Addressing the crisis in primary care

Do you need a family doctor?

Approximately one third of my constituents living on the Saanich Peninsula do not have a family doctor. The crisis could become a lot worse as many doctors are close to retirement.

This issue is by no means restricted to Saanich North and the Islands. It is an issue felt in communities across the province that was inherited by the BC NDP government.

In Question Period I had the opportunity to ask Minister Dix about his Ministry is dealing with the incentives drawing doctors away from primary care.

In my supplemental question, I ask Minister Dix about the Alternative Payment Program (APP) which has salaried doctors working alongside doctors billing on fee-for-service and I ask if he is considering opening this up to doctors currently practicing primary medicine.

[Transcript]

A. Olsen:

At some point, I guess we’ll get back to addressing global warming.

As I’ve shared with the minister, I’ve been receiving a constant flow of advocacy from my constituents about the very real cost of the crisis in primary care delivery is having on their health and well-being. There are between 10,000 and 14,000 people currently unattached to a primary care provider on the Saanich Peninsula. In other words, about 30 percent of my constituents on the peninsula don’t have a family doctor.

While the doctor shortage is a crisis in my riding, there is another problem lurking just under the surface. We know that 40 percent of the physicians in B.C. are over the age of 55, with the average age of retirement being 65. So this has the potential to get much worse. A CHEK News story last week highlighted that the Yates Integrated Health Clinic, which services almost all of downtown, is expected to close this summer — thousands more without a family doctor.

In the end, government policy incentivizes doctors away from family practice. My question is to the Minister of Health. We need to change the incentives to make becoming a family doctor more appealing. What is the minister doing to address this challenge?

Hon. A. Dix:

Thank you to the member for his question. The member will know that when I became Minister of Health, about 18 percent of British Columbians were without a family practice doctor or nurse practitioner.

The member is correct that many doctors are also preparing to retire. In British Columbia, we’re 12th of 13 Canadian jurisdictions in the use of nurse practitioners. So what have we done? We’ve established…. Working with divisions of family practice across British Columbia, the Premier and I announced a primary care plan that I think starts — starts — to address this situation.

We’re establishing primary care networks around British Columbia, which, working with divisions of family practice, will establish team-based care across the province and improve services for people who are in our mind’s eye.

We’re establishing urgent primary care centres — seven so far, with more to come. We’re establishing and supporting new community health centres, including many in the member’s constituency who we’re supporting right now with direct supports. To support all of those initiatives, we’ll be hiring 200 new family practice doctors, 200 new nurse practitioners and 50 new clinical pharmacists to support these networks.

In direct response to the exact question the member raises, they will be paid by alternate payment methods. Eight-five percent of resident doctors in a recent survey in B.C., from UBC, said they wanted to see alternate payment methods in primary care. In direct response to that, all 200 positions will have alternate pay methods which we hope will support family practice medicine in the future.

Mr. Speaker:

Saanich North and the Islands on a supplemental.

A. Olsen:

I’d like to thank the minister for taking the time with me last week to discuss the issue on the Saanich Peninsula and to canvass as many issues as you can on health care in a very short period of time.
I’m glad that the minister raises the issue around the 200 salaried doctors and nurse practitioners. I think how family practice doctors, in fact, how many health care practitioners, are remunerated is an important part of solving this issue.

Last week I asked about an issue in the social care sector where you have two different payment standards for people doing essentially the same work. To the point of the alternative payment program, I’d just like to get the minister’s response to whether or not he feels that the APP system and doctors getting paid under that model working alongside doctors that are in fee-for-service is also creating the same effect — it’s about the question that I asked last week — and if he’s going to include family practitioners already practising under the APP model.

Hon. A. Dix:

I think there’s some good news, although I think these are significant challenges. I think many British Columbians who are in need of family practice doctors, many British Columbians — many women who are seeking support in pre- and post-natal care, many frail seniors, many people addressing mental health and addictions — understand the real vulnerability of not having a family practice doctor or nurse practitioner.

There is some good news. In terms of the 200 family practice doctors and 200 nurse practitioners, we’ve had 727 expressions of interest so far. We’re established and have signed with local divisions of family practice: in other words, local divisions of family doctors; 18 primary care networks already; seven new urgent primary care centres; three new community health centres. We’re working hard in the member’s constituency to establish one there.

The thing we have to do, in cooperation, I think, with divisions of family practice, with communities, with nurse practitioners, with other health professionals and with skilled health workers is work together to solve this problem. We’re doing that step by step, community by community. I’m very optimistic and proud of the progress made so far, but we’ve got a lot more work to do.