With a shortage of doctors around the province, questions around how to attract doctors — particularly to rural locations — is becoming increasingly important
Health care has been a hot topic in Merritt as of late.
Both the Interior Health Authority (IHA) and the official opposition BC New Democrat Party are recognizing a change in doctor recruitment and retention.
“Its an area where the game has been changing a lot for some time now,” IHA executive medical director for the Thompson Cariboo Shuswap region Dr. Malcolm Ogborn said.
On July 2, Ogborn and other representatives from the health authority, spoke with city council to answer any health concerns they had. One of those was doctor recruitment.
Ogborne said one of the challenges in this regard is that physicians themselves have changed.
Going back 40 years, he said his colleagues might work in up to three communities during their career.
“They would go somewhere that would set themselves up,” Ogborn said.
“What we see now is a lot of physicians graduating [and] the one to three jobs that my contemporaries would do in a career, [now] they would do in five years.”
Ogborn said it would take more than one doctor to replace an existing one currently working in town. They are used to working under the old model with long hours, the new one’s aren’t.
They also want clear parameters around the type of shifts they work.
Last week, leader of the BC NDP John Horgan and NDP spokesperson Judy Darcy were in Merritt, speaking to staff at the Nicola Valley Hospital as part of a health care tour in the province.
Darcy said that what she’s hearing is that young doctors are interested in delivering family medicine, but don’t want to set up their own private practices.
Horgan and Darcy called for more team-based care in B.C.’s small and rural communities, where other health care workers such as nurse practitioners can help shoulder the load with doctors.
“One of the things I hear from young doctors, and doctors just graduating from medical school, is that the old model of family practice — you open an office, you hang out a shingle, you’re in private practice, fee-for-service — is not attractive,” Darcy said.
“They want to work in teams. they want to work with nurse practitioners, they want to work with public health nurses, with dietitians,” she said.
Horgan said young doctors don’t want to have the burden of an entire community on their backs.
BC Nurse Practitioner Association (BCNPA) president Kathleen Fyvie told the Herald via email that her organization regularly hears from physicians wanting to bring a nurse practitioner into their clinic. She’s working with the provincial government to discuss how to make this more plausible for both physicians and nurse practitioners.
Darcy and Horgan acknowledged the government has some teams in place, including an interdisciplinary squad on the North Shore at the King Street medical clinic in neighbouring Kamloops. But Darcy said the practice needs to go mainstream.
“It’s the exception rather than the rule,” she said. “And in Ontario, for example, they have gone in the direction of nurse practitioners for many years. They have many more times as many per capita as we do here in British Columbia.”
Fyvie said B.C. has only had nurse practitioners for the past 10 years, educating about 45 per year.
B.C. has just 341 nurse practitioners at the moment.
As of 2011, there were 2,486 nurse practitioners across Canada.
Ontario had the most, with 1,482, trailed by 263 in Alberta.
B.C. came in third, with 129.
When it comes to millennial doctors, Ogborn said its difficult to get them to accept being on call all the time.
“They come with a very different set of expectations from previous generations and that has very much hit medicine hard,” Ogborn said.
“It hits very hard on recruiting, particularly small rural communities because in many instances the practice structures in those communities, and Merritt’s a good example of this, are actually based on the old model,” he said.
“You have one or two doctors in their own practice, invested a lot of capital in that practice … and then you have graduates coming in who basically want to know when they get their first cheque.”
Health Minister Terry Lake has said a team-based approach works, but said it’s not an across-the-board solution.
“Ontario has done a lot of work in these family health centres and, what they’ve done in Ontario is, they’ve actually put a bit of a hold on it because what they were seeing is the costs were rising substantially while the number of patients being seen was going down,” he said.
B.C. prefers to use the team model for mental-health and substance-abuse treatment, as well as for care for lower-income patients, Lake said.
“Those integrated teams do a great job of serving vulnerable populations,” Lake said.
“For the rest of the population, certainly there are situations where team-based care works extremely well and it’s something we’re doing more and more, but we have to make sure it’s sustainable.”
Physicians work for themselves and not a particular health authority, meaning the government health organization has no control over their working conditions, Ogborn said.
“You need to have a strong and robust community to attract health care professionals,” Horgan said.
When it comes to doctors being independent practitioners, Horgan pointed out doctors can’t necessarily go wherever they want.
“There’s a supply and demand question here as well and all the doctors can’t go to Surrey just because all the people are there because at some point you’re not going to be able to find a place to practice.”
Horgan noted the provincial government’s failure to provide a family doctor to every person in B.C. who wanted one by 2015.
Two years ago, the B.C. Liberal government announced it would spend millions to expand A GP For Me, a program matching patients with doctors, provincewide — a promise that’s supposed to be met by the end of this year.
He said there are still 250,000 British Columbians without a family doctor.
HERE AT HOME
Horgan said that one issue he heard from people at the Merritt hospital is the emergency room is being accessed for the wrong reasons, becoming the “de facto drop-in clinic” in town.
He said people are capitalizing on shorter wait times there as opposed to making an appointment at a clinic.
“The public is responding to the deficiencies in funding by making their own health care decisions on how they’re going to access the system,” Horgan said.
“Every British Columbian needs to have access to a family practitioner, whether that’s a general practitioner or a nurse practitioner,” Darcy said.
Recently, the province released a request for proposal for conceptual plans to expand the Nicola Valley Hospital’s emergency room.
As opposition leader, Horgan says he intends to ensure the government follows through on the project.
“You want to be optimistic whenever a government, regardless of its political stripe, makes a financial commitment to improve services in a community,” Horgan said.
The concern, however, is the conceptual plans will sit on the shelf once completed.
“Until you see the capital dollars allocated in the annual budget … you can’t have any realistic expectation that those dollars are going to flow,” he said.
Horgan said he thinks improving the hospital should help attract more health care practitioners.
With files from Andera Klassen KTW