B.C. Green Party leader calls on province to transition away from fee-for-service model

B.C. Green Party Leader Sonia Furstenau is calling on the province to get rid of the fee-for-service model to address a worsening family doctor shortage, an issue she says is having a downstream effect on the rest of B.C.'s health-care system.

Her comments come as nearly one million British Columbians are without a family doctor, a shortage Furstenau describes as a "critical" issue.

Furstenau says the current fee-for-service model, where patients pay doctors for each office visit, is antiquated and leads to ineffective payments for doctors.

"The current system is like paying a teacher per student per lesson, and requiring the teacher to set up the school … with their per-student-per-lesson payment in their spare time," Furstenau told reporters at a news conference on Thursday.

Furstenau says the province should immediately move to provide financial support to existing family practices, and also address "waning" morale in the health-care system at large.

"Health-care professionals should not fear repercussions for speaking up when their work conditions are unsafe or patients are put at risk," she said. "Nor should they feel abandoned by their government and hopeless at work in the long term."

She adds that the province should instead shift to a team-based approach for primary care, where multiple family doctors can combine their practices through community care centres, freeing them and nurse practitioners from administrative duties.

Furstenau was speaking from Whistler, B.C., which has seen several clinics close in the past few years, according to Dr. Karin Kausky of the Whistler 360 Health Collaborative Society.

"I think having community involvement in primary care is really kind of the secret sauce these days," Kausky told Gloria Macarenko, host of CBC's On The Coast.

The society is a non-profit organization that offers access to a network of health-care professionals.

Kausky said she and other employees have much more energy as a result of their collaboration, and it has created "much better outcomes" for their patients during the pandemic.

"Having it be team-based, having that professional management so that I'm not talking to the accountant every day [is] really great and allows me to see patients more," she said.

More staff being hired

The province has pointed to new hiring initiatives, including one for internationally-educated nurses, as a way they are responding to the crisis.

Health Minister Adrian Dix has said the province is increasing alternative payment models for family doctors, and connecting more British Columbians to physicians by building Urgent Primary Care Centres.

"Action is being taken, and the full health human resources plan will be available soon," said Dix on the floor of the legislature on April 27.

Premier John Horgan has also said he would ask the federal government for increased funding — in the form of federal health transfers — to help address the crisis.

But Furstenau says she is skeptical of the province's actions thus far, and that the government was blaming everyone but themselves for the crisis.

"While we must always invest in new spaces for medical students, this is like putting more water in a leaky bucket when it comes to primary care," she said.

Downstream effect

Furstenau says the family doctor crisis is having a negative impact on other parts of the health-care system, including on urgent care, hospitals and surgeries.

She says reports of massive wait times at the province's hospitals were indicative of a broken primary care system.

"When people aren't able to just access basic health care, they are ending up in emergency rooms and that's contributing enormously to the wait times that we're seeing, for sure," she said.

The province's recent focus on surgical renewals, she says, was not merited given the crisis in primary care, and that the government should instead focus on what she calls the "backbone" of the health-care system.