Finding a family doctor in British Columbia is almost impossible, and political decisions made decades ago may be partly to blame.
The latest figures show that almost a million British Colombians do not have a family doctor, while waiting times in clinics are higher than in any other province.
Questions about the shortcomings prompted Prime Minister John Horgan to swear in British Columbia’s parliament this week, analysts say, showing the government’s vulnerability.
And it turns out that Horgan may be able to trace the roots of this problem to the policy changes made three decades ago, when the newly elected BC NDP government struggled with its own healthcare challenge: too many doctors.
Too many doctors
When Mike Harcourt became Prime Minister of British Columbia in 1991, he appointed Elizabeth Kull Minister of Health, a position she held until 1993.
In his role, Cul received a report on the state of health in British Columbia, entitled “Closer to Home: Summary of the Report of the Royal Commission on British Expenditure on Health”.
A previous government commissioned the report in response to rising health care costs not only in British Columbia but across the country.
“He came to the conclusion that there is a mismatch between the health professionals we need and what we actually have,” Culle told CBC On the Island.
The report found that BC had more family doctors than needed, and that the number of doctors across the province had increased by more than 50 percent since the 1970s. He also found that they accept fewer patients than anywhere else in Canada.
To reduce costs, immigrant doctors were advised not to be allowed to practice in British Columbia, international medical students to be forced to leave the countryside after graduation and local graduates to study in areas where there was a shortage – which this time does not include family medicine.
Kull said those recommendations had been followed, but in retrospect “there were unintended consequences of simply limiting the supply of doctors.”
Among the problems: The surplus does not apply to all parts of the BC equally. The concentration of family doctors was mainly in the urban areas of the southwestern part of the province, while the rural and northern areas did not have enough.
But the changes in policy will affect BC as a whole for decades to come.
As Cull says, “It wasn’t that simple.”
On Island 12:48 As the growing number of Greater Victoria loses access to a family doctor, we’ll hear how we got to this point of stressful service – and what it might take to get out of it.
Gregor Craigie spoke with Deborah Wilson of CBC Victoria about the origins of the shortage of doctors. 12:48
Unforeseen consequences
Dr Benjamin Chan highlighted the implications of these policy changes in a 2002 report to the Canadian Institute of Health Information.
Chan found that in the new millennium, most medical internship programs in British Columbia have been turned into specialized positions, reducing the number of new family doctors trained between 1993 and 2000.
His research also shows that doctors’ retraining opportunities have been reduced, and suggests that this discourages graduates from starting a family practice because they worry it will prevent them from being able to specialize later.
Chan also says that there was a large exodus of doctors in the United States in the 1990s, which peaked in 1994. He suggests that this may be due to the fact that BC doctors are wanted to change majors or because they wanted to make more money outside of the BC system service fee, which has been accused of discouraging ambitious doctors from continuing their work.
Service charge system discouraging doctors
These changes continue to affect BC’s medical system, even as successive governments try to redirect opportunities for people to enter into family practice.
For example, a record number of family medicine graduates are coming out of UBC’s medical program, which has campuses on Vancouver Island, Prince George and Kelowna.
But the BC College of Family Physicians says many of these graduates refuse to go into family practice because they don’t think there is enough support for it.
Many British Colombians are struggling to find family doctors available, while others are worried they will be in trouble as their doctors approach retirement. (Shutterstock)
Darlene Hamel, a clinical professor in the Island Medical Program who has worked with students since the early 2000s, says many are reluctant to practice family medicine because of all the additional administrative work created by the service fee system in which doctors manage practice. its as a business, receiving a salary of about $ 30 per patient and covering overhead costs such as staff and office space with these fees.
“The new cohorts are watching us practice and say no, thank you,” Hamel said.
Office rents and housing costs have also jumped sharply since the 1990s, and BC Liberals lifted the freeze on university education in 2002, making it difficult to leave as a new graduate.
“We are in crisis”
Carrie Marshall, a family doctor in Ucclelet, British Columbia, on the west coast of Vancouver, says that although rural and remote, the average house price is about $ 1.6 million, and current inflation rates have made the practice virtually unbelievable. expensive.
“Reimbursing primary care costs is simply out of step with how expensive it is to run a business, so we are in crisis,” she told CBC On The Island.
On the island12: 28It is difficult to find doctors in rural areas – We will hear how two rural and remote places on the island are affected by the shortage of doctors
Gregor Craigie spoke with Deborah Wilson of the CBC about how rural communities on the island are coping with a shortage of doctors. 12:28
Doctors of BC President Ramneek Dosanjh says the province needs to consider alternative payment models to improve the current system, such as paying doctors salaries or signing contracts. The Green Party BC also called for a major overhaul of the system.
Health Minister Adrian Dix says doctors in British Columbia receive the highest fees in the country, but the province is increasing alternative payment models and connecting more British Colombians to doctors by building emergency first aid centers.
BC residents fear the situation could continue to worsen.
According to a February survey conducted by the Mustel Group on behalf of the College of Family Physicians in British Columbia, 40% of British Colombians with a doctor are worried that they will lose them due to retirement or closure.
“We will have to keep working every day for the next few years,” Dix told On The Island on Thursday.
On the Island 14:27 We continue our series, looking at the shortage of family doctors. Listen to BC Health Minister Adrian Dix, who answers some of your questions
Gregor Craigi talks with British Columbia Health Minister Adrian Dix. 14:27
Learn more about the shortage of BC family physicians in the CBC Victoria A Crisis In Care series.
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