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Comment: Two examples of government inertia in health matters

Provision of safe births and adequate primary care are widely accepted minimum standards in most developed countries — yet B.C. fails miserably in both.
An Urgent and Primary Care Centre in the Cook Street Village neighbourhood of Victoria. DARREN STONE, TIMES COLONIST

A commentary by a retired professor of medicine and a director of B.C. Health Care Matters.

Provision of safe births and adequate primary care are widely accepted minimum standards in most developed countries — yet B.C. fails miserably in both.

Recent government announcements give insufficient hope that it is capable of optimizing proactive measures that can meaningfully impact these obvious deficiencies.

Across Canada, smaller maternity units have been closing for years for understandable reasons, the most obvious being the impossibility of recruiting either enough midwives or physicians for round-the-clock coverage.

Many such B.C. units have suffered this fate. For instance, if you live on Salt Spring Island or Squamish (both with populations less than 25,000), at 37 weeks you must move to a larger centre for obstetrical care.

Regrettably, the provincial government offers no assistance toward the significant expenses incurred.

But over many years, many obvious signs have appeared that far more serious problems exist.

In Kamloops (population 100,000) an entire obstetric unit is about to close. Warning signs have been flashing for more than a decade. The number of family practitioners who perform deliveries has fallen from 21 to three over 13 years.

This closure represents 60 per cent of the total hospital births of 100 per month.

Abbotsford (population 150,000) is experiencing the same problems where the number of midwives has fallen from 21 to 10 in 13 years in spite of its population increasing by 18 per cent in that period.

People choose to live in larger urban centres because of availability of choice of schools, higher education opportunities, culture and health facilities. If larger cities lose their midwives with painful regularity then there is clearly significant dissatisfaction with their working conditions.

Our government has been fully aware of these concerns. The task force on sustainable midwifery (2020) clearly defined the problems which stressed inadequate remuneration.

It has been shown that B.C. midwives have significantly higher burnout rates than their counterparts in Alberta, largely due to remuneration inequalities.

Midwives are involved in about 40 per cent of Canadian births, so their falling numbers is a threat to what should be sacrosanct, namely the safety of giving birth.

So how does our government respond to these crashing numbers? With great fanfare and self-congratulations, an extra 20 midwifery training slots were announced in February 2023.

But let us look at the numbers. There are about 500 midwives in B.C. We know that discontent within that group runs high.

Let me make a conservative “guesstimate.” Fifteen per cent, or 75 of them, will retire per year. The proposed increase in training numbers will not even replace normal attrition.

The government refuses to improve working remuneration for midwives. There are no on-call payments. Sick pay is zero. They were left out of recent “stabilizing funding.”

Fully qualified midwives wanting to relocate back to B.C. face a major financial hurdle to get accredited. No help from government here.

The maternity component of family practice was not included in the recent new payment model so the numbers of those doctors will predictably continue to decline.

Once again, our government shows a lack of planning, a dearth of stated aims for its decisions and imposition of solutions that solve nothing.

This is not surprising for a government that silently watched while hundreds of thousands of residents lost their family practitioners and nursing vacancies skyrocketed to 4,200.

Our expectations should be at a minimum given the fiasco of Urgent Primary Care Centres, created to ensure a significant chunk of the population would attach to them, where, in reality, nowhere near the target numbers has been obtained.

B.C.’s absence of a physician assistant program is another example of poor planning.

Hundreds of physician assistants have been employed across most of Canada starting in 2007. They increase physician productivity, saving health dollars.

The executive director of the B.C. Rural Health Network has requested physician assistants. Even the College of Physicians has agreed in principle.

Fifteen percent of Canada’s 800 practising physician assistants want to work in B.C., a gift horse if ever there was one.

How does our health minister respond when asked about a physician assistant program? Nothing other than “careful consideration needed.”

Yet another example of head-in-the-sand approach so we in B.C. remain behind the times with a continuation of our multiple health crises.

The issue of physician assistants becomes even more pressing as a medium-term solution to our primary care crisis.

Recruiting new family practitioners in numbers that will significantly impact our dire shortage will take many years, whereas training physician assistants takes two years.

Indeed 120 qualified individuals are ready to come here! Send a plane. I say. And another 120 of these graduate in Canada per year.

The lack of constructive forward planning, worsened by lack of transparency and involvement by interested relevant players, is a continuing black mark in the government’s already ugly copy-book.