Congratulations to the teachers of British Columbia on their recent victory in court. It should not have taken 15 years, but justice did prevail thanks to their tenacity. I think that the doctors of British Columbia have failed the citizens of this province by not similarly challenging the government.
In 2001, the newly elected B.C. Liberal government had inherited a binding-arbitration award that was brought about by the failure of negotiations between the preceding NDP government and the- then B.C. Medical Association. The arbitrator made some excellent suggestions — particularly with reference to family practice.
Justice Allan McEachern clearly stated that he thought there was an under-appreciation of the value of family physicians’ services. He thought that offering 24/7 coverage deserved some payment. This service is a requirement to maintain a B.C. medical licence; and this results in an apparently cynical attitude of “why pay for something which is obligated to be provided [for free].” It is still unpaid.
He suggested that a telephone repeat prescription does require time to review the medical record, prepare the prescription and send it to the pharmacy — and that there should be paid at one-quarter of an office visit. He was also in favour of electronic communication (telephone and email) at one-half of an office visit.
Then-premier Gordon Campbell, in a Trump-like move, rejected the entire award as not “binding” on his incoming administration.
The BCMA renegotiated with the government — the result of which, in my opinion, has been the death knell of family practice in this province. The new contract focused on chronic-disease management and complex-care management. This involves spending at least 30 minutes with patients, and subsequently drawing up a detailed treatment plan. Maintenance of flow sheets was mandatory.
Similar treatment-plan documentations are demanded for mental health. The outcome of this is that paperwork, already heavy, became untenable — resulting in physicians having to cut back their hours of patient contact to comply with these demands.
The laudable aim of these measures was to improve the care of patients with the hope of reducing emergency-room visits and hospitalizations. The evidence is coming in that this is not happening. This, in part, is because physicians were already doing an excellent job.
The result of this 15-year experiment is that the younger physicians are just not interested in entering family practice; and who can blame them, when they can work as a hospitalist seven days on and seven days off, and no paperwork on those days off. They can work in specialty clinics such as sexual health — at the end of the shift, they can go home with no forms to fill or reports to prepare.
It is not a simple matter of remuneration — some of the current fees are generous, but at an unacceptable cost to the quality of the family physicians’ professional and social life. It is disheartening to complete mostly meaningless forms and reports.
After going in the wrong direction for over a decade, and to compete with hospitalists and similar positions, it will be necessary to provide fully equipped clinics with team support for family physicians.
Secretaries and typists to help with the paperwork. Nurses to provide skilled triaging of patients, as well as many skilled procedures and immunizations.
Under-the-same-roof midwife care, so that the mother and baby will not lose continuity with her family physician.
An on-site pharmacist for advice and multi-medication reviews.
I have had the privilege of seeing such team health-care delivery working — and working successfully. The patients feel well-treated and the physicians are among the most fulfilled that I meet.
Such a fundamental change in health-care delivery will be expensive — but as in other aspects of life you get what you pay for. The result will be a more cohesive delivery of family practice with considerably happier and more productive physicians.
The delivery of medical care has changed and must continue to change. Having failed in 2001, the Doctors of British Columbia should regain the leadership to work with the provincial government and insist on these changes. The citizens of B.C. need and deserve relief from the current fragmented and inefficient health-care delivery model.
Dr. Chris Pengilly is a retiring family physician in Victoria.
