The family doctor shortage, which has ballooned in scope for two decades, now affects nearly one million British Columbians.
General health and wellbeing is significantly impacted by one’s access to a primary care physician. An on-going, long-term relationship with a family doctor is the cornerstone of our public healthcare system. Family doctors are our first point-of-contact when something is wrong, and they are our access point to the rest of the healthcare system.
At root of the issue is the system itself, which expects doctors to operate their family practices as private businesses. In this model, the family physician is not only responsible for patient care, they are also responsible for all business aspects of the practice: leasing, administration, human resources, procurement, etc. In other words, family physicians in BC are split between healthcare and running a business. This level of work is simply unsustainable.
Compounding this issue is the way in which family doctors are compensated for their work. British Columbia uses a “fee-for-service” model, in which doctors bill the government’s Medical Services Plan (MSP) for a flat rate for each patient session. The fee must then cover all aspects of patient care and business operations, such as rent, materials and payroll. Doctors are often not compensated well for their work, and are often torn between providing quality care for their patients and seeing enough patients to keep the lights on.
All of this has led to physician burnout, shifting to the private sector / other specialities, and early retirement, leading to the loss of family practices. New doctors are less and less likely to choose family medicine, opting instead for specializations with different operational and funding models.
Despite what Premier Horgan and Health Minister Adrian Dix have said, the family doctor shortage does not ultimately come down to funding, federal health transfers, or more seats in medical schools. It is rooted in the model itself, and requires bold action to improve.
The BC Greens' plan for Family doctor shortage
British Columbia simply cannot afford more closures of family practices. The BC Green Party has called for short-term financial support for family practices which would relieve the burden on clinical structures such as rent, admin, and supplies that doctors rely on to do their jobs.
The government needs to implement a broader team-based strategy to keep family physicians in practice. Doctors can focus on work that makes the best use of their training and background, while they work with other professionals who can provide other aspects of care.
The scale of the doctor shortage should prompt Health Minister Adrian Dix to reprioritize a team-based approach for primary care.
The government needs to urgently update their payment model for family doctors. Together with BC’s professional colleges and healthcare advocates, the government should expand alternative payment models to better reflect the demand for in-person, longitudinal, and team-based care. For example, PCCs and UPCCs have successfully adopted a salary system, which should be expanded and made available to all family doctors. New approaches should not exclude the fee-for-service model, however, as some family doctors prefer this option. The goal should be to provide compensation for quality care based on what works for the doctors who provide that care.