Family medicine must improve

Arecent comparison of family medicine in 11 developed countries ranks Canada at or near the bottom in most categories. The report, published by the Commonwealth Foundation, makes grim reading.

Fewer than half of our country’s GPs arrange for patients to see a doctor or nurse when their office is closed, the worst ranking in the survey. And only a third of family physicians in B.C. make such provisions — secondlowest in Canada.

Nationwide, seven in 10 GPs say their patients face long wait times to see a specialist, again worst in the survey. And B.C. has the poorest score in Canada.

Co-ordination between family medicine and home care is poor. Only 11 per cent of B.C. GPs make home visits vs. the survey average of 39 per cent. And only one-third co-ordinate with their patients’ home-care provider.

Fewer Canadian GPs use electronic medical records than the survey average, although in this case, B.C. leads the country.

And only 17 per cent of Canadian GPs review patientsatisfaction surveys. In B.C., just 11 per cent take time to complete this important task.

There is one important qualification to note. Canada has nothing like the population density of most countries in the survey. Patients and their GPs live far closer together in Germany or Britain than they do in Canada. That might account for difficulty in co-ordinating care in rural regions.

But that’s no excuse for most of our failings. Why do so many residents of the capital region face long wait times to see a specialist?

South Vancouver Island has 142 specialists per 100,000 population. The B.C. average is 108, and the Canadian average, 113.

Why do so many of our residents have difficulty finding a family physician? South Vancouver Island has 173 GPs per 100,000 population. The B.C. average is 124, and the national average, 115.

That hardly supports the view that we have a shortage of physicians in the capital region.

Then again, why do so few GPs track their patients’ satisfaction? And how to explain the failure of so many family physicians to arrange alternative coverage when their office is closed?

It is difficult to attribute these failures to a shortage of resources, though, of course, more money always helps. The problem is lack of accountability. Family medicine appears more responsive to the needs of practitioners than patients.

Of course, that’s not the whole story. There are many devoted GPs who work long and thankless hours.

But the picture that emerges is that family medicine is not managed in any real sense. Rather, it is a scattering of individual practitioners organizing their own resources and deciding their own hours of work.

With physician incomes higher in Canada than some European countries, many GPs have no need to work a full week. That’s one reason we have more than our share of family doctors in Victoria, but still a shortage of capacity.

The question is what can be done. Some European governments have imposed standards of patient service on family practitioners, but Canada has been reluctant to follow this example.

Health care is a provincial responsibility, and any province that pushes its GPs too hard risks seeing them leave for a neighbouring jurisdiction.

The B.C. College of Physicians and Surgeons — the oversight body for doctors — has established some guidelines for acceptable office practice, but they leave a lot of ground uncovered. Yet this is surely the place to start.

The college is responsible for defining appropriate medical practice. At present, family medicine fails to meet numerous standards of appropriateness. If physicians don’t want government intervention, the profession must heal itself.