When you set out to build a nice home, you acquire land and then develop a conceptual design for the structure. You get an architect and then a builder. You decide what the structure will look like, what will be included in it and what it will be used for. If you want the home to be built right, you must follow certain key steps.
Contrast this with how primary health care has been built in this province.
First, people want a family doctor — there is a need for services. Second, licensing authorities grant privileges to doctors to practise medicine. Third, the Ministry of Health pays for the services provided by the doctors.
This sounds nice and simple, so why is our system not working? Because primary health care operates in a foundational and structural vacuum in B.C.
I am a family doctor. To make a living, I can work in a storefront walk-in clinic, a street-corner urgent-care clinic, a medical-marijuana clinic, or any other hodge-podge of rickety clinics where I can see a person, collect their CareCard number and bill the government for the visit. I operate outside of any organizational structure because there is no structure.
Unlike the home you built, there is no home in which family doctors practise in this province. It looks more like a tent city and functions much like a tent city — disorganized and not meeting anyone’s needs.
I work in a nine-doctor clinic in Sidney, which has grown from almost nothing since it was put together three years ago.
On one day recently, I saw patients who were at a walk-in clinic a few days before and had tests done which I needed to track down. Their treatment given was not what I would have done, but they did not see me for their initial problems. I also saw an elderly woman who went to a medical marijuana clinic and wanted me to sign some authorization for pot cookies.
I filled out many forms and wrote sick notes for people whose employer said they needed proof of illness. We cannot afford to staff the clinic with nurses or social workers so my time is spent doing things that others could do if we had them in the clinic. It was a normal day.
Because there is no organizational structure in primary health care, it is a free-for-all. Only the government can change this. But government response so far has been dismal. The government says we need more family doctors. That is like saying we need more doors and windows for our home before we have an architect’s plan for the structure.
The government trains midwives, nurse practitioners, nurses and LPNs, social workers and family doctors, all components needed to create a functional medical home, and then turns them loose without having created the structure within which they should operate.
The solution is not difficult to conceptualize. The government needs to facilitate the creation of “medical homes.” These need to be physical structures designed to accommodate the primary-care providers. They need to have dedicated patients who agree to exclusively use this provider base. These medical homes need to have rules of operation such that they can adequately provide for all the needs of their patients at all times.
There needs to be a payment schedule that gives doctors an incentive to join and that allows for all the valuable health providers, such as nurse midwives, nurse practitioners, licensed practical nurses and social workers, to operate under one roof and serve one dedicated patient population.
To create “medical homes,” there must be a plan. Dollars must be spent and physical structures built. Storefront walk-in clinics and cannabis clinics must be out of the conceptual-design plan.
Fractionated health care needs to be replaced with an organizational structure that allows family doctors to make maximum use of their skills and to delegate functions to other people working in the medical home. That is why the medical home needs to have a host of ancillary health providers.
If I operated to my functional capacity, based on my training, I predict that I would be able to adequately organize and care for twice as many patients as I currently have. To say we need more family doctors without properly utilizing the ones we have is patently wrong.
Finally, by providing a comprehensive structure for patients to have their health needs met, the government can rightly be in the position to mandate that patients register with these large medical homes and quit going to the myriad “tent city” clinics now providing fractionated and substandard care.
Unless the government moves to establish medical homes and ensures they operate properly, primary health care will continue to fail.
Dr. Robert H. Brown is a physician who lives in North Saanich.