Re: “Health system needs more than baby steps,” editorial, Oct. 7.
It is refreshing to read this editorial and to see that the non-medical public can understand the problems that are causing this apparent lack of family physicians. This “shortage” dates back to the turn of the century.
About that time, it was realized that hospital patients were becoming more complicated and sicker, to the point where we family physicians could no longer offer adequate care by doing hospital rounds before going to the office in the morning. So the role of hospitalists was created.
Effectively, this has removed 70 primary-care physicians from the pool of prospective family physicians in the Island Health area. That is a lot of doctors who are no longer available as family physicians.
Why are the hospitalists appearing to be so much better remunerated than the regular family physicians? The explanation, to me, is easy. Hospitalists are a new phenomenon. They were able to negotiate a payment schedule from scratch. There was no precedent or previous history to complicate matters.
Furthermore, there was no having have to pay any overhead other than car parking and medical insurance. Even better still for them is that after 40 hours, their time is off completely — no carrying paperwork home. No emergency calls.
About the same time, the newly elected B.C. Liberal government was handed a binding arbitration that was written in inflammatory language, but clearly stated that family physicians were underpaid; that the basic fee for a GP visit should be increased; and that there should be one-half of an office fee for a telephone consultation and one-quarter fee for telephone refilling prescriptions. Furthermore, the arbitrator suggested that being available 24/7 should be remunerated.
In a Donald Trump-like move, the leader of the Liberal government refused to be bound by this arbitration, and a new set of negotiations was put into place.
The result is an absolute disaster. I have objected to this from the beginning. In order to get an increase of money into the pockets of family physicians, there are a series of bonus payments for caring for certain chronic conditions (e.g. diabetes, hypertension, congestive heart failure).
In order to qualify for these bonus payments, it is necessary to complete clearly documented extensive treatment plans and flow sheets. The result of this is that most physicians have to close their offices for one day of the working week to complete the (un)necessary paperwork. Failure to complete this could readily result in a fiscal audit — to the point that, in fact, I did not claim many of the bonuses.
I think that funding of family practice is like someone following a faulty GPS that showed a wrong turn about 17 years ago. It is time to stop and review the entire situation and admit that something has gone terribly wrong.
A major step would be to simplify the payment of family physicians, ignoring the payment schedule of the past 50 years. Emulate the hospitalists and starting negotiation from scratch. No more unnecessary paperwork. No more bonuses. No more increased risk of a fiscal audit. Part of this negotiation should be a substantial financial supplement to overhead costs for family physicians.
I am not popular with my colleagues for my opinion, but I think that we are not necessarily short of family physicians. We are just not enabling them to work to their best advantage.
Baby steps will not do it. A fundamental abandonment of past precedents and a new, simplified, team-based health-delivery system could turn things around, at no enormous increase in costs, and in a relatively short time.
It can be done — will it be done?
Chris Pengilly, MD, is formerly of Tuscany Medical Clinic.
