As many in BC struggle for access to health care, patient advocates are working with health officials to revamp the way care is provided. Big changes are on the way, including changed payment systems for doctors, relaxed admission requirements for internationally trained physicians, and staff and service overhauls at local primary care clinics.
Currently, there are approximately 15,000 people in the Kootenay Boundary area who do not have a primary care physician. Meanwhile, access to walk-in clinics is becoming increasingly limited.
“The problem has been recognized – we know we’re in a crisis,” says patient advocate Mindy Smith, an academic and physician from Michigan who now lives in the Kootenays. “You’ve got a huge group of people with nobody to take care of them. People who are being taken care of are getting less and less care.”
Smith and other patient advocates joined Dr. Selena Davis at Taghum Hall on December 1 to discuss these issues at a potluck and information session. The gathering was an installment of the ‘Food for Thought’ series, funded with a small grant from the Vancouver Foundation. Davis is a health informatics expert, focusing on the intersection of business, healthcare and technology, and an adjunct professor at both the University of British Columbia and the University of Victoria.
She is hoping sessions such as this empower more patient advocates as the system undergoes reform.
“This is the time to change, to get involved,” Davis said. “We as patients really do need to change the system.”
Smith works with the Kootenay Boundary Patient Advisory Committee to help patients have a voice in policymaking decisions.
“They’re trying to put the control into local hands to come up with local solutions,” she said.
Currently, the committee is working on a program to make private health practices more robust by bringing in nurse practitioners, social workers, physical therapists and occupational therapists to work alongside doctors.
“So, when you come in and you’ve got a particular need, you can get filtered to the right person,” Smith said.
Half of the Kootenay Boundary’s 26 private practices have already signed on to make these changes, according to Smith.
She said this has not been heavily publicized yet as the working groups involved are still ironing out what she called problems with “equity,” with private practices having a varying degree of resources available.
“A lot of this information has not yet been shared because we are in the developmental stage,” she said. “In the meantime, a lot of people are in the dark and it’s very frustrating.”
The committee has attempted to bring in more doctors to alleviate shortages, but with little success. Work is now progressing to create a “pipeline” of physicians and nurse practitioners from local colleges back into the community.
“Nobody’s coming in,” she said. “We’ve tried to find general practitioners – it’s really hard.”
The provincial government is also working on solutions. The Ministry of Health announced in a November 27 press release they would be relaxing some of the licencing requirements to try and bring more foreign doctors to the province. This will allow a tripling of the applicants taking the Practice Ready Assessment for foreign family doctors, increasing the allotment to 96 by March 2024.
Simultaneously, the Province announced new rules to allow international medical graduates to get a restricted designation if they are not eligible to be fully licenced, letting them work under another physician in acute care settings. And doctors trained for at least three years in the United States will be able to work in community health settings starting as soon as January 2023.
Another announcement on October 31 detailed an overhaul of the fee-for-service system that currently pays doctors per patient visit and often means limited time spent with each individual. The new system allows for payment based on the complexity of issues. According to the Ministry of Health, doctors will be able to work under the new system as soon as February 2023.
Davis says this move to a “value-based” approach is a step toward doctors being less involved with the financial side of health care.
“Let’s get them out of running a business,” she said. “Pay physicians for a value, not for a service.”
Davis believes whatever the path forward, a “patient revolution” is necessary to involve people more in their own care. This starts with access to one’s own health records and a focus on general health, to better integrate a patient’s history into their treatment.
“How many times do you have to navigate your own story and be your own patient advocate,” Davis said. “You have to hold the whole health record in your hands.”
Speaking at the Taghum Hall gathering, local Beasley resident Adrianna Work expressed frustration with her recent healthcare experience as she has no family doctor and must rely solely on emergency rooms and walk-in clinics for care. With nobody to follow her health history, she feels nobody understands her complete health picture.
“How do you make sure there is follow-up when you don’t have a family doctor?” she asked. “A body is an integrated unit, you don’t get symptoms in isolation.”