The following is an open letter to British Columbia Health Minister Adrian Dix and B.C. residents from provincial doctors in their first five years of practice (names appended at bottom of letter):
By now, most British Columbians are aware of how painfully difficult it may be to find a regular family doctor. The reality is that primary care, the first point of contact with the healthcare system, is on life support.
Many jurisdictions across the province and nation are trying different variations of a multidisciplinary approach involving allied health providers (nurses, counsellors, social workers, physiotherapists, et cetera), but it seems we have forgotten about our family doctors at the core of it. The gradual loss of longitudinal care (ongoing care provided over an extended time frame) has been palpable in far-reaching ways and remains woefully unaddressed.
About one in five residents of British Columbia do not have a regular family doctor. Many headlines speak about a shortage of family doctors. I do not believe that we are short of family doctors but, rather, that the current environment has encouraged a shift to other types of work that are more supportive of a work-life balance.
The result is that we are now seeing emergency-department doctors providing primary care like refilling prescriptions or making delayed diagnoses such as metastatic cancer; this is incredibly inappropriate and inefficient on many levels.
The evidence has long been clear but not been paid heed to: ongoing, comprehensive care from a regular family doctor improves health outcomes and results in fewer visits to emergency departments and hospitals. This is ultimately cost effective to the system: a visit to the emergency department costs $300 to $500; a hospitalized patient costs $900 to $3,300 daily; staying in the intensive-care unit is $7,300 daily at Vancouver General Hospital.
The revival of longitudinal care by better compensating family doctors will help prevent many of these costly visits. It is perplexing, then, that the government system disincentivizes family doctors from addressing multiple issues or spending longer with patients that need more time but instead incentivizes a walk-in model with one issue per visit.
For instance, a family doctor is paid about $30 for a visit for a Pap smear alone. If a second issue arises, which commonly occurs, the doctor is only paid 50 percent for that second concern, and only if it is deemed “medically necessary”. On top of this, this is a special case for Pap smears and certain other matters; for most other issues, family doctors are only paid to address one medical concern per visit, regardless of how many topics they actually address.
Additionally, the rates that family doctors are paid have increased by only five percent in the past nine years, despite the skyrocketing costs of running a clinic in Vancouver. Finally, keep in mind that in that single visit that charges $30, the doctor still needs to pay for their office and staff, which takes away one-third of their income (they get about $20).
Family doctors are capable of providing cradle-to-grave care; they complete about 11 years or more of postsecondary education. There is simply no replacement for this training, nor does it end upon graduation. Along with other specialists, family doctors are required to engage in ongoing medical education in order to maintain their licenses so that they are up to date with the latest research. The licensing body will soon, in fact, be implementing an additional year of residency training prior to graduating a family doctor.
Simply put, other allied care providers provide adjunct support to the primary-care team but they cannot replace the expertise or training of a doctor, despite being perceived as lower-cost alternatives. In fact, there is already evidence from the United States that they are higher-cost alternatives.
And, no, Google is not a replacement for the expertise offered by a family doctor either.
It is ironic that despite family doctors caring for the general population, the system does not afford for the same reciprocal support. Family doctors need to pay for all expenses involved with running a clinic and its staff. They do not have paid vacation time, health benefits, or pension plans. Hours are spent every week on writing or reading reports and reviewing lab results, and family doctors are expected to be available by phone outside of working hours 24/7, but none of this time is compensated for.
The research is available for the government to review, and that includes surveys from family doctors. Family doctors feel undervalued and unrecognized by the government at the frontline of our healthcare system. One approach not considered by the government would be to provide funding for the overhead expenses of operating a clinic, allowing family doctors to focus on the medicine rather than the business aspects of a clinic.
Though existing infrastructure exists, the government chose to spend money on building new Urgent Primary Care Centres, which fails to prioritize longitudinal care over episodic care. These units are akin to government-funded walk-in clinics or basic versions of emergency departments. Simply spending more money doesn’t improve our health; we need to be more strategic in how we are investing our healthcare dollars.
Family doctors advocate for patients every day, whether you are aware of it or not and whether it is appreciated or not. Now we ask for one thing. We ask that you advocate. Advocate for your primary care system, for your health, and for us. Advocate for better support for family doctors in the province and make B.C. a place to stay, work, and live. Allow our voices to be heard by speaking out for us and advocate on our behalf with both local and provincial MLAs, as they are the ultimate decision makers in shaping the current trajectory.
It does not matter how many pleas or innumerable facts are presented, it comes down to our elected decision makers. We are family doctors within our first five years of practice, and the landscape looks bleak if we cannot collaboratively make meaningful changes.
How you can help:
- Visit this link and automatically send either a pre-set or custom message to the MLA in your local area identified by putting in your postal code. https://bccfp.bc.ca/myfamilydoctorcares/#newmode-embed-16258-46812
- Join the B.C. Health Care Matters Rally for Change, either in person or virtually, on May 19. See details here: https://bchealthcarematters.com/
- Dr. Donna Lee
- Dr. Melissa Ng
- Dr. Sandy Hu
- Dr. Allan Jone
- Dr. Michelle Lee
- Dr. Andrea Dann
- Dr. Pegah Afshar
- Dr. Kristie Wong
- Dr. Forson Chan
- Dr. Dennis Ma
- Dr. Simon Lai
- Dr. Hasan Abdullah
- Dr. Soraya Nazerali-Lorenzon
- Dr. Quinn Harris
- Dr Rachel Adilman
- Dr Grace Lee
- Dr Afrah Raza