Let’s declare a family-practice emergency

Times Colonist Sept 28, 2017

Chris Pengilly, formerly of Tuscany Medical Clinic, is a part-time family physician.

[Excerpt] I read with interest the op-ed from Joanne Hamilton concerning her parents who are now “orphan patients.” The responses from Vanessa Hammond and Dr. Robin Saunders suggest solutions that offer a realistic and optimistic future. (“Physician shortage is now a crisis situation,” comment, Aug. 31; “Physician shortage doesn’t have to be a crisis,” comment, Sept. 5; “Victoria’s doctors strive to improve patient care,” comment, Sept. 19.)

I am particularly sensitive to the subject of orphan patients at the moment because I retired from family practice early in 2015. After great difficulty, I found a physician to continue the care of my patients, but because of a serious medical condition she was unable to continue.
She and I spent a long time trying to find physicians in the community to undertake the care of her sickest patients.

Unfortunately, family practice and/or Victoria were insufficient to retain one young female physician who had adopted several of my orphans, so they are re-orphaned.

What we need to do now is to make the current physicians more productive, and less burdened by unnecessary paperwork and bureaucracy — until the community health centres are up and going.

These suggestions could begin to be effective by the end of this year:

• Provide each physician with a typist service, as has long been provided to hospital physicians.

• Compensate family physicians a quarter of an office-visit fee for the responsibility and time involved in repeating prescriptions of their own patients; these are more safely prescribed by the family physician who has access to the medical record, and not infrequently the patient might not need to come to the office.

• Encourage physicians to form groups of four or more doctors (which are proven to be more effective and more efficient) by offering a one-time grant to cover the cost of amalgamating and moving offices.

• Integrate and co-ordinate public-health nurses to work in close liaison within group practices.

• Eliminate, or at least simplify, the form-filling needed for a patient to access “special authority drugs.”

To read the full article, click on: Let’s declare a family-practice emergency

Patients searching for family doctor at new Langford urgent care centre disappointed

CTV Vancouver Island Published Monday, November 5, 2018 

[Excerpt] There was confusion on opening day of a new urgent primary care facility on the West Shore Monday morning.

More than a dozen people waited in line before the Westshore Urgent Primary Care Centre opened its doors for the first time at 8 a.m.

But some of those people were frustrated to learn that they would not be able to find a new family doctor at the centre – at least for now.

“It’s just purely an urgent care walk-in clinic,” said Wendy Wilson. “I asked if there was a waiting list, no they don’t have a waiting list. I asked if they knew when the prospective pod is going to open for doctors, the answer was no, they don’t know that but it won’t be until the new year for sure.”


Related Stories: B.C. expected to announce new urgent primary care centre on West Shore

The Vancouver Island doctor shortage, explained

Thousands of Islanders have virtually no prospect of finding a primary physician, but the solution may not be more doctors

By Sol Dolor October 23, 2020 

[Excerpts] There is a doctor shortage, but it’s not unique to the Island 

It’s no secret that for newcomers to Vancouver Island, it is basically impossible to find a family doctor. And for thousands of others, the retirement of a family physician can often leave them with no place to turn. In a BC Medical Journal editorial published just before the onset of COVID-19, recently retired Parksville doctor Jonathan Winner wrote that the local doctor shortage has reached crisis proportions

Physicians have a right to decide where they want to practice, which means supply will not be equal among places. As Winner pointed out in his March editorial, it’s been apparent for decades that BC doctors are increasingly staying away from family practice. As early as the 1980s, he wrote, “the family practice model we were all working in was becoming less attractive to the next generation of doctors, who were able to work in walk-in clinics.”
In a study of 11 developed countries in 2016, The Commonwealth Fund found that a fifth of Canadians waited more than seven days to see a family doctor. Seeing a specialist, meanwhile, can take four or more weeks. 

The problem, as experts told Capital Daily, is not necessarily a shortage of qualified professionals graduating from med school; Ross noted that BC has already upped its intakes of med students and residency spots. Rather, as family doctors age out, a more realistic solution may be to reform the province’s decades-old model of family doctors as the primary gatekeepers to healthcare. Instead, Ross argues, BC could do well to pursue coordinated teams of nurse practitioners, midwives and other professionals taking on the role of primary care; lightening the load on the Island’s physicians.

Contandriopoulos says Canada has been sedate in making the shift to these “intraprofessional teams,” despite vast scientific evidence showing their success in other countries. A key change, he said, is shifting the “fee for service” model, in which physicians are paid by the visit. Whether a doctor visit is for a sore throat or for the first stages of leukemia, they’re all paid the same. As one doctor told Capital Daily, it’s akin to a dentist charging the same for a tooth polish as for complex dental diagnostics. 

To access the full article, click on https://www.capitaldaily.ca/news/doctor-shortage-vancouver-island-victoria-healthcare

Healthcare workers in Alberta are looking outside their province for jobs.

Interior Health (and others) are actively promoting BC. Michael-Ann Miller (manager of clinical operations for Princeton General Hospital and the South Similkameen Health Centre in Keremeos.) shares her story how she ended up in Princeton and loves rural medicine.
A pity for Albertans and their healthcare needs, but probably good for BC.

Alberta health-care professionals are being wooed in targeted recruitment campaigns to British Columbia, Ontario and other provinces where employers say the grass is greener. But Alberta’s UCP government isn’t bothered and believes low taxes, along with high pay, will keep Alberta competitive and continue to attract health-care professionals and doctors.

Dr. Don Wilson is one of those leaving the province.Mapping out his career, Wilson expected to spend another decade in Alberta. Now he’s headed for British Columbia, packing up his practice, his home and farm. He doesn’t have a permanent position waiting.

Pandemic Preparedness – Auditor General of Canada

For the full report, click on: https://www.oag-bvg.gc.ca/internet/English/parl_oag_202103_03_e_43785.html


8.35 We found that, although the agency engaged with provincial and territorial partners and was advanced in its preparations to test the Federal-Provincial-Territorial Public Health Response Plan for Biological Events through a large-scale exercise simulating an influenza pandemic, the agency did not complete this test exercise with its partners prior to the COVID‑19 pandemic. The test exercise had been scheduled for 2020. The exercise, developed with provincial and territorial partners, would have tested a variety of response elements, including the infrastructure for gathering and sharing public health data. The agency indicated that because of the COVID‑19 pandemic, this exercise could not proceed further.

8.36 In our view, if the agency had completed a national pandemic simulation exercise before the COVID‑19 pandemic, it could have improved its understanding of provincial and territorial pandemic response capacity, ensured roles and responsibilities were understood among partners, and identified potential obstacles to a response.

8.37 Recommendation. The Public Health Agency of Canada should work with its partners to evaluate all plans to assess whether emergency response activities during the COVID‑19 pandemic were carried out as intended and met objectives. This evaluation and other lessons learned from the pandemic should inform updates to plans. The agency should further test its readiness for a future pandemic or other public health event.

The agency’s response. Agreed. The experience of COVID‑19 has provided a lived experience of a global pandemic, the nature of which Canada has not seen in over 100 years. Recognizing that existing plans provided a framework to guide the current response but that improvements are always possible, the Public Health Agency of Canada will incorporate learnings from the pandemic into its plans and test them as appropriate. In updating and testing these plans, the agency will work with provincial and territorial partners to reflect shared responsibilities for public health emergencies. This work will be completed within 2 years after the end of the pandemic.


Out-of-Pocket Costs for Rural Residents When Traveling for Healthcare

“This report presents findings from a rural citizen-patient survey on the out-of-pocket costs incurred while traveling to access health care in BC. To our knowledge, it is the first primary research study to systematically document the financial consequences of traveling for care for rural residents in BC and, as such, provides important information for health care planners.”

The results of this survey provide a starting place for discussions on the role of public support for rural residents who need to travel for health care. These discussions must involve key stakeholders from rural communities but also regional representatives and government ministries beyond the Ministry of Health (e.g., Transportation and Highways, the Ministry of Child and Family Development). Bringing the right group together will provided a starting place for developing a system response to ensure all residents have access to the health care they require, without financial barriers.

Respondents were asked to complete the survey for the most recent health care issue that required travel (e.g., a surgical procedure, cancer care). The most recent travel for this issue must have occurred within the last two years. Respondents were instructed to include travel for that one health issue and not to include separate travel for other health issues. However, responses indicate that a few respondents likely included trips for multiple issues in one survey response. Nonetheless, in this report, the use of the phrase ‘per person’ refers to the average cost per survey participant for one health condition. All costs are reported in Canadian Dollar as of 2020.

This study is co-funded by the Health Economics Simulation Modelling Methods Cluster, BC SUPPORT Unit and the Joint Standing Committee on Rural Issues, through the larger context of the Rural Surgical and Obstetrical Networks program, which works to stabilize and enhance surgical and obstetrical services in rural communities across BC.

Click the download to access the report.
 oopc-survey_report_7.16.20 Download

UBC Rural Evidence Report

Written by Alex Nguyen
Feb. 5, 2019  

Many residents in rural communities have to travel to other communities for general and specialized care, but this process has its own challenges, such as how to ensure reliable transportation. 

As BC continues to face gaps within its rural healthcare system, UBC researchers are working to amplify rural communities’ perspectives in high-level planning processes.

Since starting a year ago, the group of researchers working on the Rural Evidence Review (RER) project has been surveying rural residents from across the province on their experiences and priorities accessing healthcare. Newspapers from communities ranging from Revelstoke to Fort Nelson have been calling for participation from their local residents.

For RER Co-Director Dr. Jude Kornelsen, it’s this grassroots approach that differentiates the project from the numerous studies that have already been done about rural healthcare.

According to Kornelsen, previous systemic reviews have seen large influence from health authorities while the team now wants to engage mainly with on-the-ground stakeholders. She added that most studies she has seen also tend to come from an urban focus, losing some nuances about rural populations — which include numerous Indigenous communities — along the way.

“Rural is not just small urban,” said Kornelsen.

As the co-director of the UBC department of family practice’s Centre for Rural Health Research, she has researched rural healthcare needs extensively.

“And you can’t really group them together. ‘If you’ve seen one rural community, you’ve seen one rural community’ is something that we often say,” she added.

Edward Staples — a lead of the BC Rural Health Network (BCRHN), which provides support for RER’s research — agreed with Kornelsen. In fact, he said this is represented in BCHRN’s structure itself, which brings together 16 autonomous organizations working in 14 different communities.

Structural gaps
But they both identified similar issues when asked about structural problems that have been plaguing rural communities in BC: shortages of practitioners and inadequate transportation.

As of January 23 [2019], RER has received around 500 survey responses, with most of them coming from communities within the Northern Health and Interior Health Authorities. While the team is just starting the first round of analysis, Kornelsen predicts that the concern is going to be “first and foremost about access to [practitioners] across the board.”

To learn more, click on: UBC Rural Evidence Review aims to identify highest-priority health needs in rural BC communities


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