That commitment has not been met. While estimates vary, it鈥檚 believed about 250,000 British Columbians who want a GP cannot find one. That number hasn鈥檛 varied greatly since Falcon gave his word five years ago.
In fairness to the minister, and others who have held his office, it鈥檚 not for lack of trying. Since 2006, the Health Ministry has plowed an additional $700 million into family medicine. Among other things, that enabled the University of British Columbia to increase dramatically its intake of medical students. In 2003, 128 students entered the program. This year鈥檚 enrolment is 288. sa国际传媒 now has more physicians per capita than ever before.
So with all this effort, why are so many patients still unable to find a doctor?
The traditional answer to this question went as follows: Partly, it鈥檚 because the average GP works fewer hours than previously.
Partly, it鈥檚 because patients today are more likely to have chronic ailments associated with aging 鈥� diabetes, heart disease, arthritis, Alzheimer鈥檚. These conditions require intensive and prolonged treatment, meaning family doctors can鈥檛 see as many patients.
And partly, it鈥檚 because general-practice medicine has become vastly more demanding. Most GPs say they are doing work today that would have been handled by a specialist in the past. And those responsibilities are time-consuming.
In short, the conventional explanation is that we鈥檙e asking too much of GPs, and the conventional solution is to hire more of them 鈥� a lot more.
Dr. Bill Cavers, the outgoing president of Doctors of sa国际传媒 (formerly the sa国际传媒 Medical Association), believes UBC should be enrolling not 288 medical students each year, but 450. That鈥檚 a massive expansion.
But increasingly, this solution is being questioned. There is an emerging consensus that the problem is not so much a shortage of GPs, as an outmoded model of care.
Physicians at the cutting edge of family medicine believe their field has become too broad for single practitioners working in isolation. They advocate the creation of community clinics, where doctors, nurse practitioners, social workers and various therapists can work as a team.
That, however, presents a problem. Across the country, the vast majority of GPs are either employed in private practice, as they always have been, or in hospitals. Only a tiny minority work in community clinics.
And outside Quebec (which manages family medicine more aggressively) no one has come up with a solution to change this mindset. Here in sa国际传媒, the ministry has tried offering financial incentives, with only limited success. The College of Family Physicians is also pushing the team model, again with modest results.
Perhaps it鈥檚 time for a different approach. Money talks, but withholding it talks louder.
This is, basically, the Quebec approach. Family physicians who choose not to work in clinic settings, when opportunities are available, see their billing rate reduced.
It would take time to introduce such a policy here. Older GPs with established practices might have to be excused.
But it is clear by now that offering incentives for modernity, yet hesitating to demand it, is taking too long. The ministry鈥檚 caution is understandable. Medicine is full of complexity, and there are drawbacks in any form of government intrusion.
Yet, at the current rate of progress, another decade will pass and there will still be thousands of patients without a GP. This is the front line of what is supposed to be a universal health-care system. It must be accessible to everyone.
