For years, the shortage of family doctors in Greater Victoria – and other B.C. cities – has plagued residents and health officials. As the spread of COVID-19 continues, experts say now is the time to think outside the box when it comes to primary health care.
“Having that solid foundation to our health care system – primary care – is really making it easier for patients to have good quality care, even in the face of an overwhelming pandemic,” said Kathleen Ross, president of Doctors of BC.
Having a doctor, she said, results in “better patient outcomes, fewer undetected cancers, better control of diabetes, better control of hypertension, weight management and other areas of mental health.” With family doctors, there is less testing and more focused, regular care, reducing the cost to the health care system overall, Ross added.
“The consequences [of not having primary care] would be all of that in reverse,” she said.
Kyle Oram has Type 1 diabetes and lives in Victoria, but when he wants to see a doctor, he drives more than six hours to the Okanagan, where he used to live.
Oram doesn’t drive all that way for a specialist – he goes just to get consistent health care from the same doctor – something he hasn’t been able to find in Victoria.
“I looked around and talked to some connections here and they all said the same thing, you just basically have to get lucky or know somebody … there’s no actual process to get a family doctor other than waiting on a 70,000-person wait list,” he said.
|Kyle Oram says managing diabetes is difficult without a family doctor in Victoria. He’s one of many people living in the Capital Regional District that don’t have a physician. (Courtesy of Kyle Oram)|
Oram said diabetes requires regular long-term blood sugar tests and at 46, he’s getting to an age where he’ll need more regular check-ups.
“I’m kind of feeling like I’m out in the dark, left on my own, not actually able to take care of my condition or myself in general,” he said.
Doctors of BC, a voluntary association of more than 14,000 B.C. doctors, residents and medical students, has been advocating for primary care networks – or PCNs – as at least a partial solution.
Ross describes PCNs as centralized wraparound patient care.
“There’s usually a physician at the centre of that model to ensure that the patient has access to the services that they need to be their healthiest,” she said. PCNs could include pharmacists, addictions specialists, physical therapists, social workers, nutritionists and more.
For example, a family physician might refer a patient to a nurse in their PCN for diabetes counselling so the physician can shift focus to another patient – increasing the reach of each doctor without compromising the quality of patient care.
In 2018, the province pledged to have PCNs set up in 70 per cent of B.C. communities by 2021. But Ross said that approach will still require more doctors.
“There’s not enough new physicians entering the scene to keep up with our population growth,” she said. “And to properly reflect the increasing complexities of patient care – patients are living longer, they need more services.”
But the pandemic should be a time for some real problem solving, Ross said. For example, the Chilliwack Division of Family Practices is building virtual care networks with the option for in-person care, as needed.
“Virtual care, whether that’s on a telephone or mobile, virtual platform, are tools in our toolbox,” Ross said.
“These are all alternate methods of accessing your primary care provider, right inside the tent of that longitudinal relationship.”
Currently, virtual care is regulated through a physician licensing body and an increasing part of the long-term plan to improve access to health care.
“We want to ensure that you have a team that you can turn to for care that meets your needs,” Ross said. “What we really don’t want to see with virtual care is a whole pack of episodic virtual walk-ins.”
For Ross, the worst case scenario is having B.C. come out of the pandemic with the same health care system it went in with.
“Now’s the time for blue sky thinking. Now is the time to really rethink what our priorities should be,” she said. “We want to emerge from this with the future vision of what primary care can do for our patient population.”
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