By Rochelle Baker, Local Journalism Initiative reporter
Rural BC communities will continue to suffer from severe doctor shortages and the ripple effect of repeated emergency room closures until BC’s primary care system is modernized, according to an expert.
New doctors shun family practice, while established doctors abandon it because of the way primary health care is delivered, said Dr. Rita McCracken, family physician and researcher in the Department of Family Medicine at the University of British Columbia.
“The province is using this very outdated idea of the family doctor as the primary care infrastructure provider,” she said.
The primary health care framework is still based on the medical practice of 1960s family physicians and the birth of Medicare and it is no longer a viable model, McCracken said.
The overhead, complexity and administrative burdens of private practice are dramatically different from decades past, and new doctors don’t want the heavy workloads and grueling hours associated with it, she said.
Team-based medicine in a publicly funded facility with administrative support offering comprehensive services – such as ready access to social workers, counselors, nurse practitioners and pharmacists – would ease physician workloads and improve patient outcomes.
Investing in medical centers and employing a well-resourced interdisciplinary team that support each other professionally and emotionally would help rural communities recruit and retain family physicians, she added.
“Think how much more appealing a job is than saying, ‘Please come to this community that is completely devoid of any kind of system-level primary care services.
One in five British Columbians, or about one million people, do not have a family doctor, a situation that has plagued rural areas for decades and is now a pressing problem everywhere.
Shortages of doctors and nurses and emergency room closures, compounded by the dire state of ambulance services in small communities, have small town mayors united in pushing Health Minister Adrian Dix to transform rural health care.
The northern region of Vancouver Island, home to more than 10,000 people, has suffered prolonged or rotating emergency department closures for much of the summer due to severe staff shortages that are expected to s worsen in the fall.
A month-long closure at the Alert Bay emergency room has just been extended for another two weeks, and the small ferry-dependent community faces the possibility that it will no longer have doctors on Cormorant Island. early December.
Other area ERs at Port Hardy and Port McNeill hospitals – which rely on family doctors for coverage – have seen repeated closures this summer and are diverting patients from one hospital to another almost daily.
Island Health announced Thursday that two new family physicians have signed two-year contracts to practice in Port McNeill. But on the same day, the health authority announced another closure of the Port Hardy ER over Labor Day weekend, beginning at 5 a.m. Friday until 7 a.m. Sunday.
“I think the North Island is most likely a community in crisis, but frankly, every community is in crisis in BC right now,” McCracken said.
The primary care infrastructure in the province is largely funded by the salaries of family physicians, she said, and disappears if they retire or leave a community.
The work differs, but surgeons are not expected to cover hospital overhead, she noted.
Nor do teachers provide the infrastructure, staff, and schools necessary for student learning in a public education system.
According to a study by McCracken, nearly half of family physicians surveyed would rather be a clinic employee than a small business owner.
And 70% of physicians want to be part of an interdisciplinary team, while 81% want planned vacations and parental leave.
The province has taken steps to establish a network of different healthcare professionals in geographic areas that doctors can call on, called Primary Care Networks (PCNs), but it’s unclear whether they’re effective or easily available across the province, she said.
“The concept of an NCP is nice, but there needs to be more consistent funding and real infrastructure behind them,” McCracken said, noting that many of the services doctors refer patients to are virtual.
“And if someone could show me how NCPs have improved access to primary care that would be amazing, but we’re not even talking about that being a metric.”
The province recently announced bridge funding for physicians while it works on a new compensation model, expected this fall.
But overhauling the primary care system must involve more than doctors want and need, McCracken said.
Healthcare professionals, service providers and patients must also have a say, she said.
“We have notoriously left out all the other people who need to be involved in this conversation, such as researchers, community members, patients with lived experience of not having a family doctor or even people who have,” McCracken said.
“I think one of the reasons we’re in this situation is that solutions are only ever negotiated between doctors and the (Ministry of Health).”
Health Minister Adrian Dix’s office did not respond to questions or repeated requests for comment from Canada’s National Observer.
North Island MP and Deputy Government Whip Michele Babchuk was also unavailable for an interview despite requests from the NWC.