A Family Doctor’s Prescription for Fixing Primary Care

BC College of Family Physicians’ president Jeanette Boyd on how to improve care and patient outcomes without the risks of corporate medicine.

Andrew MacLeod 14 Sep 2020 | TheTyee.ca
Andrew MacLeod is The Tyee’s Legislative Bureau Chief in Victoria and the author of All Together Healthy (Douglas & McIntyre, 2018). Find him on Twitter or reach him at amacleod@thetyee.ca.

Dr. Jeanette Boyd says the rise of corporate health care is a symptom of a sick system — one that governments could cure. Image from YouTube.

[Excerpts] The rise of corporate health-care providers in British Columbia is worrying, says Jeanette Boyd, president of the BC College of Family Physicians. But she says it really needs to be recognized as a symptom of a deeper disease.

Boyd, who has a family practice in Nelson, said she personally thinks corporate care is significant and “there should be concern about the real risk it has to further fragment health care in the province.”

“Absolutely they are filling a vacuum, but it’s a vacuum I feel is artificial and can be addressed in other ways,” she said. “If we all work together, we can potentially find solutions that don’t bring in the same inherent risk that bringing in a big corporate agency does.”

Boyd has practised in B.C. since 2007 and been president of the college for two and a half years. In a wide-ranging interview, she discussed the challenges to primary care, the threat corporate care poses, what she sees as the solutions and the government’s slow response.

“We know that care that is provided by a family physician working in a well-supported environment who is providing comprehensive, continuous longitudinal care is really where the best value is,” said Boyd.The Tyee is supported by readers like you Join us and grow independent media in Canada

Over time that relationship leads to improved outcomes for patients, increased rates of cancer detection, decreased amounts of chronic disease and better quality of life, she said. It also ultimately saves the publicly-funded system money.

And yet more than 700,000 people in B.C. lack access to a family physician. 

The problem is not a shortage of doctors. The province is producing more family physicians than ever, she said, but the system encourages them to move into other areas of practice.

Doctors get into family medicine because they want to make a difference and value the long-term relationships involved in providing direct patient care, she said. But they find the fee-for-service system, where each visit or treatment is assigned a dollar value, doesn’t allow them to spend as much time with patients as they may need. 

“The time it takes to provide that quality patient-centred care isn’t remunerated in a system that values more episodic care or volume of care as opposed to quality of care,” she said.

“It’s this constant battle between trying to balance the patient in front of you who is really important, but you still have 20 more patients in the waiting room that have booked appointments that also have important issues that need to be seen that day, and you need to see that many patients in order to meet your overhead to pay your staff in order for you to continue to work.”

It’s tricky to find a balance in clinics that are run on fee-for-service billings, she said. Family physicians are also now seeing patients with more complex needs, such as people with multiple diseases that need to be carefully managed.

The provincial government could do much to improve primary care, Boyd said. 

It needs to get rid of the fee-for-service payment model and instead create a system that facilitates high-quality care, she said.

She argues for more flexible funding that would allow physicians to look at the community where they’re working, assess the needs particular to that place, and build a team with other health-care professionals who have the skills and resources to meet that population’s needs. 

“When you ask the patient what they value, what they think is important to their health, it is being able to talk to somebody who knows them, who trusts them,” she said. “And we know that relationship, for people who’ve been able to access that relationship, that’s where we really see the true savings in terms of health care.

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