The worldwide pandemic highlighted the good fortune of Canadians. We experienced the extraordinary dedication of those who work in our hospitals, long-term care facilities, public health, and community services. Indomitable humanitarian efforts were sustained, even when caregivers faced insults, abuse and criticism.
At the same time, the pandemic shone a light on the glaring need to improve our health system, especially for seniors.
I claim the very foundations of patient care are in serious difficulty, resulting, in part, in the difficulty many citizens encounter in finding a family physician. We can and must fix family practice.
The problem is often blamed on a contemporary shortage of family doctors. But while there is some truth in this, difficulties in family practice are no recent phenomenon.
The reason is clear. Our current practice model, established far in the past, is inadequate for the needs of today. Its shortcomings are apparent.
First, most family physicians want to exemplify their training, expertly managing clinical issues with their patients. This is their calling. The burden of administration — hiring, billing, budgeting and reporting — is a distraction that exhausts and distracts.
Second, the current fee-for-service model encourages volume rather than in-depth patient care. It does not fit with the changes in society’s health needs.
As our population ages, treating chronic diseases, such as dementia, diabetes and mental-health disorders, occupy an ever larger part of any family physician’s practice.
Imagine the frustration in trying to maintain an adequate quality of care in these circumstances. A physician visit of only a few minutes for the typical patient with complex needs is not acceptable for most physicians, and inadequate for people with multiple ailments.
Third, patients with chronic disease are not well served by a sole medical practitioner. They require the services of a multidisciplinary team.
Lastly, the billing system is a mess. Some family physicians may not be remunerated adequately, while others are billing far above the average. This raises questions that are frustrating for physicians and patients: How many patients should a physician see to earn a reasonable income?
The public has waited too long for answers to these questions, and will no longer stand for a lack of access to care. If nothing is done, those who have resources will find and pay for private services.
A future will unfold where patients who can afford it will get primary health services that will cost more than a reformed system, and we will see physicians under more control with less independence than they would working within a team.
I suggest the following to move forward:
• All parties must focus on the health and well-being of our citizens.
• The provincial government should provide substantial new funding for transition to a multi-disciplinary team model, ensuring there is fair compensation to physicians and others in the team.
• Family physicians must accept the need to change from an outdated practice model to one that better serves current health needs.
• The Doctors of British Columbia must support these changes and actively promote them to the profession and the public.
Primary health services are in serious difficulty. Citizens need these front-line services. All primary health professionals could be accomplishing more and gaining more satisfaction.
If these essential services are not fixed, we will see erosion to privatized primary health services and eventually privatization of the whole health system.
I implore readers and physicians to support reforms that will create everyday health services with hopes that Saskatchewan’s Joni Mitchell is not prophetic in her lyrics: “You don’t know what you’ve got, ’til it’s gone.”
