B.C.'s doctor drought

[Boda]

*removed*

[The Green Barbarian]

*removed*

[The Green Barbarian]

So which social programs would you eliminate first? Medicare, as per the topic of discussion?

No brainer. Welfare for the able-bodied (at least a time limit needs to be put in place).

[Boda]

No brainer. Welfare for the able-bodied (at least a time limit needs to be put in place).

On this we can agree.
I'm stumped as to why you keep calling me a leftist? Is it because I enjoy discussing Governmental policy?
Or might it be due to an underlying bias that you haven't comprehended the gist of my position(s)?
I apologize for the references to vitriol and hate. I should realize by now it's just your way of partaking in (not so) productive debate.

[GordonH]

Took a look here to see what my family doctor makes, just over $350,000. Out of that he hires staff & rents on office space.
Of course specialist can bring in a hell of a lot more.
https://www2.gov.bc.ca/assets/gov/healt ... 016-17.pdf

[Veovis]

Took a look here to see what my family doctor makes, just over $350,000. Out of that he hires staff & rents on office space.
Of course specialist can bring in a hell of a lot more.
https://www2.gov.bc.ca/assets/gov/healt ... 016-17.pdf

And most will misread those costs in many ways. They will think that doctor pays 100% of it, where often there is a clinic with 4-6 doctors sharing 2 receptionists and maybe a nurse as well as the rent. They will of course also miss the real costs of employees as well.

Sometimes the doctor might own the practice and get a % of other doctors that simply work there and are not actual partners.

AND AND AND AND.

So many factors, so little knowledge by most people at the receiving level of the services. You might get 50% saying it's fair at 300K, and 25% yelling TO MUCH, and 25% yelling TOO LITTLE, and let's be honest....those groups are certainly the loudest.

[Boda]

and they built a lot of hospitals that the loser NDP just wouldn't build. I call that a win.

Would you consider that part of the poor management we were discussing?
Seems to me it might have been a "horse before the cart" type decision to garner votes.
What good are beds that can't be used due to staffing efficiencies?

[Cactusflower]

and they built a lot of hospitals that the loser NDP just wouldn't build. I call that a win.

Would you consider that part of the poor management we were discussing?
Seems to me it might have been a "horse before the cart" type decision to garner votes.
What good are beds that can't be used due to staffing efficiencies?

And I'd like to add, what good are hospitals with no beds or equipment? Case in point, Vernon Jubilee Hospital addition. It was years before charities and other private donors were able to raise enough money to get that part of the hospital operational.

[The Green Barbarian]

I apologize for the references to vitriol and hate.

Apology accepted.

I should realize by now it's just your way of partaking in (not so) productive debate.

LOL - I guess we both have our ways of being non-productive in debates, we just get there in different ways.

[The Green Barbarian]

And I'd like to add, what good are hospitals with no beds or equipment? Case in point, Vernon Jubilee Hospital addition. It was years before charities and other private donors were able to raise enough money to get that part of the hospital operational.

and they haven't even started building the hospital in Penticton right?

[Queen K]

I lost track of how many "how can I find a Doctor here" threads there are. Eight? Twelve? It's incredible and the struggle is real.


So in keeping with the thread, how does the Dr. shortage get solved? I'm trying to lure one here, but we need dozens.

[Cactusflower]

And I'd like to add, what good are hospitals with no beds or equipment? Case in point, Vernon Jubilee Hospital addition. It was years before charities and other private donors were able to raise enough money to get that part of the hospital operational.

and they haven't even started building the hospital in Penticton right?

Sure, they started building it, but as usual it's up to service clubs, charities, private businesses, and the general public to buy all the equipment. Otherwise it would just be an empty building that the BCLP could point at and say, "See what we built for you peons? Aren't we great?"

[Queen K]

Let's see what the NDP come up with for hospital equipment. I believe service organizations and community fund raising has a place as it involves lots of people to appreciate the specialized equipment needed for various specialized medical needs.

What we need are funded beds for those who are elderly. The facilities have waitlists a mile long and no matter how many beds are made available, it's never enough for the number in the demographics needing those beds.

[hobbyguy]

It is a Canada wide problem. Especially in family medicine.

Doctors are retiring at roughly twice the rate they are graduating. 55% of retiring doctors are from the field of family medicine. 36% of graduates have chosen family medicine.

Might as well get used to the idea that in the future, most of your interactions with the health care system will be with teams managed by a physician manager. "Teams" will likely involve nurses, nurse practitioners, midwives, and so on. The old model of family physicians will likely have to be gone in 5-10 years.

You're probably right, but it doesn't have to be this way, does it? There is something seriously wrong with our medical system. Same goes for our education system, judicial system, and other systems in our society. I think it's time for a good old-fashioned revolution.

Lots of things.


The medical system was originally designed around the needs of late 40s early 1950s needs, and has not changed much (the system, not technology etc.). It was designed around hospitals and physicians as basically the whole care system. Acute care was the focus, the tools were limited (drugs, surgical, and diagnostic).

Advances in medical care meant that more and more chronic care patients were in the system. Partly because many would have died without advances in care. Each advance in care added more and more chronic care patients to the system. Each advance extended life expectancy, creating a dramatic shift at the older end, where chronic conditions are the norm.

The medical care delivery system is also based around fee-for-service. So you have a system that is built around large institutions and bureaucracy that are innately resistant to change (top down organizations) with the initial care contact based on fee-for-service that has its own resistance points to rationalizing care. All of it set up around acute care (which it is generally very, very, good at!).

In essence though, when it comes to chronic care, the hospital/physician model is like a wholesaler trying to deal with onesey-twosey retail customers. Inefficient and very expensive (many wholesalers have a per transaction cost of $35-40.). Yet there is a lot of resistance built into the system to delegating chronic care delivery to scenarios that re both less costly, and just as effective or even more effective for chronic conditions.

There are other forces at play as well. The shortage of family physicians may also be impacted by a changing attitude and changing demographic among younger doctors. Most older doctors were male, and generally not adverse to working very long hours. Younger doctors can be either not disposed to working longer hours and/or unable to given the pressures of work/life balance. I have to think that also plays into the lower graduate percentage of family physicians.

Add in that in a fee-for-service scenario, rural areas are either less lucrative (many physicians will have student debt pressures) or less conducive to work/life balance if under serviced. Kind of a vicious circle.

So we wind up seeing things like patients with stabilized and near normal or normal blood pressure having to visit a physician to get their prescriptions renewed, or chronic care patients warehoused in hospitals (at great expense) waiting for better and lower cost care scenarios (most would like to be out of the hospital as soon as possible).

We also see far too much of the chronic care effort being tilted toward institutions. Many patients would rather see care in their own homes where feasible, but it just isn't available. Home care options avoid virtually all of the capital costs of an institution, but are better for the patients mental well being (which can lead to better outcomes). Home care also can be tailored to individual patients needs. Some patients might only need the services of practical nurse twice a week, and perhaps some housekeeping assistance. Some made need regular monitoring by a nurse practitioner or visits by a physiotherapist.

In the long run, home care options offer the fastest and lowest cost solution. The federal government seems to be waking up to this with their recent moves on home care, but much more needs to be done.

Rationalizing and modernizing the care of chronic care patients would take a huge strain off the existing medical system, likely on the order of 20% to as much as 25%. If you do that, then the outcome would be lowered wait times for services that require physicians/surgeons/hospitals as well as little or no need to build and staff more phenomenally costly hospitals.

There is a lot more to it. A big chunk of that is covered here: https://www.canada.ca/en/health-canada/services/publications/health-system-services/report-advisory-panel-healthcare-innovation.html

There are other low cost things that will feed into achieving some of the solutions the Naylor report suggests. Lean methodology is just not well developed in government systems, yet that is precisely how businesses of all types have successfully put a lid on costs, while delivering better products and services (in health care - read outcomes) for their customers (in health care - read patients, and in all government activities - read taxpayers).

It is a theme within the Naylor report, but in general that's the kind of thing that needs to be done. The folks in the delivery of medical care know what to do, it just needs a structure that will unleash that, and coordinate it - not dictate "one size fits all" approaches.

ETA: WE need to be prepared to accept a different model or models of care.

[Omnitheo]

Doctors in rural areas receive a Rural Retention Bonus for all their bills.