Forced to search for a scarce primary care physician or nurse, I joined 700,000 British Columbians without one.
My Doctor Dumped Me. Here’s Why That’s So Common
Thu, 2022-01-06 11:40
#1
My Doctor Dumped Me. Here’s Why That’s So Common
Thu, 2022-01-06 11:45
#2
My Doctor Dumped Me. Here’s Why That’s So Common
I was cut loose by my primary care doctor a few months ago. My struggle to find a new one made personal a widely shared problem. For many years now, there have not been nearly enough family doctors and nurse practitioners to meet demand. Nor have the models of how they practice delivered the quality and timeliness of primary health care we hope for.
When Dr. G. (I’ll call him) closed his practice, he moved to Telus Health, a private option that offers patients a LifePlus program for $4,650 a year.
With that tacked on to the medical services plan fees they bill the government, Telus provides premium care to those willing and able to pay, including fast access to your personal primary care physician or nurse practitioner, 30-minute appointments, a soup-to-nuts annual checkup, rapid access to specialists and associated dieticians, kinesiologists, nurses, psychologists and other professionals.
Dr. G. is an excellent physician, often ranked in the top 10 family doctors in British Columbia by rate-my-doctor, but he’s had challenges on the business side. He’s worked in five different settings since 2007, when I became his patient, including two stints running his own office and three different times in walk-in clinics.
His farewell letter to patients noted that he was attracted to Telus by their supportive care model, preventative health program, low patient-to-physician ratio and administrative support. His previous clinic is not replacing him, which placed me in good company. According to the Canadian Medical Association, five million Canadians don’t have primary care. For B.C., a little over 700,000 British Columbians have no family doctor or nurse practitioner providing primary care.
My first stop: the Vancouver Division of Family Practice, which lists clinics or physicians taking on new patients. I checked again and again, finding only one option: a physician who had just moved to B.C. from another province, but whose profile from his previous practice included numerous complaints and poor ratings.
I then turned to my social media connections and received some leads, which turned out to be dead ends. All were full up.
Two root causes
The crisis in primary care is pretty easy to understand, based in two factors, both of which our provincial government is aware of and has committed to change. Number one is not enough family doctors and nurse practitioners to serve our population, while the second root cause is a system of primary care delivery that has increasingly come to depend on walk-in clinics.
As a senior fellow at Simon Fraser University’s Morris J. Wosk Centre for Dialogue, I’m often asked to facilitate workshops and strategic conversations. A few years ago I had the opportunity to explore with family doctors how they practised their craft, and what they might prefer in the future.
This deep dive into primary care was sponsored by a non-profit health care think tank, the Institute for Health System Transformation and Sustainability, and resulted in a report, Physician Heal Thyself, that uncovered the physician’s perspective that walk-in clinics had decimated British Columbia’s primary care ecosystem. But my interviews and focus groups also revealed a love-hate dynamic with walk-ins; many doctors prefer them to the traditional office model that represents primary care’s past, while at the same time bemoaning walk-in shortcomings....
Thu, 2022-01-06 11:59
#3
..from above.
quote:
Why do family doctors, and more recently nurse practitioners, work in walk-in models at all? They are trading off quality of care for no overhead costs, more rapid payback of student loan debts, and reduction of the massive amount of paperwork associated with the fee-for-service models ubiquitous in Canadian health care.
Visions of a better approach
Our project asked doctors how they would prefer their practices to be structured. The results offer a roadmap towards a new primary care model. For one thing, these family doctors preferred salaried positions, adjusted for each physician’s workload including number of patients, complexity of patients’ health care, age and gender of patients, hours of work and extent of on-call or weekend hours. They recognized that fee-for-service might be the most lucrative model, but also most vexing administratively and in terms of quality and continuity of patient care. They were willing to reduce income for improvements in the care they could provide to patients and their own work-life balance.
There also was strong support for group practice models, especially including nurse practitioners as first contacts for patients. Only patients with more complex or serious issues would need to move on to a physician visit. As well, the family docs we talked with desired clinics that included models with longer office visit times than the standard fee-for-service 10-minute slot, and wanted non-medical professionals to be associated with their model clinics.
In short, they were proposing the Telus high-end model, but available for everyone, not just rich people. This model is consistent with experimental projects funded by the B.C. Ministry of Health, projects that unfortunately have remained merely pilots. Our provincial government has also supported an increase in nurse practitioners, but funding has lagged far behind the need.
Perhaps it’s too bold to suggest during a pandemic that we need to increase the number of primary caregivers, trained for new models of health care that strive for the same quality of care that the private sector is providing through corporations like Telus. Or perhaps COVID-19 will finally jump start what we’ve known for at least a decade or two: primary care in British Columbia and throughout Canada is broken, and it is way beyond time to fix it....
Thu, 2022-01-06 12:25
#4
..i would prefer to see the coop model whereby the gov or community pays for the office and administration. which releases the health care staff to focus on the individual seeking help.
..coop in sask.
Welcome to the
Co-operative Health Centre
The Co-operative Health Centre is a Primary Healthcare Facility. Our Primary Healthcare Team understands the importance of a holistic client-centred approach to health and wellness, and we recognize that health is influenced by many factors outside of the traditional health system.
Our continuum of services addresses the social determinants of health, health promotion and the prevention of disease within a primary health care approach. We use education and awareness to promote health and well-being. We believe that this approach encourages people to become less dependent on health care services to maintain good health and more involved in the habits that promote healthier living. We strive to empower people to take an active role in their health and our healthcare providers are committed to meeting people where they are at.
Serving Prince Albert for Over 55 Years
Thu, 2022-01-06 12:27
#5
..check out the services provided at the coop
Respiratory Therapy , Physiotherapy Services, Recovery Program, Mental Health Services, Nutrition Services, Transportation, Laboratory, Diagnostic Testing, Pain Clinic, Nursing Services, Foot Care, Day Surgery and Endoscopy Procedures
Thu, 2022-01-06 12:39
#6
..when i lived in van i recieved my health care from reach which has been going since 1969....
WHO ARE WE?
REACH Community Health Centre has been providing community-based health care for fifty years, and strives to be more than just a doctor or dentist's office. Our interdisciplinary team offers a variety of health and social services under one roof:
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Team-Based Primary Health Care.
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Dental care.
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Pharmacy services.
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Counselling and social work services.
Thu, 2022-01-06 12:56
#7
..at reach i saw a nutritionist for a while. she was also a therapist which turns out to be great as these 2 fields are connected. at least they are in my case. :)
Thu, 2022-01-06 21:39
#8
laine lowe
I was lucky that I had an excellent GynOb specialist at the Winnipeg Clinic who put me on the short list for a GP back when there was a huge shortage in the city. Prior to that, I was using a close-by walk in clinic and it was a very frustrating experience (and a few crappy diagnosis thrown in the mix). My wonderful, kind GP moved to TO but assured us that her young replacement would be good. He barely got to know us before the pandemic hit but he managed to get one of the few A/Z vaccines he had into my husband's arm when the government prioritized those for people with underlying conditions.
I find that BC has really let private interest seep into their healthcare as has Quebec. That Telus Medicine option should not exist under our universal healthcare system.
Fri, 2022-01-07 10:16
#9
I was lucky that I had an excellent GynOb specialist at the Winnipeg Clinic who put me on the short list for a GP back when there was a huge shortage in the city. Prior to that, I was using a close-by walk in clinic and it was a very frustrating experience (and a few crappy diagnosis thrown in the mix). My wonderful, kind GP moved to TO but assured us that her young replacement would be good. He barely got to know us before the pandemic hit but he managed to get one of the few A/Z vaccines he had into my husband's arm when the government prioritized those for people with underlying conditions.
I find that BC has really let private interest seep into their healthcare as has Quebec. That Telus Medicine option should not exist under our universal healthcare system.
..i agree with que and bc. also other prov like ont. and that telus med should not exist.
Mon, 2022-02-28 14:10
#10
Is Two-Tier Health Care Growing in BC?
Two seniors were told they would need to pay $4,600 each to keep seeing their family doctor after he moved to a Telus clinic.
quote:
“We’ve got to aggressively recruit and promote team-based care, that’s the alternative, because it’s one thing to get into a debate about scarce resources, but we have to deliver a high level of service in the public system,” Dix said. “We’ve got to continue to be better in the public system.”
Green MLA Adam Olsen and leader Sonia Furstenau have raised a series of questions in the legislature about extra billing and corporate involvement in the health-care system.
“There seems to be an entrenchment of at least one, maybe more than that, major corporate player on the primary care landscape,” said Olsen, MLA for Saanich North and the Islands, in an interview. “There’s a very real threat to the entire business model being turned upside down.”
He said he received many complaints when a clinic in his constituency asked patients to begin paying a $50 “continuity of care allowance” annual fee.
The danger is that allowing that kind of fee will lead to two-tier health care, Olsen said.
Some people will get basic, walk-in, episodic care, while others who pay a premium will get access to annual screenings and other services the providers describe as “extras” that really are part of a well-run primary care system.
“What I’m shocked at is seemingly this government... [has] been standing on the sidelines while this has been becoming more entrenched in the primary health-care system,” he said. “What has Minister Dix done to protect the primary health-care services from a corporation monopolizing it? Because the reality of it is there are... clinics [are] closing down because doctors are getting put on contract.”
Family doctors are being attracted to work in Urgent Care Centres and other facilities the government has created, Olsen said, but also to clinics owned by Telus, a corporation that has access to billions of dollars.
The family doctor shortage was the number one issue in Olsen’s community when he was first elected, he added, and since then, as the population has grown, the problem has gotten worse.
“I’m quite concerned there’s a disparity between what the minister was saying back in 2007 as critic, and what he’s standing by and watching happen right now while he’s the actual minister,” Olsen said.....