Wait times to see a dermatologist are now so long, provincial Health Minister Terry Lake has felt obliged to intervene. Lake visited the only skin-care specialist in Kamloops recently and inquired what could be done.
There is indeed a problem. But why the minister undertook an 800-kilometre round trip is unclear.
All he had to do was spend an hour or two in Victoria 鈥� things are just as bad here. It takes at least six months to see most dermatologists in the capital region. Some patients wait a year and more in Nanaimo.
Several regional centres, Prince George among them, have only one skin-care specialist to serve the entire population.
And this isn鈥檛 a recent occurrence; it has been going on for years.
In short, this is not a localized inconvenience; it is a provincewide crisis.
Slow service is not unique to dermatology. Generally speaking, sa国际传媒 has a dreadful record in specialty medicine. Nationwide, our wait times are some of the worst in the developed world.
Nevertheless, while there are often delays to see other specialty providers such as allergists and orthopedic surgeons, wait times for dermatology are a medical disgrace.
One aspect of the problem is apparent: sa国际传媒 has too few skin specialists. With only 69 to serve the province, we鈥檙e well below the national average.
Why this situation arose is another matter. Dermatologists believe it all comes down to money. And they do have a case: Their fee schedule is one of the lowest in sa国际传媒. That leads a growing number to look for greener pastures elsewhere 鈥� their colleagues in Alberta make twice as much.
Yet compared with other specialists in sa国际传媒, dermatologists do pretty well. In 2006, (more recent figures are unreliable) they were by far the highest-paid medical specialists. Their yearly billings averaged $367,500, 40 per cent above the group average. They also billed more than some surgical specialists (who are usually the top-ranked earners).
In short, there is more going on here than an inadequate fee schedule.
A different aspect of the problem lies in a quirk of our health-care system. It鈥檚 against the rules for physicians to bill the Medical Services Plan for an insured service, then also charge the patient. Doctors who want to have a private practice and set their own fees must leave the public system, a financially risky proposition.
But there is nothing to prevent physicians billing government for insured services, and charging their clients for uninsured add-on treatments. That鈥檚 what some dermatologists are doing.
So-called 鈥渕edi-spas鈥� are sprouting up, where clinical procedures such as skin-cancer treatment are offered alongside cosmetic services like Botox injections.
As the current legislation stands, this is not illegal, nor is it considered a breach of medical ethics.
Most physicians occasionally charge for minor uninsured services, such as providing a vaccination to someone travelling abroad. But usually, these take up only a small part of the doctor鈥檚 time.
The problem in skin care is that cosmetic work is rapidly growing beyond a sideline. A number of dermatologists in sa国际传媒 are now committed full-time to this form of practice, and many more devote substantial chunks of their work day.
Moreover, because these clinics combine public and private care, taxpayers are contributing to their upkeep. The owner of one such operation on Vancouver Island billed the Medical Services Plan $330,000 last year.
It鈥檚 clear a complete rethink is needed around the financing of this service. Dermatologists appreciate being able to keep a foot in the public system, while offering a private service.
But patients with urgent medical problems shouldn鈥檛 have to compete with a beauty parlour for their physician鈥檚 time. That鈥檚 not how our health-care system is meant to work.
