By Wade Tomko
“I am not saying we don’t need physicians because we do but we need to do better with how we utilize them,” said Stan Marchuk, former president of the BC Nurse Practitioners Association.
Contrary to what many British Columbians have heard, the standards set by the College of Physicians and Surgeons of British Columbia regarding walk-ins, urgent care and multi-physician clinics aren’t exactly new.
Earlier this summer, the College worked to revise, update and combine two sets of standards developed in 2008.
The primary objective of the update was to reiterate that a patient is owed the same level of care, no matter the physician.
This was done in part to decrease the anxiety felt by walk-in regulars who may have felt their treatment was hurried or compromised and to clarify commonly held misconceptions about the perceived second-tier nature of walk-ins.
Firstly, the CPSBC’s updated standards require that all patient medical records identify the primary care provider (if one exists), even if the primary care provider is a physician at a walk-in clinic.
Regular patients of the clinic, who do not identify a family physician, are assumed to be receiving their primary health care from that clinic — including access to after-hours coverage. As such, physicians at that clinic are responsible for that patient’s longstanding care.
Secondly, clinics may no longer employ a designated medical director who is not a licensed physician, a position that was held largely by business owners. Medical directors are now responsible for upholding the College’s standards, establishing administrative procedures and acting as the clinic’s representative when communicating with the College.
In addition, all clinics and any practice providing transient medical care must have on-site access to PharmaNet (the Ministry of Health’s central database for patient records and prescriptions), and provide immaculate documentation of medical records.
Despite the College’s good intentions, there are approximately 700,000 B.C. residents without a family physician. And while trying to maintain standards at every practice, it is proving difficult for the College as many patients are unaware that the standards changed and some physicians are finding it difficult to adjust to the new expectations.
Used to quick appointments where a follow-up appointment was rarely necessary, walk-in physicians may now have to start putting a cap on the number of patients they see.
Dr. Chris Watt, an owner of several walkins in Victoria and Vancouver told the Vancouver Sun’s Pamela Fayerman (of Medicine Matters) that he fears the new standards may force the retirement of the older physicians at clinics.
Many clinic physicians are older, only work part time and are near retirement. For them, continuing working under the College’s new standards may prove too onerous and only push them closer to retiring.
This trend has been especially prominent in Victoria and elsewhere on Vancouver Island as walk-ins have started to close down. But this problem isn’t subject to just a few specific areas of B.C.
Our province currently has postings for 317 general practitioners. The Interior hasn’t quite felt the effects of the new standards as much as regions with higher population density, though that doesn’t mean problems won’t arise.
Given Kamloops’ significant senior population and a lack of funding towards clinics and transient care centres by the B.C. government, clinics here in Kamloops could soon feel the pressure.
It is quite possible that in a few years, walkin clinics may become part of a bygone era in our healthcare system, as they stop acting on a first-come-first-serve basis and instead only take appointments.
One solution proposed by Stan Marchuk, former president of the Nurse Practitioners Association, was the employment of nurse practitioners.
Given the opportunity, he said nurse practitioners could provide a very viable primary health care alternative to British Columbians, though they lack the necessary government support.
Nurse practitioners are present in many medical fields and environments but are looked at as second tier health care providers despite their high level of education and training in health promotion, prevention techniques, diagnosis, as well as management and treatment of acute illnesses and chronic conditions.
Marchuk would like to see a system where nurse practitioners are allowed to open their own practices as well as being able to obtain fee-forservice and innovation funding, which is only ever provided to the General Practice Service Commission.
It isn’t the amount of money being pumped into the medical system that is the conecern, it is how the money is being distributed.