The B.C. government has entered into an agreement with the two Green Party members of the legislature to conduct a review of primary care.
Interim Green Leader Jeremy Valeriote says the party expects the assessment will lead to “real action on the deep challenges in B.C.’s health-care systems.”
We have no such expectation. Rather, to quote Sir Humphrey Appleby in the British comedy series Yes Minister, we imagine something like this:
“We will give it the most serious and urgent consideration and insist on a thorough and rigorous examination of all the proposals allied to a detailed feasibility study and budget analysis before producing a consultative document for consideration by all interested bodies.”
Supposing for a moment, however, that the two parties mean business, there are some steps they could take immediately.
Physicians who face patient lawsuits have their legal costs covered by an agency called the Canadian Medical Protective Association. It has an investment portfolio worth $5.4 billion.
While the agency collects fees from physicians, the province refunds most of that cash to the doctors.
These refunds, which can amount to $35,000 a year, are basically an insurance against physician error.
In total, they cost the taxpayer $53 million per year, enough to pay for an additional 175 family physicians. So let’s cancel this absurd deal.
Then fix the physician fee schedule. Family doctors are paid an average of around $250,000 to $300,000.
Most surgeons make an average of $450,000. Yet some ophthalmologists are billing the Medical Services Commission $1 million a year.
Since a good part of their work consists of removing eye cataracts, a procedure that takes all of 20 minutes, no general anesthetic and little follow-up care, this is gross overpayment.
The Health Ministry did make a small reduction in this fee scale some years ago, but the ophthalmologists fought it every step of the way. If we’re serious about fixing our health-care system, start here.
Then there is the reality that B.C. has by far the fewest medical school places per head of population, country-wide.
While Quebec has a medical school place for every 9,221 residents, the B.C. number is 17,445. The national average is 13,099.
It’s the same story with family medicine residencies — these are the interim placements for trainee physicians before they enter full practice.
While Quebec has a residency placement for every 17,017 Quebecers, in B.C. the number is 43,601.
The reality is that this is a crisis years in the making.
It began in the 1990s, when the organization representing physicians, the British Columbia Medical Association (now Doctors of B.C.) lobbied the provincial government to limit the number of new doctors being trained.
The association was concerned that an over-supply would drive down physician remuneration. The province went along.
What everyone involved failed to account for was the inevitable pressures created by a growing and rapidly aging population.
When the new Simon Fraser medical school opens its doors, planned for next year, there is some hope for the future.
Yet even so, the school’s output will barely keep up with physician retirements.
In the short term, then, the only hope is to recruit foreign-trained doctors.
The province is reaching out to American healthcare workers who would be willing to come to B.C.
But it’s a very limited advertising campaign, planned to last just six weeks and reach only the West Coast states.
A more aggressive campaign, lasting longer and reaching further into the U.S., is needed.
For the reality is that we aren’t going to train all the physicians we need for years to come.
