BY DR. ALASTAIR TEALE
As an infectious diseases specialist at NRGH, I am routinely seeing the effects of our primary care crisis.
With alarming frequency, I am making a new diagnosis of diabetes when a patient presents with a limb threatening infection as a result of undiagnosed and uncontrolled diabetes. When these infections develop, patients are put through weeks of intensive treatment with no guarantee of success. Some of these patients go on to require life-altering amputations. Each of these infections costs our healthcare system thousands of dollars. These situations can be prevented by a simple, cheap screening blood test and effective treatment of diabetes, which would be a normal part of a patient’s relationship with a community family physician.
I hear similar stories across other departments in our hospital. Our emergency room physicians are diagnosing late-stage cancers, some of which could have been diagnosed through routine screening and effectively treated earlier if patients had access to primary care. The common theme to these examples is the lack of community family medicine is simultaneously leading to worse outcomes for patients while costing our health system more.
We need to acknowledge that this is a crisis, and it is getting worse. About a million British Columbians are without a primary care provider, while locally roughly 30 per cent of residents of our city do not have a primary care provider. This makes Nanaimo one of the worst municipalities in British Columbia when it comes to access to primary care.
What has contributed to this crisis? Like most issues, there are multiple factors at play. We first need to acknowledge that providing community family medicine is not easy. I would argue that family medicine is the hardest specialty in medicine. There is a completely hidden, unpaid administrative burden of family practice. The sheer amount of information that longitudinal family physicians are bombarded with on a daily basis is incredible. Every laboratory result, imaging test, and specialist consult received needs to be reviewed and addressed. There can be hours each day of unpaid work reviewing tests and doing paperwork, and family doctors are often working into evenings and weekends after office hours instead of spending time with their families.
The amount that family physicians receive per patient visit through the archaic fee-for-service system has not kept up with the increasing costs of running a family practice. Overhead, such as the cost of equipment, computer systems, staff, and office space, comes out of the physician’s billing. With costs increasing, family physicians are increasingly turning to other practice options such as shift work in the hospital.
We see how this all affects newly trained family physicians. Nanaimo is a training site for approximately eight family medicine residents per year. Over the past 15 years, only about one-third of these graduates are practising longitudinal family medicine. Ultimately, with less stressful, more lucrative and better work-life balance options, it is little wonder why newly minted family physicians aren’t choosing to open family medicine practices.
The time for excuses is over. We need bold, innovative change now to incentivize and make community family medicine an attractive, sustainable and fulfilling career for physicians. We need to ensure that primary care providers and the primary care system as a whole are the first to the proverbial dog dish, not the last. We all know the current system is not sustainable with our rapidly aging population.
Only through bold reform with a focus on primary and preventative care can we avoid the downstream costs of these preventable issues and ensure the health care system is there for us in the future when we need it.
Dr. Alastair Teale is an infectious disease specialist at Nanaimo Regional General Hospital.