The Doctors of B.C. says, ideally, every patient in the province should have a family doctor — but there’s no timeline on when or if that will ever happen. Only one thing is for sure — it won’t be like the old days.
“Even though not every B.C. citizen has a family doctor yet, I think that is still the ideal,” said Dr. Shelley Ross, a family doctor and 2012-13 president of Doctors of B.C.
When will that happen?
“It’s hard to say, but our expectations are high,” Ross said.
The B.C. Liberal government’s 2013 re-election promise to match every patient who wanted one with a family doctor was an “aspirational target,” Ross concedes.
A GP for Me is a joint effort of the B.C. government and Doctors of B.C. The government allocated $132 million in 2013 to create A GP for Me, negotiated with Doctors of B.C.
“The A GP for Me was just the start of attaching [patients and family doctors],” Ross said. “So many different projects went on with the GP for Me, and we’ve learned an awful lot from many of these.”
A GP for Me program funding continues and touts more than 150 projects underway in B.C. communities to help more people find doctors and health care — everything from better ways and more funding to recruit, train and retain family doctors in urban and rural areas to more efficient ways to run doctors’ offices, initiatives to transfer patients from retiring doctors to new doctors, and a push to increase the number of nurse practitioners.
Prior to A GP for Me, the B.C. government established nurse practitioners in 2005 to help meet the growing need for primary and community health care — $17 million is provided annually to health authorities for nurse practitioners. In May 2012, the province announced $22.2 million in funding for 190 new nurse practitioners. This project was new funding over the annual amount.
About 397 practising nurse practitioners are registered with the College of Registered Nurses of B.C. The province has the ability to train as many as 45 nurse practitioners per year through universities. The University of Victoria has 15 seats each year.
Nurse practitioners, who are advanced registered nurses, are not only helping family doctors with the monitoring and care of patients, but they are running their own practices, serving patients in a similar manner to family doctors.
B.C. Health Minister Terry Lake said a lot of community-based groups of family physicians — called divisions of family practice — are just maturing into their implementation of A GP for Me initiatives, “so there’s been a bit of a time lag.”
Physicians continue to be recruited at a good pace and learn how to make their practices more efficient, based on legwork by prototype communities, including the Cowichan Valley, Lake said.
In the pilot-program communities of Cowichan Valley, White Rock-South Surrey and Prince George, there are enough doctors for every resident who would like one, said the Ministry of Health.
As part of the pilot program in the Cowichan Valley, for example, a new maternity clinic opened in the Cowichan District Hospital in March 2011, providing pre- and post-natal care to women who did not have a family doctor. By May 2014, the maternity clinic had cared for 2,003 mothers and babies, delivered 788 babies and found family doctors for 314 patients, according to the GP for Me website.
The Health Ministry said provincewide, the GP for Me program has seen more than 88,600 patients with complex-care needs matched with a primary-care provider.
In addition, more than 60,000 patients have been transitioned from a retiring GP to a new primary-care provider as part of the program.
Specifically, the South Island and Victoria divisions of family practice have created access for about 25,000 people to a family doctor.
The Health Ministry said it has also more than doubled the number of medical-education spaces in B.C. — from 128 in 2003-04 to 288 currently. The program has also increased residency positions from 134 in 2003 to 346 positions in 2016 — 288 positions for Canadian medical graduates and 58 for international medical graduates.
Critics claim it’s far from enough.
While almost 300 doctors graduate in B.C. each year, few choose family practice, Bill Cavers, a past-president of the Doctors of B.C., said last year.
On Friday, NDP health critic Judy Darcy said despite improvements in some areas of the doctor shortage, she hears from constituents that the crisis is as bad as ever. Retiring doctors are a growing problem.
As doctors are hired or recruited, others retire or leave.
The overall problem with the Liberal election promise is that it seems to have been an “election slogan” rather than a true measurable goal, she said. Why? Because the government started it in 2010 and re-announced it in 2013 “without either a clear starting point or measurable goals,” she said.
“They clearly had no intention of meeting that goal. It was an election promise. If they meant to meet the goal, they would have set out clear ways to measure any progress toward the goal and they didn’t do that,” Darcy said.
Further reducing access to the available pool of family doctors in Victoria are doctors working at walk-in clinics, working part time, working shorter days and specializing — only taking maternity patients or patients with few complications or, conversely, only patients with chronic illnesses age 70 and older, for example.
“There’s no doubt that we would prefer that everybody has a basic general practice and then you can have an area of special interest, but there still should be a core of your work that is general practice, you need to keep that generalism,” Ross said.
Some believe the answer to providing “primary care” access to all patients in need of a family doctor is seen to be in the formation of integrated practices.
“Care is different now. When I started as a doctor 30 some years ago, care was pretty much episodic. You came to your doctor, you had your pap smear and you went home and that was it,” Ross said.
“Now we’re doing so much more chronic-disease management … patients’ expectations are much higher … there’s more monitoring,” Ross said.
“The day of the solo practitioner is coming to an end. It’s just impossible to do everything for everybody, be everything for everybody.”
The goal is for family doctors to work more closely, not only with other physicians and specialists but as teams within other teams of allied health professionals — in a best-case scenario, many of them are in the same building or nearby. A team-based approach allows patients to more easily connect with the specific health-care providers they need, and family doctors are freed up to do what they do best, Ross explained.
Under this model, most patients might still get their care from a family doctor, but the monitoring of chronic illnesses can be done by a nurse practitioner, for example, or other health professionals or clinics.
In integrated team-based models, the family doctor can see more patients because more work can be delegated or referred. The most successful models are tailored to community needs, Ross said. If there is higher demand for mental-health care in a certain community, maybe that physician circle has a mental-health worker. In other areas, the demand might be for a social worker, nutritionist, physiotherapist or pharmacist.
John Mabbott, executive director of Health Match B.C., said there’s reason for optimism. The provincially funded service has increased the number of placements it has made for the past three years.
In the first quarter of 2016, 60 permanent physician vacancies were filled and another 20 locum positions, for a total of 80 — of which 49 were family physicians.
On Vancouver Island, nine permanent and six locum positions were filled for a total of 15.
“For the past three years, in each successive year, we’ve matched more physicians to available vacancies than in the previous years,” Mabbott said. “If first quarter is anything to go by, it could be our best year ever.”