Comment: How can we best improve health care in B.C.?

Thank you to Gery Lemon and View Royal Mayor David Screech for their excellent and thought-provoking commentary concerning excessive wait times for diagnostic imaging, specialist services and large numbers of citizens without access to a family physician (“Why the long wait to see a doctor in Victoria?” comment, March 17).

As a GP in View Royal for 15 years, and in Langford for six years before that, I am acutely aware of wait lists and family-physician shortages, most notably in the West Shore, one of the fastest-growing regions in B.C.

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I agree wholeheartedly with Lemon and Screech’s statement: “Over the past few years, something has gone awry in health care in Greater Victoria.”

Regarding the shortage of family physicians: We struggle to recruit young physicians to family practice for many reasons, the main one being lower income than for most specialists. Family physicians must buy or lease office space, equipment and supplies, then hire staff, in order to open a practice. This is daunting for those who have just finished their training.

It remains far easier and more lucrative to provide episodic care by working in a hospital or walk-in clinic, but falls far short of providing patient-centred comprehensive and continuous care to the population (which the government has realized saves health-care costs in the long term). Continuous care of those in the community would prevent many admissions to acute care, where expensive care is delivered to those who need it.

To keep the hard-working family doctors we have, and to attract the next generation of them, the payment model needs to change from fee-for-service (where the physician bills $30 to $45 for the visit depending on the patient’s age, not depending on the complexity and number of their presenting issues), to a blended system (part salary based on number and type of patients in their practice, and part fee-for-service to maintain efficiency) so that patients receive more comprehensive and cost-effective care, instead of five-minute visits where they can discuss only one problem.

This is where the provincial government must be courageous, and expand on the numerous pilot projects thriving in various corners of the province, using this blended payment system and supporting team-based care, in which allied health providers team up with family doctors to provide comprehensive care. For example, a social worker to help my patients living in poverty to access housing, income tax and child-care supports, a pharmacist to help minimize the cost and number of medications required by my senior patients, a nurse to help educate groups of my patients currently pre-diabetic, to prevent progression to diabetes.

There are exciting opportunities for municipalities to become involved partners in the health of their communities. Recently, the Township of Sidney financially supported the fantastic work of the Saanich Peninsula Primary Health Care Society, which has attracted new physicians to join an expanded Sidney clinic and work at the Saanich Peninsula Hospital, providing primary care to several thousand citizens who were previously unable to access it.

The health authority has shown great vision in supporting this work by providing case-manager staff for frail seniors at the clinic. Expansion of this to a network of multiple clinics is planned, and will be supported in part by the forward-thinking Saanich Peninsula Hospital Foundation.

Langford, Colwood, View Royal and Esquimalt each have development opportunities to partner with private and public health-care providers to improve the health of their communities. Preliminary discussions are underway, and momentum is building.

Much work in this area is being carried out in Greater Victoria by the two divisions of family practice, South Island and Victoria, which represent the more than 600 family physicians working from Sidney to Sooke. Please read more at their websites: divisionsbc.ca/south-island and divisionsbc.ca/victoria.

Now is the time for communities, foundations, health authorities, providers and government to build a future of comprehensive, accessible primary care for all of us.

 

Vanessa Young, MD, co-chairs the board of the South Island Division of Family Practice.

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