Government has to stop looking for cheap way to address doctor shortage, says GP

Nova Scotia's doctor shortage — about 10 per cent of the population can't find a general practitioner —  is a hot-button issue in the election campaign that just started April 30.

And it's an issue voters on the other side of the country are talking about in B.C. as they head to the polls next week. They are also facing a shortage of family doctors. About 700,000 people in the province don't have a family doctor — which is about 15 per cent of the population. 

Family physician Chris Pengilly in Victoria, B.C., points to the changing face of family medicine as part of the issue.

Fewer family physicians are interested in the traditional family practice model, with the high overhead, long hours and added responsibilities that go with it.

He suggests scrapping the fee-for-service model that governs most of the Canadian health-care system is the place to start.

"It's time it was rewritten completely. It's like an old car. It's got three new gearboxes and four new engines, new upholstery and new tires. But, you know, it's time to just dump it and get a new one," Pengilly tells The Current's Anna Maria Tremonti.

Pengilly says "hospitalists" — family physicians who work out of hospitals — are paid an hourly rate and have none of the overhead costs associated with running their own practice. And they work a regular 40-hour work week, allowing them to maintain a better work-life balance. 

However, the biggest challenge Pengilly points out will be the money needed to make substantive change to the health-care system.

"Governments are not looking for a better way. They're looking for a cheaper way, and it's not going to be cheaper. There is not a cheaper way."

Dr. Danielle Martin, a family physician and a vice-president at Women's College Hospital in Toronto, adds the full-service, cradle-to-grave primary medicine — where the family doctor is the starting point for all of a person's medical needs — is no longer sustainable. 

"We need to work in a different kind of model," Dr. Martin tells Tremonti.

It's not necessarily the numbers of doctors, it's how we're using them.- Health policy consultant Michael Rachlis

"[We're] moving away from the traditional model of the doctor as independent entrepreneur, fiercely separate from the rest of the health-care system and moving towards models that acknowledge that we can't do this on our own anymore, with the black bag going down the street in the evening to visit people."

She suggests new doctors want an arrangement that fits their expectations.

"If people are coming out into practice with that different set of expectations about how their work life is going to look, then someone has to take responsibility for organizing a system around them to ensure that the needs of communities are met."

Health policy consultant Michael Rachlis says provincial medical associations are also part of the problem. They represent doctors, and continue to advocate for keeping doctors at the centre of family medicine, even if it is costly and inefficient.  

He tells Tremonti while there are countless Canadians who are struggling to find a family doctor, he's not sure that means there is a doctor shortage.

Rachlis points to the number of family doctors as rising to about three per cent annually — well ahead the country's population growth of one per cent.

"It's not necessarily the numbers of doctors, it's how we're using them."

Listen to the full segment at the top of this web post.

This segment was produced by Willow Smith, Sujata Berry and Pacinthe Mattar.