After doing some back-of-the-envelope math, Vancouver family physician Anna Wolak concluded that each patient visit at a Richmond urgent and primary care centre funded by the B.C. government cost the province about ten times more than a visit to her clinic.
At a time when thousands of British Columbians are struggling to access a family doctor, and while family physicians who remain in practice are battling rising costs, Dr. Wolak and many of her colleagues are feeling undervalued in the province. Her math, she said, proves the point. They are frustrated that the government has invested millions of dollars in building and staffing urgent and primary care centres, or UPCCs, while leaving them in lurch. When asked if she considers leaving family medicine, Dr. Wolak responds: “Every day.”
“It all does come back to compensation, and it’s not because we’re greedy. It’s because we need to be recognized that we provide so many facets of care,” she said.
The Ministry of Health did not respond to a request for data comparing per-visit cost in its urgent and primary care centres with the fee-for-service payments to physicians such as Dr. Wolak.
Almost one million people in British Columbia are without a family physician, but Health Minister Adrian Dix has repeatedly highlighted the alternative care those people can access at UPCCs. According to Vancouver Coastal Health’s explanation, the centres are intended to take the pressure off emergency rooms by offering care to people with non-life-threatening injuries and illnesses. Those centres, though, are not meant to replace family doctors and are frequently packed with hours-long waits.
New figures released this week in the legislature show the centres are vastly understaffed: The Richmond primary care centre Dr. Wolak examined was supposed to have 32 full-time-equivalent physicians. Instead, it has one.
Meantime, Doctors of B.C. said this week that family physicians such as Dr. Wolak earn between $114 and $130 per hour, whereas a doctor working at an urgent and primary care centre earns $164 per hour and a general practitioner working in a hospital earns $174. That gap is further widened after family doctors pay out their overhead costs, such as staff and office space. To cover these expenses, which are rising, many family physicians try to see as many patients as possible in a hour. Dr. Wolak, who has 1,500 patients, attends to four to six people per hour.
The provincial NDP government saw high approval ratings for its handling of the pandemic, but the issue of family doctors has put Premier John Horgan on the defensive. It also comes as doctors are in negotiations for a new contract. Last Tuesday, after a meeting between the two parties, Mr. Horgan made a rare confession that the lack of access to an in-person family physician is “a real problem” in B.C.
“While this is a problem across Canada, it is very acute here in B.C.,” he said in a news release.
Dr. Wolak said family physicians in the province have not received any significant pay raise since 2006. Under the predominant funding model in B.C. – fee-for-service – family doctors are paid $30-$40 per visit, regardless of whether they are renewing a patient’s prescription for just a few minutes, or treating a complex health problem that takes much longer time.
Outside of the negotiation of a new contract, Doctors of B.C., which represents 14,000 physician members, is in discussion with the provincial government to develop a new compensation model.
It’s “specific to addressing the compensation challenges faced by our family physicians,” said Sharon Shore, a spokesperson for the association.
Ms. Shore noted the current physician master agreement expired March 31, but will remain in place until a new contact has been ratified, which she said won’t happen until later in the year.
The lack of family doctors is a problem that has been brewing for years.
In 2003, there were 437,000 people in the province without a dedicated primary care practitioner; by 2017, that number had doubled to 897,000, according to the premier’s statement.
Mr. Horgan noted he’s made it clear to the federal government that they must come to the table to address the lack of federal funding in health care throughout the country. But Doctors of B.C. said Mr. Horgan had acknowledged the funding requirements go “beyond monies that may be transferred from the federal government.”
Goldis Mitra, a family physician and a clinical assistant professor at the University of British Columbia, said physicians want to see an action that “makes a measurable difference to this problem.” Dr. Mitra said the fee-for-service system needs to be modernized, and alternative payment models, such as capitation funding – where doctors in clinics are paid per patient per year, rather than per visit – should be expanded.
To address the lack of access to primary care in B.C., both Mr. Horgan and Mr. Dix have responded by stressing the government’s historic investments in establishing team-based care in primary care networks, community health centres, Indigenous-led clinics, and UPCCs.
Family doctor Kimberly Rutherford acknowledged UPCCs’ value in providing urgent care, but said those clinics are poaching family physicians and nurse practitioners out of longitudinal care. “[They’re] further worsening the problem.”
According to documents provided to the B.C. Liberals, as of March, only 19,500 new patients are attached to a primary care provider at a UPCC.
Those documents also show that many UPCCs and primary care networks are significantly understaffed. The Fraser and Interior authorities are only staffed to 62 per cent of the promised commitment. In the health authority covering Vancouver, that rate is 55 per cent; in the province’s north, the rate is 49 per cent and on Vancouver Island, it is only 39 per cent.
Earlier this month, a leaked document obtained by the BC Liberal Party suggested that between April and December 2021, practitioners at 24 UPCCs only saw 4.6 patients per day on average. But in response to the leak, the Ministry of Health insisted the UPCC figures were not from a finalized report, but rather a “mockup” that indicated how the correct information ultimately would appear.
The ministry said UPCC physician services averaged 26 in-patient visits per day in 2021/22, compared to an average of 22 in-person patient visits per day for family physicians in community service locations.
“What we need to do, it seems to me, is continue our work with family practice doctors,” Mr. Dix said.
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