All things Horgan

[flamingfingers]

Urbane wrote:

The BC Liberal government created new medical schools.....

So now after 16 years of BC Liberals in power, how come many people in BC haven't a family physician????

In May, Health Minister Adrian Dix said 780,000 people living in B.C. do not have a primary-care doctor or nurse practitioner.

[Urbane]

^^ We need to train more doctors and at least the BC Liberal government moved things in the right direction. We also need to look at why so many doctors are choosing to specialize rather than go into family practice. We need to make the latter more attractive. Of course we're desperately short of doctors in some specialities too. No easy solutions.

“Whether it’s the north, the Interior, the Island, the ever-more-expensive urban areas, the primary care crisis and the shortage of physicians and the issues with access are common across the province of British Columbia,” he said.

Cadesky said the province is in the midst of a “perfect storm” caused, in part, by governments decades ago making the poor decision to train fewer doctors.
“And we still haven’t caught up,” he said. “We’re still every year about 170 doctors short of where we should be in terms of training people to replace those that are leaving.
“The doctors that are trained — they’re facing increased demands both in terms of how complex the health-care needs are of our communities and, as well, the increased administrative burdens that are being placed on doctors.”

The result, he said, is that doctors are experiencing higher rates of burnout. “We’re also seeing doctors are not choosing community practice at the rates that we would like.”

https://www.timescolonist.com/news/loca ... 1.23604486

[flamingfingers]

Why train more physicians?

We're graduating more doctors than ever, so why is it so hard to find a GP?

https://www.cbc.ca/news/canada/british- ... -1.4100251

[Urbane]

Why train more physicians?



We're graduating more doctors than ever, so why is it so hard to find a GP?



https://www.cbc.ca/news/canada/british- ... -1.4100251

Are you NOT in favour of training more physicians? Certainly it's not JUST a matter of having plenty of doctors. We also need to look at the structure. Let me ask you this: Which sounds better to you? Decreasing the number of seats in medical schools OR increasing the number of seats? I favour the latter and good on the Liberals for creating the new medical schools.

[flamingfingers]

From the article:

Churning out more medical graduates won't solve the problem, says Pengilly and others.

"If you doubled the number of doctors, it still wouldn't help because they'd go into easy things."

Hospitalists
Pengilly says one of the big challenges is not a lack of doctors; it's the lack of doctors willing to work as family physicians.

Many choose to become specialists — or focus their practice on a specific need — and a good chunk of them become what he calls "hospitalists."

---------------------------------

Creating new opportunities for nurse practitioners as part of team-based care system
Share

News Release
Vancouver
Wednesday, May 23, 2018 11:15 AM

Minister of Health Adrian Dix has announced that the Province is creating 200 new nurse practitioner (NP) positions to support patients as part of a shift to a team-based primary health-care system.

The positions are being supported by approximately $115 million over three years, to secure NPs’ employment in primary care settings throughout British Columbia. Government is also increasing the number of NP education seats by 66%.

Nurse practitioners are health practitioners who can work on their own, or with physicians and other health professionals, to provide care across a person’s life span. This includes diagnosing and treating illnesses, ordering and interpreting tests, prescribing medications and performing medical procedures. There are 426 practicing NPs in B.C. The new positions will make a total of 626 NPs working in communities throughout the province.

“This move is backed by the largest investment in NPs in the province’s history, and is a critical building block of a broader plan to improve access to primary health care,” added Dix.

https://news.gov.bc.ca/releases/2018HLTH0034-000995

This certainly is an initiative we should all get behind.

[Urbane]

^^ Yes, as with public education it's not just a matter of throwing money at it. We can all be proud of many aspects of our healthcare system but the lack of a family physician for so many people and the unacceptably long waiting times for various surgical procedures are two things that need addressing.

It would seem that the answer to my question is that you have a preference for cutting spaces in medical schools and you regret that the Liberals created new medical schools. If that isn't your answer then please actually answer my question.

[hobbyguy]

^^ actually training more physicians doesn't solve the problem. That may sound weird, but here is why:

1. something like 57% of retiring physicians are family doctors and they are retiring at twice the rate Canada graduates doctors
2. only about 36% of graduates want to go into family medicine
3. a high proportion of the family medicine doctors are female, and they are in a cohort that wants a better life/work/family balance
4. the government has, in its infinite wisdom, opened up "hospitalist" positions in our hospitals for resident family medicine - so why go into family practice where the hours are longer, and have all the hassle of staff, finding a facility, book keeping etc.?

So what is the real solution?

1. Train more nurse practitioners
2. Train more home care nurses
3. Train more home care workers
4. train medical care coordinators
5. delegate low level health care work
6. set up local team care offices under the supervision of doctors

Using that "Team" model family physicians upgrade to health care supervisors, only seeing patients who present with changes in condition, new conditions, plus an annual. Things like renewing blood pressure meds etc. etc. go away from family physicians's work load, and they can each see more patients who really need them.

To give an idea of how effective that can be, I have an eye condition that requires monitoring every 6 months. My ophthalmologist works with my local optometrist (at my request and he agreed) to have the optometrist monitor the condition. That means I only need to see the ophthalmologist (and they are in short supply) once every 3-4 years. So instead of me chewing up the ophthalmologist's time, he can see up to 8 patients in the time he would normally spend with me.

The "Team" model also incorporates things like "if you have been hospitalized and released, the home care nurse makes a follow up visit to ensure all is well".

This kind of thing is being used in other jurisdictions and has and is proving to not only have better patient outcomes, but lower incremental costs. That is largely because our traditional acute care/hospital model is super expensive and not well suited to chronic care and recovering patients. ( You don't use an 18 wheeler to move your couch, you use a pick up truck).

To his credit, Adrian Dix has made some small moves in this direction, but they have kind of petered out. Cutting the ribbon on "more of the same" hospital wings is soooo much more attractive to politicians.

Lord knows I don't think much of the NDP, too many goofs like looney Lana Popham, egregiously dumb Eby and clueless Claire Trevena. But I do think that in Adrian Dix has made some good moves.

Even a broken clock is correct twice a day....

[Smurf]

Last week in a conversation wit a local well known specialist whom I know and trust I was told he could do many more procedures but the government will not allow him because of cost. I also know a doctor who has cut his hours in his office because he is treating the maximum number of patients the government will allow. Sounds to me like part of the problem is Government money.

What is the solution, more taxes, money distributed differently. I don't know but would bet money is the basis of all problems from training to doctors being able to do their jobs. Who wants to increase their taxes. Any takers???????? Your ideas sound good Hobby but they also require extra money. Some might come from savings but will it be anywhere near enough.

[Urbane]

Last week in a conversation wit a local well known specialist whom I know and trust I was told he could do many more procedures but the government will not allow him because of cost. I also know a doctor who has cut his hours in his office because he is treating the maximum number of patients the government will allow. Sounds to me like part of the problem is Government money.

What is the solution, more taxes, money distributed differently. I don't know but would bet money is the basis of all problems from training to doctors being able to do their jobs. Who wants to increase their taxes. Any takers???????? Your ideas sound good Hobby but they also require extra money. Some might come from savings but will it be anywhere near enough.

I like HG's ideas as well but I agree with you, Smurf. When you notice walk-in clinics closing early while displaying a sign that says that the daily quota has been met you know that there is an issue with money. The federal government certainly has a role to play here. Allow provinces to experiment and be flexible with the Canada Health Act. There are various European models with universal health care and much shorter wait times. We need to examine what really works and how we could improve our system.

I know that we've drifted way off topic so . . . let's see how John Horgan and Adrian Dix do with the health care file moving forward.

[flamingfingers]

Smurf wrote:

I was told he could do many more procedures but the government will not allow him because of cost.

It's the cost of staffing Operating Rooms. Some surgeons would be absolutely THRILLED to have an Operating Room dedicated solely to them, every day of the week for as many hours as they wish; however, there are other patients who have priorities and all must be balanced with availability of anesthesiologists, surgical technicians nurses, &etc.

I also know a doctor who has cut his hours in his office because he is treating the maximum number of patients the government will allow.

As far as I can find out, a cap on patient numbers is only applicable to Walk-In Clinics who limit the number of patients seen by Walk-In physicians to 50 a day (this number of pts receive full pay for services rendered; over that number, the doctors receive less pay per service.)

[alanjh595]

From the article:

https://news.gov.bc.ca/releases/2018HLTH0034-000995

This certainly is an initiative we should all get behind.

It's been over 1 year since that article was published on

Vancouver
Wednesday, May 23, 2018

What progress has been made on that initiative?

[Urbane]

I'm not convinced that our physicians per capita rate is adequate. In one study Canada ranks 29th out of 33 countries with 2.7 doctors per thousand people. Germany has 4.1 per thousand people and Australia is at 3.5. With so few doctors per capita it seems like we have no choice but to be creative. More doctors isn't the only answer but surely it's at least part of the solution.

Again, I know we're off topic so back to Alan's question when he asked what progress has been made on that initiative.

[butcher99]

Last week in a conversation wit a local well known specialist whom I know and trust I was told he could do many more procedures but the government will not allow him because of cost. I also know a doctor who has cut his hours in his office because he is treating the maximum number of patients the government will allow. Sounds to me like part of the problem is Government money.

What is the solution, more taxes, money distributed differently. I don't know but would bet money is the basis of all problems from training to doctors being able to do their jobs. Who wants to increase their taxes. Any takers???????? Your ideas sound good Hobby but they also require extra money. Some might come from savings but will it be anywhere near enough.

Sure. If it means better healthcare and better healthcare outcomes increase my taxes a bit. Yours as well. Perhaps we can finally have a real prescription drug plan as well like the rest of the healthcare for all societies have.

[butcher99]

From the article:

https://news.gov.bc.ca/releases/2018HLTH0034-000995

This certainly is an initiative we should all get behind.

It's been over 1 year since that article was published on

Vancouver
Wednesday, May 23, 2018

What progress has been made on that initiative?

You cant just flip a switch and turn them out. They hare highly trained individuals. I don't know how long it takes but I can assure you it is much longer than a year. It would probably take at least a year just to get the schools setup to start to train them.

[butcher99]

[/list]
I like HG's ideas as well but I agree with you, Smurf. When you notice walk-in clinics closing early while displaying a sign that says that the daily quota has been met you know that there is an issue with money. The federal government certainly has a role to play here. Allow provinces to experiment and be flexible with the Canada Health Act. There are various European models with universal health care and much shorter wait times. We need to examine what really works and how we could improve our system.

I know that we've drifted way off topic so . . . let's see how John Horgan and Adrian Dix do with the health care file moving forward.

The quotas were set because some Doctors were just running a turnstile with patients. In one door out the other. I did not look hard but I could not find a news story on the abuses some doctors were doing in BC before quotas were set.
I could be wrong but I believe the time is set at just less 10 minutes per patient. It was done not as much to save money although obviously that was part of it, but to assure patients actually had time to discuss with the Dr. what the problems were and find solutions.
If the office is closing early then the Doctor is not giving the patients the average time that the government says should be allotted to each patient. Then there is the billing and other forms to fill out on top of that. 10 minutes per patient is an 8 and a half hour day with no coffee breaks.

The NDP have started to put into force new rules and regulations to attempt to curb overbilling and double billing by Doctors which has cost BC millions just in fines from Ottawa. I believe it was 16, million last year alone.
https://www.theglobeandmail.com/canada/ ... a-billing/