A woman in my neighbourhood was diagnosed with late stage colon cancer by a doctor a walk-in clinic. She was given two years to live, and recently passed away after three years. The reason she was diagnosed too late for medical intervention? She couldn’t find a family doctor.
In Vancouver where I live, over 120,000 people don’t have a family doctor, and another 25,000 arrivals are expected each year. That means the problem will get compounded, as new arrivals to Vancouver are the least likely to have a doctor – even after being here for 10 years.
Who will solve the problem? Getting family doctors to take up the slack is unrealistic for two reasons. First, they are already working at or over capacity. Second, even if each doctor in Vancouver took on another 150 people as patients, their patients would have to wait longer for an appointment. We could recruit and retain more doctors, but those efforts would only solve the problem for a short time.
What we need is innovation in the way that primary care is provided, to multiply the impact of the doctors we have now. Most system experts believe that involving nurses and pharmacists as part of a team of care, is the best way to increase access to family doctors without increasing costs to the system. After all, it is comparatively expensive and time-consuming to train doctors, so increasing their efficiency through team-based care is a good long-term investment.
However, consider that changing to team-based care requires a different business model, and we can’t expect family doctors – who are at the same time business owners – to absorb the risk of changing their model of care in BC…If a family doctor hires a nurse to help provide care, they have to pay their salary and risk reducing their main source of income. Some are ready to take on this challenge, but many are not.
Enter the social enterprise: non-profits that embody a hybrid of business and community values that have the ability to change the game. Social enterprises can absorb the risk of exploring new models of care. Good ones can imagine, build and operate family practice clinics in new ways, so that doctors can focus on doctoring and more people can have a family doctor. If done well, we could find a model that ensures that our children will have a strong health care system as well.
Examples are already out there. REACH and Mid-Main are non-profits that have operated interdisciplinary care models for decades. There are community dental clinics that have found a way to remove the barrier of cost for low-income individuals and families using a business model that reinvests any profits into free treatment. In White Rock / South Surrey, a non-profit clinic operated by a group of family doctors and Fraser Health, has helped to make a primary care provider available for everyone…without family doctors having to shoulder the entire burden themselves.
BC’s healthcare system is being pressed from all sides. We need enterprising non-profits to help us find new ways of making a continuous relationship with a primary care provider accessible for everyone.
In my next blog, I’ll describe how the next generation of primary care providers have the right stuff for saving universal healthcare in Canada, partly because they will work shorter hours than previous generations of family doctors.