Concerned about primary care in BC? Learn more below.
Primary Care Crisis Myths
These six myths have been frequently repeated in the context of BC's primary care crisis. On the surface, they sound compelling. But they are all misleading and distract us from real solutions.
Myth #1:
We need more money to solve this crisis.
Variant: We can't do anything without more health transfers from Ottawa.
Variant: We need to raise taxes or reinstate MSP premiums.
Variant: Clinics need to charge user fees.
Fact: We have enough money now but are wasting it.
The BC government funds lavish clinics full of administrators but no healthcare workers. They force independent clinics — providing more healthcare for less money — to close. We have enough family doctors, but the BC government makes it impossible for them to treat patients. Many work in hospitals and specialty clinics. Others are paid more for low-value episodic care that doesn't help patients and creates backlogs across the health system. Pay the right people to do the right work.
Further reading: UPCC Facts, BYO UPCC, First Aid or Medicine?
Myth #2:
Training or attracting more family doctors is the answer.
Variant: We need a new medical school or more family medicine residency spots.
Variant: We need to fast-track credentialing of doctors from elsewhere.
Variant: We need to pay off loans, subsidize housing, or offer other perks.
Fact: Family doctors will keep choosing alternatives to family practice.
All these things can potentially increase the supply of doctors trained in family medicine. However, just like current doctors, they will not choose to work in longitudinal family practice, which is where we need them. We do not have a shortage of doctors. The BC government has made family practice an unsustainable career path. No matter how many family doctors we attract, they have better options and will keep choosing them.
Further reading: First Aid or Medicine?, Time-Based Fees
Myth #3:
Replacing family doctors is the answer.
Variant: Nurse practitioners or other healthcare workers are cheaper and provide better care.
Variant: Family doctors can be brought in when needed, leaving most care to others.
Variant: Being attached to one family doctor is antiquated and inefficient.
Fact: Longitudinal family doctors improve health, save money, and reduce backlogs.
Problems treated in primary care, by physicians who know your history and have the time to spend, result in faster recovery, better outcomes, fewer delays, fewer referrals, fewer ER visits, and far lower costs than problems treated downstream. When you factor in overhead and efficiency, family doctors providing longitudinal care provide far more effective treatment at a lower cost. Truly integrated, multidisciplinary teams directed by family doctors who understand all aspects of your care are the future. They are not interchangeable cogs that can be replaced.
Further reading: UPCC Facts, First Aid or Medicine?, Time-Based Fees, Should you Believe the Teleheath Doctor...
Myth #4:
Replacing fee-for-service with new payment models is the answer.
Variant: Fee-for-service is broken, so we need a different way to pay doctors.
Variant: Fee-for-service can't support longer appointments and the paperwork burden.
Variant: Fee-for-service is unpopular so we need to offer doctors something different to keep them.
Fact: The majority of family doctors prefer a modernized fee-for-service model with fees that fairly compensate them for their work.
Fee-for-service works well in BC — for specialists. Fees are sufficient to compensate them for the required work, including longer appointments and the paperwork that goes with any job. Fees for family doctors do not. The answer is not to abandon a proven model that is fully capable of efficiently and fairly compensating highly-skilled experts for their valuable work. Fix the fees paid to family doctors to reflect the work they do in 2022, not 2002. The majority of family doctors prefer a model that supports them as professionals to make the best decisions for their patients while also rewarding them for their hard work and long hours spent doing what they love.
Further reading: Primary Care Reboot, Time-Based Fees, We Must Change Course Now
Myth #5:
Raising family doctor fees is the answer.
Variant: Fees are too low for family doctors to survive, so they must be increased.
Variant: If we raise existing fees, family doctors will spend more time with patients.
Variant: If we want to get the care we need, we'll have to pay more to get it.
Fact: Paying more for the same care won't help; paying for better care will.
Current fees incentivize episodic care by paying the same for 10min as 40min visits. Longer visits are effectively volunteer work. Raising fees will produce more expensive episodic care. However, more doctors will survive to subsidize their volunteer work in longitudinal care. Don't increase fees, but shift fees to incentivize longitudinal care. Pay family doctors to provide the valuable work we need: one longer visit vs. many short ones that still land patients in hospital. They don't want to be patient-churning robo-docs. Pay them the same amount for the useful, satisfying work they trained for and crave.
Further reading: Primary Care Reboot, Time-Based Fees, We Must Change Course Now
Myth #6:
Putting all family doctors on salary or contract is the answer.
Variant: Family doctors can't run clinics as well as trained administrators and don't want to.
Variant: It would be much cheaper for governments to run clinics and let doctors be doctors.
Variant: If governments run clinics and doctors treat patients, everyone wins.
Fact: Fee-for-service protects patients and saves money. Doctors need choices.
UPCCs have been disastrous failures, despite not being run by doctors. In fact, because of it. Doctors hire experts to manage logistics but retain control. They're highly motivated to operate efficiently. Government clinics are unaccountable, inefficient, operate with no oversight, and are not responsible to you. Working in clinics run by administrators who do not understand how family medicine works is maddening to doctors. When doctors give up control of operations, they give up some of their ability to act in your best interests. There are tradeoffs to working in both government-run and independent clinics. Both options must remain to protect the interests of doctors and patients.
Further reading: Primary Care Reboot, Funding is Control, Open Letter to Doctors of BC..., We Must Change Course Now