As the B.C. doctor shortage crisis continues, preventative and continuous care is taking a back seat to episodic and sporadic clinic visits.
Almost one million people in B.C. lack a family doctor, according to a 2022 report from the BC College of Family Physician. Many people are now forced to rely on walk-in clinics or virtual appointments only when they are sick, often putting preventative health care on the back-burner.
Charles Aruliah, advocacy manager for the Canadian Cancer Society, said screenings for cervical cancer dropped by as much as 39 per cent from 2019 to 2020 due to COVID-19. While those screening have largely resumed, they are anticipating a rise in late-stage diagnoses and undiagnosed cases.
A cervical cancer screening, also called a Pap test, is done every three to five years to look for potentially cancerous cells in the cervix. Regular screenings can prevent seven out of 10 cases of cervical cancer, which is the ninth most common cancer in B.C., according to BC Women’s Hospital and Health Centre.
Until a few months ago, patients were waiting a lengthy five months for the results of cervical cancer screenings, a test that had taken around four weeks to come back before COVID-19 caused a backlog, according to BC Cancer Lab Services.
After switching from a manual glass slide test reading system to a liquid-based cytology method, however, that wait has been reduced significantly to pre-covid levels of approximately 20 days, according to a news bulletin from BC Cancer.
Still, getting a screening takes some time, with clinics in Victoria averaging about a month and a half of wait time. This is due in part to the volume of patients needing to be seen, but there is also a financial system that makes doing cervical cancer screenings less than appealing for non-primary providers.
According to the 2021 fee schedule for B.C. providers, routine pelvic exams including a Pap test bring in $31.62 for clinics.
Sean Birdsell, office manager for Vancouver Island Women’s Clinic, said performing them on patients who are unattached to the clinic on a consistent basis is not sustainable financially, as they have to cover the majority of the intake process, actual procedure and follow-up if needed.
A newly implemented Longitudinal Family Physician (LFP) Payment Model offers more financial incentives, but there are requirements physicians must meet.
Longitudinal care refers to long-term and continuous treatment, which has been shown to reduce the amount of chronic conditions people experience, as well as hospitalizations.
In Victoria, however, where there are gaps in patient attachment to doctors, longitudinal care is less accessible and some doctors are missing out on the increased pay.
“Most of my patients are episodic, which means they don’t come back to see me for all of their personal health questions and I’d say over half of the patients I talk to don’t have a family doctor,” said Dr. Emily Stuart, a sub-specialist who performs cervical cancer screenings and other women’s health services at a clinic in Victoria. “The longitudinal program is a great step. However, to get that funding you have to have rostered patients, which is the main issue that is standing in the way of a doctor like me. It kind of takes anyone with a practice like mine out of the new funding model, which is unfortunate.”
Still, preventative care – specifically related to cancer care – is on the provincial government’s radar. B.C.’s Ministry of Health recently announced $440 million toward cancer prevention and detection, aspects of which could take episodic care like cervical cancer screenings off provider’s plates.
Minister of Health Adrian Dix told Black Press Media the Cancer Care Action Plan and primary care improvements are intrinsically connected.
“In terms of recruiting health and human resources, the health-care workers, the doctors, the nurses that we need and the oncologists that we need, we’ve made significant changes to make sure that B.C. is competitive,” Dix said. “All of that action on primary care supports cancer care. The efforts we are making in primary care, while not directly apart of the Cancer Care Plan, are critical to its success.”
One of the recent investments the announcement points to is a 2021 pilot program for an at-home screening for Human Papillomavirus (HPV), which can cause “abnormal cell changes in the cervix,” which if not found and treated can develop into cervical cancer, according to BC Cancer.
With the combination of increasing screenings through the at-home pilot, as well as HPV vaccinations, Dix said it is possible to eliminate cervical cancer in B.C.
“Cervical cancer, it is a cancer that is preventable, both by vaccination and screening and how screening which detects it earlier,” said Gina Ogilvie, an affiliate researcher at BC Cancer. “We would encourage everyone to attend preventative screening as much as they can.”
While the pilot is not currently available in Greater Victoria, Dix said he expects it to be province-wide within the year.
“We are very, very pleased with how the initiative is going and it is demonstrating its value in the pilot, so it is absolutely our intention to expand it province-wide,” he said. “It is an important way to make progress in that area, to improve care and to improve the speed of diagnoses.”
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