Les Leyne: Counting on doctors not a sure thing

Les Leyne mugshot genericB.C. has 1,000 more doctors doing general-practice work than there were 10 years ago, according to the most recent count from the Health Ministry.

And the share of the population that is “attached” to a family doctor, a critical measure of how their primary care is being addressed, has declined only marginally over the past four years, according to the most recent estimate.

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So why is the doctor shortage such a chronic problem in health care, to the point that it might become one of the election-campaign issues in the weeks ahead?

The simple answer is that the various moves to keep a growing, aging province supplied with general practitioners just haven’t kept up with demand. That makes the count even more concerning. Enormous amounts of money have been invested in getting more doctors and boosting the attachment rate. But it’s still getting increasingly difficult to find a family doctor.

The latest count is from the annual Medical Services Plan Physician Resource Report, compiled by the Health Ministry from the fee-for-service data in the MSP system. Some in the field consider it misleading, because the general-practice billing code can be a catch-all, and not a specific measure.

Nonetheless, it puts the number of doctors in general practice, or at least billing to some degree in that category, at 5,747 for 2015-16. That’s up from 4,755 in 2006.

There are similar increases in the doctor count across most of the numerous specialties, as well.

But the GP situation is the one getting sustained attention.

B.C. Liberals invited just that four years ago, when they made an election issue of promising continued focus on the “A GP for Me” program. It got $134 million in funding so that, according to the Liberal platform, “every British Columbian who wants a family doctor is able to access one by 2015.”

The funding mechanism, which included bonus payments to doctors who improved their attachment statistics, continued. But the public focus on the program has ebbed. By last year, the slogan was acknowledged to be an “aspirational target,” after the stats showed it wasn’t met.

Although the Liberals will take some political hits for the falldown, the failure wasn’t for lack of trying. The effort has connected more than 100,000 people with family doctors.

But there are still hundreds of thousands of people, many of them actively looking, who don’t have GPs. The grabby slogan overlooked the impossibility of achieving the goal.

That’s made clear in a recent document released through a freedom-of-information request. It’s a measurement of the attachment rate over five years up to 2015. It describes the percentage of the population that goes to the same doctor or clinic more than half the time.

The ministry counts 77.7 per cent of British Columbians as attached to a practice in the most recent year, down slightly from 78.9 per cent in 2010. The percentage attached to a specific GP is 64.7 per cent in the most recent report, down a half-point from 2010.

The more pertinent measure is the percentage not attached to a GP or a practice. It’s now 14.2 per cent, up a point over five years. (The numbers don’t add up to 100 for various statistical reasons.)

An association representing walk-in clinics is starting a media push to highlight the problem during the campaign.

Director Michael McLoughlin, who owns a Kelowna walk-in clinic where his wife practises medicine, said the estimated 300 such clinics in B.C. are feeling the shortage of doctors, as well. Several, including some in Victoria, have closed or curtailed hours due to staffing problems.

Although the ministry counts more doctors, the stats show they’re seeing fewer patients. The average number of patients per physician is now 1,560, down from 1,787 in 2006. McLoughlin said it reflects the increasingly complex care needs of older patients, or those with chronic diseases. Doctors are also curtailing unsustainable workloads, which contributes to shortages.

The trends suggest a GP for everyone was never achievable. A GP for about 80 per cent of B.C. is likely as good as it’s going to get.

lleyne@timescolonist.com

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