The problem is doctor distribution, not shortage

The number of doctors in Canada is increasing faster than population growth says Dr. Michael Rachlis on CBC Radio’s The Current:

  photo: Nancy Bepple

“We’ve been increasing the number of physicians at about three per cent per year for the last 10 years and the population is only going up at one per cent per year.”

Another of the panellists on the program, Dr. Danielle Martin, author and VP at Women’s College Hospital, warns of a surplus of doctors:

“In fact you know in some parts of the healthcare system, people are worried about a glut and you hear stories of people coming out [of medical schools] and being unable to find a job.”

That’s certainly not the view from the streets of Kamloops. NDP candidate Nancy Bepple regularly visited lines of people lined up at a clinic to see a doctor. An estimated 30,000 Kamloopsians don’t have a family doctor (one-third of the population). In B.C. overall, it’s 15 per cent.

Why can’t people find doctors if there’s so many of them? Are they hiding?

Well, some of them have chosen to work for a salary rather than billing for each patient. They work exclusively in hospitals says Dr. Chris Pengilly of Victoria, another of the panellists. He calls them “hospitalists.”

They prefer to work only 40 hours a week. Who can blame them? And they are paid better. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. After paying staff and rent, a family doctor would have to earn $400,000 a year, to take home that much; and work longer hours with less support.

The choice is obvious says Dr. Pengilly:

“So anybody coming out of medical school with a big student loan, which do you think they’re going to go for? A family physician [with] no time in hours a week or a hospitalist 40 hours a week and $300,000 with minimal expenses?”

Furthermore, hospitalists don’t want to work alone says Dr. Rachlis “Well, I say good for them that they’re looking to work in teams with other groups, with other physicians.”

One-half of Canada’s physicians focus on sports medicine or palliative care, says Dr. Martin:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

The current model is not working because doctors no longer want to work in the silos of a fee-for-service practice.

It’s ironic that the provincial government has created a hospital environment which doctors prefer to work but one that removes them from the general public.

The solution is obvious but the BC Liberals have been slow to implement it: Build walk-in clinics and hire doctors on a salary basis. Everyone, doctors and patients alike, will be happier.

It’s going to cost more because the government will own the clinics. But the alternative, privately-built clinics, is a failure. The reason that two walk-in clinics in North Kamloops closed their doors is because doctors don’t want to work for less in an environment where they don’t have the same support that hospitalists enjoy.

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B.C.’s failed health-care experiment

Other provinces have opted for the team approach to solve the growing problem of patient access to doctors. Not in B.C. The team approach is not new. Roy Romanow recommended it in his 2002 report:

NorKam Medical Clinic (Google street view)

NorKam Medical Clinic (Google street view)

“in view of …changing trends, corresponding changes must be made in the way health care providers are educated and trained. If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.”

B.C. decided to keep doctors in their silos and try monetary reward.

B.C.’s experiment has failed, according to a report published in the Canadian Medical Association Journal. The report’s authors, Kimberlyn McGrail and Ruth Lavergne, professors at UBC and Simon Fraser University, respectively, wrote of their results in the Globe and Mail (August 17, 2016). Taxpayers have paid $397 million on the plan without much to show for it. Here’s how it was supposed to work.

The plan, called the Complex Care Initiative, was negotiated between the government of B.C. and doctors a decade ago. It gave doctors who treated patients with complex health problems an extra $315 each year per patient.

The rational was that if doctors cared for patients who were really sick, rather than those with minor complaints, the rest would go to a walk-in clinic. Dr, Shelley Ross, co-chair of the General Practice Services Committee, says that a doctor’s time is sometimes taken up with minor complaints, sometimes more serious. It could be a runny nose and sore throat or it could be case of diabetes, stroke, high blood pressure, and memory loss.

“So you can see the difference,” said Dr. Ross, “It is basically a time issue, it is not a knowledge issue. It’s not that we don’t know what to do, it’s just a matter of being able to spend the time to do the quality of care (Globe and Mail, August 15, 2016).”

While doctors understandably want to direct more attention to those in dire need, more walk-in clinics haven’t happened.

The failure of planning for clinics has left patients out on the street. I know, because last year I was one of them. Last year when my doctor was on vacation and I had an eye infection, I only got into the clinic on Tranquille with great persistence and intervention from the pharmacist next door.

Kamloopsians are expressing their concerns on social media. On Tuesday of this week, Megs (‏@PirateMeghan) tweeted “The walk in clinic doesn’t open til 8am and I’m waiting in a line up of 28 people outside. The need for doctors in #Kamloops is intense.”

I’m lucky to have a doctor. Tens of thousands of Kamloopsians don’t according to former city councillor Nancy Bepple: “Which is why it is no surprise that studies have reported between 15,000 and 30,000 people in Kamloops don’t have a family doctor. That is, between one in three and one in six people don’t have a doctor.”

The B.C. Liberal plan has left us with a shortage of doctors, overcrowded clinics, and no improvement in health care. Some plan.