Editorial: Health system needs more than baby steps

After years of inadequate funding, our provincial heath-care system is on life support. About 700,000 British Columbians have no GP. Wait-lists for various types of surgery — particularly hip and knee operations — are unacceptably long. And it can take a year to see some specialists, depending on the field.

Yet it is becoming increasingly obvious that no one in authority is serious about doing anything. Two recent developments make clear the near-total lack of focus.

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First, Health Minister Adrian Dix has announced a crackdown on private surgery clinics. Starting immediately, these facilities will no longer be allowed to extra-bill their patients.

That means they can’t charge add-on fees for procedures that are already covered by the Medical Services Plan. Doctors who do can be fined $10,000 for a first offence and $20,000 for a second.

Yes, private clinics run contrary to the notion of a universal health-care system. And yes, they divert resources from the public system. Yet if Dix persists, the probable outcome is that most of the private surgery clinics will close. How is that going to shorten wait-lists?

The problem isn’t private clinics. The problem is a shortage of operating rooms in the public system.

Over the past few years, hundreds of millions of dollars have been spent to build three new hospitals on Vancouver Island, with a fourth about to break ground in the Cowichan Valley.

No doubt these are welcome, though our health-care system has been held hostage by the glamour of hospitals for too long. If money is short, and it is, the place to begin is by opening more surgical suites — a lot more.

Then we have the spectacle of Canadians who studied medicine abroad launching a lawsuit. They complain that residencies — the last stage in medical training — are awarded preferentially to graduates who studied in Canadian universities.

In effect, we’re turning away apprentice physicians when the province has a serious shortage. Why?

Partly because the government refuses to fund enough GP residencies to make up the shortfall (they cost about $100,000 each).

But in addition, medical students increasingly don’t want to go into general practice. Many would rather work as hospitalists — meaning they treat patients only in hospital. It’s not difficult to figure out why.

A hospitalist working at Royal Jubilee earns $300,000 with no overhead. GPs working in the community would have to earn $400,000 to pay their own office costs and still take home as much. Mathematically, that’s nearly impossible.

If you were trying to concoct a system that would result in too few GPs, it would look like this.

So what should be done? The critical step is to increase the take-home pay for family physicians. Until the income gap with hospitalists is closed, there is little incentive to enter general practice.

In part, this could be done by recruiting family physicians to work in clinics where the overhead costs are paid for, either by the local health authority or the province.

Dix has taken a step in this direction with the announcement that patient-care centres will be set up where 200 GPs can work in collaboration with other caregivers. While well-intentioned, this is a drop in the ocean.

The bottom line is we have an inverted salary scale that turns GPs away. Until this is corrected, nothing else will matter. Our provincial health-care system has been marching downhill for years. Baby steps are taken and proclaimed as giant moves forward, when in practice we’re still going backward.

Only two people can reverse this — Dix and his premier, John Horgan. Are they up to it?

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