A study by researchers at the University of B.C. helps explain why one in six British Columbians cannot find a family physician. Between 2005 and 2012, the number of family physicians increased 13 per cent — almost twice the rate of population growth. Yet over that same period, the number of patient visits declined 14 per cent, and the number of patients in each practice fell 10 per cent. GPs in B.C. now have the second-lowest practice sizes in Canada.
These findings mirror a recent Canadian National Physician Survey, which showed that across the country, the number of hours spent on direct patient care declined 10 per cent between 2004 and 2014, despite an increase in the number of physicians.
The UBC study provides part of the reason. Physician remuneration has increased significantly over the past two decades. But that makes it feasible for doctors to see fewer patients and still make a good living. In practice, we are paying physicians to work less.
This effect is particularly noticeable in female physicians, who, on average, see almost 40 per cent fewer patients than their male colleagues. Of course, there are legitimate reasons for some portion of this difference. Much of the burden of child-rearing falls on women.
Nevertheless, the study strongly suggests that merely raising the income of physicians will not improve access. It might decrease it.
That is not the whole story. Doctors argue, reasonably, that as the population ages, their patients are more likely to have multiple ailments that entail spending more time with them. GPs also complain that government-inflicted paperwork is an increasing burden. We can all sympathize with that.
But the hard truth is this: The largest components of B.C.’s health-care budget are hospitals, physicians and drugs, in that order. Together, these three make up nearly 80 per cent of all expenditures.
Significant improvements have been made over the past 20 years to bring hospital and drug costs under control. The same cannot be said of family medicine.
Part of the context, as a University of Montreal study found, is that the majority of GPs still consider themselves self-employed entrepreneurs. Given that the vast majority of family physicians are paid out of the public purse, it is hard to see this service as a private business.
Two years ago, the Quebec government confronted the problem directly. Legislation was passed reducing fees for doctors who see too few patients. The bill was put on hold after physicians in the province promised to do better.
We’re not suggesting such a dramatic move here. There are still some steps the Health Ministry can take.
Additional training spaces have already been added at our medical schools, but more could be funded. As well, we should stop asking physicians to carry out procedures that others can perform, such as giving flu shots, which pharmacists are trained to provide.
Encourage doctors to renew routine prescriptions online. Establish group practices with specialists such as dermatologists and mental-health practitioners, so patients’ needs can be addressed more quickly. And employ more social workers and nurse practitioners to share the workload.
Yet the fact remains that many of these measures have already been tried, and still the problem continues. If GPs, in balancing their personal lives with their professional responsibilities, place too much weight on the former, no amount of government support will suffice.
It is a disgrace that in the second decade of the 21st century, tens of thousands of British Columbians are denied the most basic medical service — reliable access to a family doctor.
While there are two sides to this issue, we must ask physicians to bear more of the burden.